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American Medical Schools and the Practice of MedicineA History$
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William G. Rothstein

Print publication date: 1987

Print ISBN-13: 9780195041866

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780195041866.001.0001

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(p.331) 19 Epilogue
American Medical Schools and the Practice of Medicine

William G. Rothstein

Oxford University Press

The expansion of the functions of medical schools since mid-century has had many unanticipated and adverse consequences for medical education. As a result, medical schools have lost some of their societal support. In the years since 1900, medical schools have made major changes in their structure in order to solve specific educational problems. University hospitals were built to provide clinical training in hospitals that emphasized education and research rather than patient care. Full-time clinical faculty members were employed in order to professionalize a role previously occupied by part-time practitioner-educators. Biomedical research was undertaken to enable faculty members to advance medical knowledge and enhance their skills as educators. Internships and residencies became restricted to hospitals affiliated with medical schools to replace the poorly supervised practical experience provided in community hospitals with a more structured education administered by professional educators. Each of these changes assumed that medical schools could be removed from the hurly-burly of professional life and made to fit the model of the liberal arts college. This assumption failed to recognize the fundamental differences between the two types of institutions. In liberal arts education, the body of knowledge taught to students need not be suitable for practical application in the community. In many fields, like most of the humanities, it has rarely been used outside of institutions of higher education. In others, like the social sciences, the knowledge has been sufficiently tentative that its direct application has been problematic. In still others, like most natural sciences, the knowledge has been so highly specialized that it could not provide a basis for viable careers. As a result, most faculty members in the liberal arts and sciences have spent their careers in teaching and research without the option of nonacademic employment in their disciplines. Medical schools, on the other hand, have continually influenced and been influenced by the practice of medicine in the community. The knowledge taught in medical schools has affected the way that physicians have practiced medicine, but it has also been tested by practitioners and fed back to the faculty for modification and refinement.

Keywords:   in teaching hospitals

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