EDITORIAL

From Flexner to Bologna

De Flexner a Bolonia

Albert Oriol Bosch

Presidente de la Fundación Educación Médica.
E-mail: aoriolb@terra.es

One hundred years ago the Flexner´s Report [1] revolutionized medical education in North America and served as a compass along the past century. Flexner´s Report forced the conversion of all schools of medicine into university faculties, increasing the students admissions requisites accordingly. It firmly established that the medical knowledge body was constructed on the base of scientific knowledge that required an inquisitive mind and a research mental attitude. Flexner´s report established also that the acquisition of the medical knowledge required also of clinical experience. One hundred years ago Flexner´s Report aspired that north American medical education emulate the best European medical schools. Its success resulted in drastic organizational and educational changes so that this goal was reached in few decades while in the second half of the 20th century some of the American medical schools become leaders in the world ranking. Flexner´s proposals were not new ones, since they had numerous examples in the United States and Canada, but they arrived at the right time with the due authority to be followed.

Many advances occurred along the past century and many of them caused a profound impact on medical education. The scientific discoveries and technical innovations introduced drastic changes in the diagnostic and therapeutic procedures for known or new diseases; advances in the cognitive sciences that allowed a better understanding of the learning processes and how to improve educational processes; the tremendous development of health care provision systems of increased complexity requiring new health professions and changing the role of the physicians; the rising expectations of a more educated population, are, all of them, elements of great impact on the kind of doctors required now, and in the future, to take care of societal needs, and challenging the medical education systems to respond adequately.

Due to the great and prolonged impact of the Flexner´s Report, one should not wonder that coinciding with the centenary of its publication the Carnegie Foundation for the Advancement of Teaching has presented a new report on the actual situation and the present needs of medical education [2]. The new Carnegie Foundation report reaches Europe when the Bologna process of university changes, including medical schools, is advancing full speed. We would be wise to take this new report into consideration while we are adapting to the demanded changes in order to succeed in accomplishing the necessary changes.

Cooke et al [2] consider that in spite of the multiple advances in medical education along the 20th century, the north American medical education system has still some critical shortcomings. It is too inflexible and too prolonged, is not enough learning centered, lacks connections between the acquisition of formal and clinical experiential knowledge, shows contents´ gaps (population´s health, health systems, non-clinical roles of physicians, professional values, among others), insufficient longitudinality in the clinical experiences due to the hospital context in which they are acquired, etc. The report [2] prioritizes and fully justifies four educational objectives that should urgently be remediated:

• The standardization of the learning objectives (outcomes) while individualizing the educational processes.

• The integration of the acquisition of formal knowledge with the clinical experience.

• The development of mental inquisitive habits and motivation for innovation.

• The development of the professional identity.

The journal Educación Médica, in this issue, on the occasion of the centenary of the Flexner´s Report, wants to render homage to Abraham Flexner and the Carnegie Foundation that patronized the study demanded by the American Medical Association, for the relevant and prolonged impact on medical education in America and around the world. Educación Médica tries always to contribute to the diffusion of the "state of the art" of medical education as a specific area of knowledge and practice and of the relevant advances and the changing processes of the health professions education. Being immersed in the Bologna process we can not obviate "benchmarking" nor forget the innovations already underway in our context and similar or more advanced one, in order to facilitate its emulation.

Now, that our medical schools have just had to prepare and submit to ANECA the adaptation of their curriculae to the Bologna´s requirements, and the internal institutional debates are still fresh in the minds of all the educational authorities, it seems convenient to remind us all that the Bologna process should give response to the societal needs as interpreted by the governmental regulatory agents as well as to the fact that the Medical School and the Postgraduate specialist training system should provide the adequate responses to them, thanks to their accumulated know-ledge and collective intelligence. Cosmetic changes so efficiently engineered previously by the Universities to resist the external pressures of the regulatory administration should not be put in practice now.

For a while Educación Médica is going to publish under to generic title "The Bologna Process" a series of articles to contextualize relevant basic elements for the educational reform required that hopefully now will finally become incorporated into the system.

References

1. Flexner A. Medical education in the United States and Canada. New York: Carnegie Foundation for the Advancement of Teaching; 1910.        [ Links ]

2. Cooke M, Irby DM, O"Brien BC. Educating physicians: a call for reform of medical schools and residency. The Carnegie Foundation for the Advancement of Teaching. San Francisco: Jossey-Bass; 2010.        [ Links ]