In September 1904, Abraham Flexner (13 November 1866–21 September 1959) wrote (1960, 61), “I want to influence in some measure the life of my time in so far as that can be done through education. I don’t mean to get tangled up with prominent people; that always involved fixed and commonplace aims, and one could better one’s life out without result. The poorest opportunity with a free hand to work would make me at least happier and more useful.” With this personal philosophy as his guide, Flexner became a guiding influence in the development of medical education during the early 20th century.

A native of Louisville, Kentucky, Flexner’s childhood was filled with simple pleasures at home and school. His father died when Abraham was an adolescent, so his mother figured prominently in his development. She instilled the self-respect and self-reliance that drove Flexner to seek truth and understanding, and to be open to new paradigms.
Many of Flexner’s early teachers at Louisville High School were often untrained, elderly, and selected to teach based upon their influence in the community. Ironically, their perceived incompetence helped Flexner’s education by giving him time to read extensively on topics of his own choosing.
At age 17, Flexner enrolled at Johns Hopkins University to study business, and received his bachelor’s degree in two years (Flicker 1963). His brother, a drugstore owner, not only financed Flexner’s education, but also served as a source of medical inspiration and thought. Upon graduation, Flexner became a teacher at the local high school in Louisville.

His love of teaching eventually drove him to establish his own private school in 1890. Called “Mr. Flexner’s School” (Flexner 1960), it primarily attracted boys who had difficulty in regular school situations. Being a schoolmaster, however, was not to be Flexner’s final achievement. In 1905, after 15 years of school administration, he closed the school and began a new chapter in his life.

Flexner returned to college, studying at Harvard’s Graduate School of Education, where he received his master’s degree in 1906. Afterwards, he traveled extensively throughout Europe. During this time, Flexner wrote a staunch criticism of American collegiate teaching methodology entitled The American College (1908), which opened the door to his future. Dr. Henry S. Pritchett, President of the Carnegie Foundation for the Advancement of Teaching, invited him to join his staff (Flexner 1960). He subsequently encouraged Flexner to conduct research on the 155 medical schools in the United States and Canada.

Beginning with the medical department of Tulane University, Flexner developed criteria by which to evaluate medical education. These included entrance requirements, size and training of faculty, endowments and fee payments, quality of laboratories, and the relationship between the school and area hospitals (Flexner 1960). In his final report, Medical Education in the United States and Canada (1910), Flexner noted that most schools did not meet his criteria, and he wrote scathing reviews of their programs. He praised only a few medical schools, including that of Johns Hopkins University. As a result of his report, many of the colleges he severely criticized closed, and others revised their policies and curricula.

Flexner believed that the solutions to American medical education problems would come from abroad. In 1910, he traveled to Europe and studied the medical schools in Great Britain, France, and Germany (Flicker 1963). Flexner particularly was impressed with the German system of medical education. Comparing it to the American system, Flexner stated, “To sum up, German medical education was sound precisely where I had found American medical education deficient: there were adequate entrance requirements and they were enforced; relations between laboratories and clinics were close; teachers were professors, not practicing physicians . . .” (Flexner 1960, 105).

In a bizarre change of subject matter, Flexner went from researching medical schools to researching and analyzing prostitution. In 1910, a special grand jury led by John D. Rockefeller conducted an investigation on the connection between the New York City’s police department and prostitution rings. Rockefeller approached Flexner to study prostitution in Europe, believing that “America had much to learn from the European experience” (Flexner 1960, 117).

In 1914, after educating the public on prostitution, Flexner joined the Rockefeller Foundation-funded General Education Board whose purpose was to make recommendations to improve the American educational system. Flexner was asked to plan a model college preparatory school and conduct an educational survey of the Maryland schools (Flicker 1963). A result of this endeavor was that the General Education Board enlisted the Teachers College of Columbia University to “carry out experiments in modern education based on the theories of Charles W. Eliot and Abraham Flexner” (Flicker 1963, 13). Flexner believed that the survey assisted in “setting a pattern for improving educational standards throughout the United States” (Flexner 1960, 61).

The Board’s focus then turned toward studying medical schools. One dominant issue in their discussions was whether medical schools should fund full-time faculty (at great cost) or use part-time teachers, with faculty physicians relying heavily on their independent practices as their primary means of income. The Board supported the concept of funding full-time faculties due to a strong view that faculty should place the education of their students first (Flexner 1925).

The Board in general, and specifically Abraham Flexner, then began the arduous process of funding to endow teaching and research chairs at U.S. medical schools. Flexner was able to solicit substantial donations from benefactors—over half a million dollars—to make significant improvements in U.S. medical education in the early 20th century. The long-term impact of those initial gifts to general research programs paved the way for major medical breakthroughs.

Flexner retired from the General Education Board in 1928, and was invited to give a series of lectures. They were well received and eventually were organized into a book, Universities, American, English, German (1930). The lectures also inspired the idea for the institute of advanced study at Princeton University for intellectuals who wanted a stage beyond the Ph. D. level.

This institute gave Flexner the opportunity to develop his ideas for an academic and professional educational program. It provided a forum for individual learning, spontaneous collaboration, and opportunities for in-depth discussions. Initially, Flexner recruited only mathematicians for the institute’s faculty. As time passed, however, Flexner expanded the faculty to also include professors of economics and politics. A professor of mathematics who participated in the Institute, said of the experience, “…I have felt the dark closing in; I could hardly understand the most recent developments. But now (after participating in the institute) the windows are flung open, and I have two papers that I am ready to write” (Flexner 1960, 256). Institute participants included such noted individuals as Albert Einstein, Hermann Weyl, and John von Neumann.

During the remainder of his life, Flexner wrote biographies of men who had profoundly affected him, including Henry Pritchett and Daniel Coit Gilman. Flexner also wrote Funds and Foundations in 1952. In this book, Flexner critically analyzed the state of corporate foundations.

Many today argue for a return to the standards of Flexner (Herren 1999). Whether researching and evaluating medical schools, guiding the General Education Board, creating the Institute for advanced Study, writing biographies, or passing judgment on the misuse of foundations by trustees, Flexner continually advocated for excellence in higher education.

Contributed by Eleanor S. G. Luke, The University of Texas at Austin

References
Flexner, A.1960. Abraham Flexner: An autobiography. New York: Simon and Schuster.
Flexner, A.1910. A report to the Carnegie Foundation for the advancement of teaching on medical education in the United States and Canada. New York: The Carnegie Foundation for the Advancement of Teaching.
Flexner, A. with E.S. Bailey. 1952. Funds and foundations; their policies, past and present. New York: Harper and Brothers.
Flexner, A.1925. Medical education: A comparative study. New York: Macmillan Company.
Flicker, B. 1963. Abraham Flexner’s educational thought and its critical appraisal. Ann Arbor, Mich.: New York University Microfilms, Inc.
Herren, G. E. 1999. Motivation for medical education reform; the post Flexner era. Pharos Alpha Omega Honor Medical Society 62(1):25–30.
Vevier, C.1987. Flexner: 75 years later: A current commentary on medical education. Lanham, Md.: University Press of America.
Wheatley, S. 1988. The politics of philanthropy: Abraham Flexner and medical education. Madison: The University of Wisconsin Press.

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