Robert C. Bowman posting to HlthProf
I would urge caution in responding to such studies. First step is to check
on the data and the analysis. Next is to explore hypotheses, collect
additional data.
Because race is so difficult to measure, and is related to so many areas
such as poverty, socioeconomics, education level, fatherlessness, cultural
barriers, etc. It is impossible to interpret such studies with any degree
of reliability. Data on race is relatively easy to gather, but these other
factors that may be more important is much more difficult to obtain.
Debates in past centuries and decades have caused more harm that good.
Flexner's work was excellent and his recommendations were flawless. The
interpretation of his work and the layers of concrete bureaucracy that have
distorted his work have given rise to the current severe maldistribution of
health providers and impacts education and other areas as well.
The genius of Flexner was in his understanding of how all levels of
education fit together. It was his nature as a principal, an educator, a
researcher of colleges and medical schools, and as a med ed leader. Few
will ever have such an opportunity or background.
A focus on the deficiencies of students or graduates will lead to very
little improvement.
A focus on the environmental influences such as K-12 education in inner
city and rural areas can and has led to improvements in the distribution of
physicians as well as improvements in access. These have been put together
with very little funding, mostly involving cooperation between professional
schools and middle or high schools or colleges with health advisors playing
key roles.
Everyone interprets information out of a frame of reference. I see our job
as educating the media and political leaders in what we have learned from
Flexner and from outstanding programs.
If we make charges and countercharges, there is only a defensive
entrenchment with no chance for learning or change. And we will only be as
guilty of intolerance as the others.
Robert Bowman, M.D.
rcbowman@atsu.edu
Controversy in Medical Education
Physician Discipline and Caring for the Underserved