The Family Business — To Educate
Authors: Ronald A. Arky
Journal: New England Journal of Medicine (2006)

hen the massachusetts medical society (mms) was established in 1781, cofounder John Warren explained its purpose to the public."The design of the above institution," he wrote, "is to promote medical and surgical knowledge."Throughout the years, one important mission of the MMS has continued to be the education of its members, as well as all medical professionals; in recent years, that mission has extended beyond the profession to the education of the public.Through its publications and continuing medical education programs, the MMS has promulgated new scientific knowledge that has been incorporated into undergraduate and postgraduate medical curricula.In 1921, the MMS purchased for the sum of $1 the journal that became the New England Journal of Medicine.A vital element in the vigorous growth of the Journal as a tool of education has been its editorial independence under the society's "benign proprietorship."Surprisingly, though the MMS has cleaved to its mission of medical education, only 3 of the previous 114 Shattuck Lectures have been directly concerned with this subject.The 15th lecture, delivered in 1904 by George Summer Huntington, a general medical practitioner from East Hampton, New York, discussed the "Relation of Comparative Anatomy to Medical Education and Practice."Unfortunately, the text of Huntington's lecture is not available, but one must conjecture that he discussed his astute observations about the nature of familial chorea, which represented the best of the clinical investigations being undertaken in his day.One can only marvel at the enormous effect those observations had on the fields of genetics, neurology, and psychiatry in the decades that followed -and on the education of physicians in those fields.James Faulkner was the dean at Boston University's School of Medicine when, in the 1954 Shattuck Lecture, he discussed reform of the medical school curriculum and the schism between the basic science and clinical faculties.He feared that the rising cost of medical education would change the composition of medical school classes.John Millis, speaking in 1967, was the first nonphysician to deliver a Shattuck Lecture, and he used his role as chair of the Citizens' Commission on Graduate Medical Education to elaborate on the "large and perplexing problems" besetting postgraduate medical education in the United States.Many of that commission's recommendations have been implemented, but many observers still share Millis's deep concern about the "severity of discontinuities" in medical education.Whereas Faulkner focused specifically on undergraduate education, Millis on postgraduate education, and Huntington on continuing education, I wish to address the entire spectrum of medical education.One hundred years ago, the Carnegie Foundation initiated a review of college education in the United States.In the process of conducting this review, the foundation was sensitized to the disturbing variation in admissions requirements at the country's 150 medical schools.Abraham Flexner was selected by the foundation in 1908 to report on the facilities, resources, and methods of instruction at these schools of medicine.Flexner and the staff of the foundation visited all the medical