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Introduction
There is a widely held belief among social historians of medicine that the transformation of medical education in North America from mediocre to one of the best in the world which occurred within a few decades in the twentieth century was mainly due to Abraham Flexner, author of the famous Flexner Report.1 A plethora of books and essays over the years has transformed Flexner into a "patron saint," who rescued North American medical education from the control of private medical schools and raised its scientific standards to produce the best medical practitioners in the world. As one author argued, "the Flexner Report took medical education out of the hands of the practitioners and put it in the hands of the universities, where quality presumably could be assured."2 Another went as far as to suggest that there is a "flexnerian" tradition "signifying strong convictions about the role of basic science in the curricula of medical schools."3 As recently as 1993, reflecting on the progress of a half-century of Canadian medical education, a leading medical educator wrote: "The Flexnerian paradigm of medical education, rooted in biomedical science and conducted under the aegis of a university, reached its apotheosis by the late 1960s and the early 1970s."4 These remarks represent the general perception of Flexner's role in medical education reform.
Although glowing tributes to Flexner continue, there has been very little effort to examine his precise role in medical education reform in a broader historical context of the late nineteenth and early twentieth centuries.5 As Kenneth Ludmerer argues, the revolutionary transformation of American medical education was a result of a mixture of political (growing professionalism), historical (increased private funding) and intellectual (advancement of quality research) forces that shaped the American higher education's coming of age. The Flexner Report and its immediate impact on medical education in North America have been, for the most part, examined without taking into account a vast amount of archival materials pertaining to a6 complex historical background of educational reform during that period. Although these archival records became available to researchers in the early 1970s, the influence of the Flexner Report on medical education was such that it had created the powerful image of Abraham Flexner as being the single contributor to medical...