Alzerwi NAN. Flexner has fallen: Transitions in medical education system across time, a gradual return to pre-Flexnerian state (de-Flexnerization). World J Clin Cases 2023; 11(21): 4966-4974 [PMID: 37583863 DOI: 10.12998/wjcc.v11.i21.4966]
Corresponding Author of This Article
Nasser A N Alzerwi, PhD, Associate Professor, Department of Surgery, Majmaah University, Riyadh Region, Majmaah 11952, Riyadh, Saudi Arabia. n.alzerwi@mu.edu.sa
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 26, 2023; 11(21): 4966-4974 Published online Jul 26, 2023. doi: 10.12998/wjcc.v11.i21.4966
Flexner has fallen: Transitions in medical education system across time, a gradual return to pre-Flexnerian state (de-Flexnerization)
Nasser A N Alzerwi
Nasser A N Alzerwi, Department of Surgery, Majmaah University, Majmaah 11952, Riyadh, Saudi Arabia
Author contributions: Alzerwi NAN solely contributed to concept, literature review of the opinion review.
Conflict-of-interest statement: There is no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nasser A N Alzerwi, PhD, Associate Professor, Department of Surgery, Majmaah University, Riyadh Region, Majmaah 11952, Riyadh, Saudi Arabia. n.alzerwi@mu.edu.sa
Received: December 23, 2022 Peer-review started: December 23, 2022 First decision: March 10, 2023 Revised: March 29, 2023 Accepted: July 3, 2023 Article in press: July 3, 2023 Published online: July 26, 2023
Abstract
The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.
Core Tip: Learning is the process by which experience is transformed into new knowledge. Flexner's suggestions should be reinstituted in the medical education system. There are many dilutions almost to the pre-Flexnerian level, mostly on the part of students who are focused on just getting their degree and becoming doctors and on the part of faculty who spend less time with the students because more time is given to patient care. Although the majority of them are professed to be implemented.
