In the following pages, I argue for a new way of looking at the history of medical education. The growth of medical training, I believe, has too long been viewed in almost exclusively national terms. Changes in medical teaching seem to have come only when creative individuals or powerful centers of innovation in a single country—Leyden, Vienna, Edinburgh, Paris, Giessen, Leipzig, or perhaps Baltimore—have discovered new ideas and techniques and radiated them outward to peripheral training centers in less advanced cities and towns. Strong personalities have put their stamp on new methods of imparting medical knowledge. The periodization of historical development is marked by important discontinuities that center on large historical events. The historical focus is understandably on dramatic change, new schemes of conveying learning, the advance of science in medicine, or the travels of foreign physicians to centers of innovation. Students appear in standard accounts, if at all, only as passive and voiceless participants in an impersonal process. History becomes a tale of successive national centers of influence that wax and wane in their importance to medicine. Rarely is it clear why these centers climb suddenly to historical prominence or why they later decline. And almost always, in even the best writing on medical education, a teleological thread is visible in which nineteenth-century and earlier patterns are followed largely to reveal how they helped shape twentieth-century realities. In short, medical education, like medicine itself, is often portrayed as a story of steady and sometimes heroic progress. In this book, I seek further answers to the reasons for change in medical teaching in the social, industrial, political, and educational transformations of Europe and North America that took place between the Enlightenment and World War II. Especially important, I believe, was the differential impact on individual nations of such major shifts in Western thought and society as the eighteenth-century Enlightenment, the rapid bursts of population and explosion of cities in the Industrial Revolution, the expansion of the market for health practitioners due to educational and urban growth, the rise of an entrepreneurial spirit in education, the widespread transformation of secondary and higher education in the nineteenth century, advances in the explanatory power of observational and experimental science, and the differing roles played by nation-states, as well as by the students themselves, in matters of health and education.
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