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Standards body forced med school changes … 99 years ago

1910 American Medical Association report reshaped Dal’s medical school.

Dalhousie’s medical school is in the process of changing administrative procedures and elements of its curriculum to comply with American Medical Association standards. However, this is not the first major program overhaul that has taken place at the Faculty of Medicine following a critical examination by the American Medical Association.

Jock Murray, professor emeritus, former medical school dean and now medical historian, shares some of what he’s been researching and collecting for years.

In the early 20th century, people were very concerned over the quality of medical education in the United States.

“There was no regulation - you could set up a medical school in your house. After six months or a year you could give people a medical degree...Louisville, Ky. had 50 medical schools,” Murray explains.

In response, the American Medical Association hired an educator, Abraham Flexner, to visit every medical school in North America and publish an evaluation on them.

“He said about Dalhousie that the laboratories were inadequate, the libraries were inadequate, they didn’t have enough full-time faculty (and) there were not enough endowments.”

Murray calls Flexner’s 1910 report one of the most important evaluations ever conducted in medicine. It was responsible for the closure of half of the medical schools in the United States alone.

The evaluation was very critical of all Canadian medical schools, including Dalhousie.

“At that time they justifiably didn’t agree with all the criticisms, however within a year they had made a lot of the changes that Flexner had criticized,” says Murray.

The Dalhousie medical school was founded in 1868 by 11 graduates of the University of Edinburgh and one from Glasgow. Edinburgh’s medical school was one of the best in the world and many of its graduates went on to found medical schools in North America, modelling their curriculum after their alma mater.

“They set up a four-year program, which was much longer and much more extensive than most medical schools,” Murray explains.

About 15 years after the faculty of medicine was founded at Dalhousie, there was a split.

“[The faculty] couldn’t get any grants or any support. Only Dalhousie could, and the medical faculty thought it was getting starved financially. It became independent so that it could apply for government grants by itself.”

The original medical school operated out of a building that stood in Grand Parade square, where the current city hall is.

When the faculty made the choice to become independent, a new building was erected near the corner of Carlton Street and College Street. The new school was named the Halifax Medical College.

“When the students finished their training at the medical school they applied to Dalhousie for an MD. And Dalhousie had a group of faculty that examined them…but if you look at the records, the examiners were the same faculty as at the college.”

Murray says the reason the split occurred was to ensure that the medical training school received adequate funding to train students but that the graduates—on paper, graduated from Dalhousie.

Years later, when Flexner visited Dalhousie in 1909 he was confused by the two separate schools.

“What Flexner said was what kind of a bizarre relationship is this? Dalhousie is granting the degrees but has no control over the teaching,” Murray explains.

When Flexner visited Dalhousie he said the relationship made the school look like a proprietor in medical schools, that they were only out to make money.

“That got Dalhousie very upset. They had organized a good, Edinburgh-based medical school. They got paid very little and they often gave up their salaries to help build new laboratories in the school. It was not a justified criticism,” Murray explains, “but within a year they had become the Faculty of Medicine at Dalhousie again.”

Murray says that like 1910 there were no plans to change the curriculum before the evaluations were released, but that curriculum changes are always good.

“It’s good for the students and it’s good for the faculty. It makes them think, and it makes them re-evaluate what they’re doing. I think it’s a positive thing, whereas initially bad news sounds like a negative thing.”