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The Flexner scale problem

Flexner, I just can’t quit you.

A few weeks ago, Education Week was kind enough to run my op-ed on Abraham Flexner’s report on medical education in 1910. My argument was that the standard story often told about the Flexner report — namely, that it revolutionized medical education by galvanizing the closure of bad medical schools — is woefully incomplete. If the field of teacher preparation is to draw lessons from Flexner, I argued, we need a more robust understanding of the relevant history.

In the time since publication, Deans for Impact has launched this new blog (hooray!) and held a major gathering of our member deans that featured Dr. Kenneth Ludmerer, a leading medical-education historian, as one of our guest speakers. As a result, I have not one but two blog posts offering some extended thoughts on the implications of medical education transformation for teacher preparation. This first post dives deeper into data, and the second post will share some of Dr. Ludmerer’s key points in his address to our member deans.

Let’s start with some data visualization. Below is a graph I found in an old Journal of American Medicine from 1922 (thank you, Google books):

I find two aspects of this graph particularly interesting. First, note that the rate of medical school closures remained constant for five years before and after point “C”, when the Flexner Report was published. Second, check out the dark shading at the bottom of the graph — this represents the number of medical schools that required at least two years of college for admission. In 1906, only 3 percent of medical schools required two years of college, but just 13 years later that number had risen to a remarkable 93 percent. The critical driver of that change is seen at point “D”, when the Council on Medical Education made two years of college a required entry standard for any program seeking to receive a “Class A” rating.

It’s tempting to look at this data and conclude that if teacher preparation programs want to follow the medical transformation model, entry requirements will need to be raised. Indeed, CAEP, the national accreditor of teacher-prep programs, has promulgated new standards to do just that, and some states (e.g., Delaware) have acted recently to raise entry requirements. Commentators such as Amanda Ripley have suggested that if entry standards are raised, the prestige of teaching will rise, creating a virtuous feedback loop.

But we have a size problem. Take another look at the medical school data from 1905 to 1922 — at its peak in that period, the total number of programs preparing teachers never exceeded 160 schools. Flexner himself thought 31 was the optimal number of medical schools to produce the number of doctors we needed: 2,000 annually, or about one doctor per year for every 46,000 citizens in the US. According the envelope I just scribbled on the back of, applying the “Flexner ratio” to teacher education today would result in roughly 1,150 teachers annually prepared to serve 53 million public-school children. That just isn’t going to work in a country as large as the US. Indeed, edu-darling Finland prepares about that many teachers each year to serve its 1.2 million students. Put simply, size matters.

So if we can’t consolidate our way to improving teacher preparation, what other strategies might work? Well, Dr. Ludmerer shared some thoughts with us about that, so check back soon for part two.


Benjamin Riley

Founder and Executive Director


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