Outside looking in: observations on medical education since the Flexner Report

Medical Education 2011: 45 : 29–35Context  This article focuses on the current state of medical education as it relates to the reforms introduced in the wake of the Flexner Report of 1910. The usefulness of outsiders in both understanding and analysing any specialised endeavour, and, specifically, medical education, is carefully considered. No voices call more loudly for change in medical education today than those emanating from within the arena itself. Interestingly, however, the monumental reforms of the Flexner Report were impelled largely from outside the specific discipline of medical education. Observations  Internal tensions exist between the natural and social sciences. These tensions present formidable obstacles to the balance between advances in biomedical knowledge and the humane and socially acceptable application of that knowledge. Medical education’s responses to society’s pressures for accessibility and humaneness occupy the next discussion point, named here as ‘re‐democratisation’ and ‘re‐humanisation’. A final observation questions whether the current proliferation of literature about reforms in medical education can lead to real change, or whether it constitutes a self‐referential agitation that, in the aggregate, holds little promise. Conclusions  It is suggested that not only are outsiders useful, but they may perhaps represent the only channel through which medical education can align its current practice with both its internal ideals and the demands of the public, members of which live and die by its efforts.