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The forgotten history of defunct black medical schools in the 19th and 20th centuries and the impact of the Flexner Report

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Abstract

There are currently four medical schools dedicated primarily to training African-American physicians. Two of these schools were established in the last 40 years. For a generation prior to that, only Howard University College of Medicine and Meharry Medical College existed. Forgotten is the history of black medical schools established in the 19th and early 20th centuries, most of which are now defunct. While barriers to the medical education of African Americans in majority institutions have largely disappeared, the continued education of students at our four present-day black medical schools is again threatened. It is incumbent upon us not to allow these modern-day threats to destroy an important resource and legacy in the annals of African-American people. This paper explores medical education in the 19th and 20th centuries, the creation of black medical schools and the forces that lead to the demise of many of these institutions. In recalling this history, we acknowledge the almost-impossible odds faced by these pioneers and learn from their mistakes and failures.
:..........
The
Forgotten
History
of
Defunct
Black
Medical
Schools
in
the
19th
and
20th
Centuries
and
the
Impact
of
the
Flexner
Report
Earl
H.
Harley,
MD
Washington,
District
of
Columbia
Presented
at
the
Hinton-Gladney
Lecture
before
the
Oto-
laryngology
Section
of
the
National
Medical
Association,
Dallas,
TX,
August
6,2006.
There
are
currently
four
medical
schools
dedicated
prmorily
to
training
African-American
physicians.
Two
of
these
schools
were
established
in
the
last
40
years.
For
a
genera-
tion
prior
to
that,
only
Howard
University
College
of
Medi-
cine
and
Meharry
Medical
College
existed.
Forgotten
is
the
history
of
black
medical
schools
established
in
the
19th
and
eady
20th
centures,
most
of
which
are
now
defunct.
While
barriers
to
the
medical
education
of
African
Ameri-
cans
in
majority
institutions
have
largely
disappeared,
the
continued
education
of
students
at
our
four
present-day
black
medical
schools
is
again
threatened.
It
is
incumbent
upon
us
not
to
allow
these
modern-day
threats
to
destroy
an
important
resource
and
legacy
in
the
annals
of
African-
American
people.
This
paper
explores
medical
education
in
the
19th
and
20th
centuries,
the
creation
of
black
medical
schools
and
the
forces
that
lead
to
the
demise
of
many
of
these
institutions.
In
recalling
this
history,
we
acknowledge
the
almost-impossi-
ble
odds
faced
by
these
pioneers
and
learn
from
their
mis-
takes
and
failures.
Key
words:
black
medical
schools
U
Flexner
Report
©
2006.
From
the
Department
of
Otolaryngology,
Head
and
Neck
Surgery,
Georgetown
University
Hospital,
Washington,
DC.
Send
correspondence
and
reprint
requests
for
J
Natl
Med
Assoc.
2006;98:1425-1429
to:
Dr.
Earl
H.
Harley,
Department
of
Otolaryngology,
Georgetown
University
Hospital,
3800
Reservoir
Road
NW,
Washington,
DC
20008;
phone:
(202)
444-8186;
fax:
(202)
444-1312;
e-mail:
harleye@gunet.georgetown.edu
INTRODUCTION
T"r1he
negro
needs
good
schools
rather
many
schools
..."
Abraham
Flexner
wrote
these
words
in
the
early
20th
century.
In
1910,
The
Carnegie
Foundation
commissioned
Flexner
to
study
medical
education
in
the
United
States
and
Canada.
As
many
as
14
black
medical
schools
existed
in
the
late
19th
century
(Table
1).
In
1910,
when
Flexner
wrote
his
report,
only
seven
such
schools
had
survived.
Flexner
further
wrote,
"Of
the
seven
medical
schools
for
negroes
in
the
United
States,
five
are
at
this
moment
in
no
position
to
make
any
contribution
of
value
..."
He
continued
stating,
"Flint
at
New
Orleans,
Leonard
at
Raleigh,
the
Knoxville,
Memphis
and
Louisville
schools
are
ineffec-
tual."
The
force
of
this
report
is
evident
in
the
failure
of
these
five
schools
and
the
survival
of
the
remaining
two,
Howard
and
Meharry.
For
Flexner
asserted,
"Meharry
at
Nashville
and
Howard
at
Washington
are
worth
devel-
oping
..."
The
recommendation
for
this
survival
is
put
into
context
with
further
analysis
of
Flexner's
words
when
he
stated,
"The
negro
must
be
educated
not
only
for
his
sake,
but
for
ours"
and
"Ten
million
of
them
live
in
close
contact
with
60
million
whites."'
The
impact
of
this
report
reverberated
for
over
a
half
a
century.
In
the
years
following
the
report,
the
number
of
black
physicians
decreased
while
the
number
of
white
physicians
increased.2
It
was
not
until
1966
that
another
black
medical
school
was
founded,
when
The
Charles
R.
Drew
Medical
School
was
established
in
Los
Angeles,
CA
(Table
2).
Early
African-American
Physicians
After
350
years
of
enslavement,
the
struggle
for
edu-
cation
of
newly
freed
black
people
should
give
us
pause
as
we
reflect
on
sheer
determination
and
desire
in
improving
their
lot.
Nowhere
is
this
story
more
enlight-
ening
than
in
the
history
of
medical
education
of
African
Americans.
The
barriers
to
medical
education
were
many.
Despite
such
barriers,
at
least
14
black
med-
ical
schools
or
departments
of
medicine
were
estab-
lished
in
the
decades
following
the
end
of
slavery.
The
most
successful
of
these
schools
was
The
Leonard
Med-
ical
College
at
Shaw
University
in
Raleigh,
NC.
One
of
the
graduates
of
the
medical
schools
was
Herbert
Erwin
Sr.,
MD.
Erwin's
son,
Howard
Erwin,
was
quoted
in
the
Gastonia
Observer
in
1990.
Erwin
recalled
his
father
talking
of
using
candles
to
study
because
the
school
required
lights
out
at
9
or
10
o'clock.3
JOURNAL
OF
THE
NATIONAL
MEDICAL
ASSOCIATION
VOL.
98,
NO.
9,
SEPTEMBER
2006
1425
DEFUNCT
BLACK
MEDICAL
SCHOOLS
AND
THE
FLEXNER
REPORT
The
medical
education
for
the
"Negro"
student
before
the
20th
century
was
largely
due
to
the
efforts
of
religious
organizations
such
as
the
American
Baptist
Home
Mis-
sion
Society
and
The
Freedman's
Aid
Society
of
the
Methodist
Episcopal
Church.
Some
of
the
missions,
such
as
Meharry
Medical
College
in
Nashville,
TN,
supported
the
development
of
medical
schools
for
blacks.2
During
slavery,
some
free
Negro
students
either
trav-
eled
to
Europe
or
trained
at
a
small
cadre
of
eastern
or
midwestern
universities.
Notable
among
these
were
the
University
of
Pennsylvania,
the
University
of
Michigan,
Harvard
University,
Yale
University,
Indiana
University
and
Northwestern
University.4
Other
than
receiving
a
formal
medical
education,
training
was
by
apprenticeship.
The
first
African-Amer-
ican
physician
learned
from
this
method.
James
Durham
(Derham),
a
former
slave
who
was
born
in
Philadelphia,
PA
in
1762,
is
thought
to
be
the
first
black
doctor
in
this
country.
Durham
learned
medicine
from
two
different
physician-slave
owners
who
taught
him
the
art
of
mix-
ing
medicines
and
working
with
patients.
He
bought
his
freedom
at
the
age
of
21
and
began
practicing
medicine
in
New
Orleans,
LA.
In
1789,
the
city
of
New
Orleans
limited
his
practice
because
he
did
not
have
a
formal
medical
degree.5'6
The
first
black
physician
to
earn
a
formal
medical
degree
was
James
McCune
Smith,
who
studied
in
Europe
at
the
University
of
Glasgow.'
The
first
African-
American
woman
to
graduate
from
an
American
med-
ical
school
was
Rebecca
Lee
Crumpler.
Crumpler
grad-
uated
from
The
New
England
Female
Medical
College
in
1864.7
The
Flexner
Report
Before
the
turn
of
the
20th
century,
medical
educa-
tion
for
African
Americans
was
haphazard,
inconsistent
and
of
uneven
quality.
Black
medical
schools
were
either
church-related
missionary
institutions
or
propri-
etary
operations.2
In
fact,
several
early
graduates
of
mis-
sionary-related
schools
established
proprietary
schools.2
The
schools
were
often
underfunded,
had
limited
facul-
ty,
poor
facilities
and
lack
of
access
to
large
numbers
of
patients.2'3
That
some
proprietary
schools
were
pure
commercial
endeavors
and
little
more
than
diploma
mills
further
complicated
and
compromised
the
medical
education
of
African
Americans.2
Flexner
spoke
deri-
sively
of
schools
that
began
in
October
and
graduated
a
class
the
following
spring.'
This
phenomenon
was
decried
by
Henry
S.
Pritchett,
president
of
The
Carnegie
Foundation
for
the
Advancement
of
Teaching.
In
the
introduction
to
the
Flexner
Report,
Pritchett
stated
"Overproduction
of
ill-trained
men
is
due
in
the
main
to
the
existence
of
a
very
large
number
of
commercial
schools,
sustained
in
many
cases
by
advertising
meth-
ods
through
which
a
mass
of
unprepared
youth
is
drawn
out
of
industrial
occupations
into
the
study
of
medi-
cine."'
Pritchett
also
stated,
"For
25
years
past,
there
has
been
an
enormous
overproduction
of
uneducated
and
ill-trained
medical
practitioners."'
It
was
in
this
climate
that
the
move
to
change
medical
education
began.
Well
before
the
Flexner
Report,
the
American
Medical
Association
(AMA)
and
the
Associa-
tion
of
American
Medical
Colleges
(AAMC)
began
to
exert
pressure
to
improve
medical
education.
In
1904,
the
AMA
created
the
Council
on
Medical
Education
(CME).
The
CME
had
evaluated
medical
schools
several
times
before
The
Carnegie
Foundation
commissioned
the
Flexn-
er
Report.
In
1907,
the
CME
described
proprietary
schools
as
menaces
and
urged
their
nonrecognition.2
In
seeking
to
reform
the
educational
process,
the
AMA
and
its
CME
had
two
main
goals:
*
To
standardize
educational
requirements
for
acceptance
into
medical
school
*
To
create
a
medical
school
curriculum
consisting
of
years
of
basic
science
and
laboratory
work
followed
by
two
years
of
clinical
exposure
in
teaching
hospitals
Flexner
felt
that
Johns
Hopkins
Medical
School
Table
1.
Defunct
black
medical
schools
in
the
United
States
1.
Lincoln
University,
1870-1874,
Oxford,
PA
2.
Straight
University
Medical
Department,
1873-1874,
New
Orleans,
LA
3.
Leonard
Medical
School
Shaw
University,
1882-1918,
Raleigh,
NC
4.
New
Orleans
University
Medical
College(Flint
Medical
College),
1889-1911,
New
Orleans,
LA
5.
Louisville
National
Medical
College,
1888-1912,
Louisville,
KY
6.
Hannibal
Medical
College,
1889-1896,
Memphis,
TN
7.
Knoxville
College
Medical
Department,
1895-1900,
Knoxville,
TN
8.
Knoxville
Medical
College,
1900-1910,
Knoxville,
TN
9.
State
University
Medical
Department,
1899-1903,
Louisville,
KY
10.
Chattanooga
National
Medical
College,
1899-1904,
Chattanooga,
TN
11.
University
of
West
Tennessee
College
of
Physician
and
Surgeons,
1900-1923,
Jackson,
TN;
1900-1907,
Memphis,
TN;
1907-1923
12.
Medico-Chirurgical
and
Theological
College
of
Christ's
Institution,
1900-1908?,
Baltimore,
MD
1426
JOURNAL
OF
THE
NATIONAL
MEDICAL
ASSOCIATION
VOL.
98,
NO.
9,
SEPTEMBER
2006
DEFUNCT
BLACK
MEDICAL
SCHOOLS
AND
THE
FLEXNER
REPORT
exhibited
"unprecedented
academic
virtue"
and
should
be
emulated.'
Hopkins'
adequate
endowment,
genuine
university
affiliation,
well-equipped
laboratories
and
its
own
hospital
were
among
the
virtues
Flexner
sought
to
impose
on
all
medical
schools.'
Over
an
18-month
period,
Flexner
visited
155
Amer-
ican
medical
schools
and
made
recommendations
to
improve
medical
education.
Flexner
examined
five
aspects
of
medical
education:
1.
The
medical
school
entrance
requirement
2.
The
size
and
training
quality
of
the
faculty
3.
The
size
of
endowment
and
tuition
4.
The
quality
of
laboratories
5.
The
availability
of
teaching
hospitals
and
their
clinical
teaching
staff
The
Flexner
Report,
which
was
published
in
1910,
proposed
"development
of
the
requisite
number
of
prop-
erly
supported
institutions
and
the
speedy
demise
of
all
others."'
Shaw
University-Leonard
Medical
School
Established
in
1882,
the
Leonard
Medical
School
was
the
medical
department
of
Shaw
University
in
Raleigh.
Leonard
was
named
in
honor
of
a
white
bene-
factor,
Judson
Wade
Leonard.
Leonard
Medical
School
was
the
most
successful
of
the
defunct
black
medical
schools,
graduating
almost
400
doctors
of
medicine.
Leonard
Medical
School-like
its
parent,
Shaw
Universi-
ty-emphasized
strict
discipline
and
Christian
values.
The
medical
school
closed
in
1918,
largely
a
causality
of
the
Flexner
Report.8'9
However,
problems
for
Leonard
began
prior
to
Flexner.
In
periodic
reviews
by
the
CME,
Leonard
always
received
a
rating
of
"C"
compared
to
Howard
and
Meharry,
which
received
"B"s.
After
the
Flexner
Report,
the
situation
spiraled
downward.
In
1914,
32
junior
and
senior
students
transferred
to
a
proprietary
medical
school
(the
University
of
West
Tennessee)
as
the
university
reduced
Leonard
to
a
two-year
school
and
finally
closed
four
years
later.4'8
Lincoln
University
Medical
Department
Lincoln
University's
medical
department
was
notable
in
that
it
was
the
only
black
medical
school
in
the
north.
It
had
an
auspicious
beginning
in
September
1870,
with
three
students
and
four
faculty.
Located
in
rural
southeastern
Pennsylvania,
it
was
doomed
by
a
combination
of
unfavorable
geographic
location
and
underfunding.
For
unexplained
reasons,
in
its
short
life
span,
Lincoln
never
conferred
any
medical
degrees.
It
matriculated
six
students,
four
of
which
were
eventually
awarded
medical
diplomas
at
other
schools-two
at
Howard
University
and
two
at
Yale
University.
After
failing
an
attempted
move
of
the
medical
department
to
Philadelphia,
the
board
officially
abandoned
the
pro-
gram
in
1876.10
Straight
University
Medical
Department
Straight
University
was
founded
in
New
Orleans,
LA,
by
the
Congregationalist
Church
in
1869.
The
school
was
named
after
Seymour
Straight,
a
merchant
who
was
an
early
supporter
of
the
university.
In
1873,
the
medical
department
was
inaugurated
and
operated
for
about
one
year.
The
school's
fate
was
inextricably
tied
into
Recon-
struction
Era
politics.
Issues
of
race,
money
and
religion
further
complicated
this.
The
dean
was
James
T.
Newman,
whose
medical
education
credentials
are
uncertain.
Despite
his
leadership,
Newman
could not
save
the
med-
ical
department.
The
medical
department
closed
in
1874
without
ever
graduating
a
physician."I
Flint
Medical
College
of
New
Orleans
University
In
1873,
the
Freedman's
Aid
Society
of
the
Methodist
Episcopal
Church
founded
New
Orleans
Uni-
versity.
In
1889,
the
university
established
the
Flint
Medical
College.
The
medical
school
closed
in
1911
after
graduating
approximately
116
physicians.
It
is
notable
that
Straight
College
and
New
Orleans
Univer-
sity
merged
to
form
Dillard
University
in
1930.54-2
Knoxville
College
Medical
Department
Knoxville
College
was
initially
established
in
Nashville
by
the
Freedman's
Bureau
of
the
United
Presby-
terian
Church.
It
moved
to
Knoxville
in
1875.
The
Depart-
ment
of
Medicine
was
established
in
1895.
The
board
of
the
Freedman's
Bureau
of
the
United
Presbyterian
closed
the
school
in
1900,
after
graduating
two
physicians.
The
school
was
later
reorganized
off
campus
as
the
Knoxville
Medical
College
but
closed
again
in
1910.'3
Hannibal
Medical
College
Hannibal
Medical
College
was
established
in
Mem-
phis,
TN
in
1889
by
Tarleton
C.
Cottrell.
The
school,
which
never
achieved
the
success
or
popular
acclaim
of
other
pro-
prietary
medical
schools
of
the
day
such
as
Louisville
National
Medical
College,
probably
never
graduated
any
more
than
five
physicians.
It
appears
to
only
have
operated
for
four
years.
There
is
great
controversy
surrounding
the
Table
2.
Current
black
medical
schools
in
the
United
States
*
Howard
University
College
of
Medicine,
1868,
Washington,
DC
*
Meharry
Medical
College,
1876,
Nashville,
TN
*
Charles
R.
Drew
Medical
School,
1966,
Los
Angeles,
CA
*
Morehouse
School
of
Medicine,
1975,
Atlanta,
GA
JOURNAL
OF
THE
NATIONAL
MEDICAL
ASSOCIATION
VOL.
98,
NO.
9,
SEPTEMBER
2006
1427
DEFUNCT
BLACK
MEDICAL
SCHOOLS
AND
THE
FLEXNER
REPORT
school
in
that
the
founder
claimed
to
have
graduated
from
a
nonexisting
medical
school
called
Bethel
Medical
Col-
lege
of
Southwestern
University
in
Little
Rock,
AR.
Con-
troversy
also
exists
regarding
the
degree-granting
process
for
three
of
the
five
known
graduates.
The
fate
of
Hannibal
was
similar
to
the
fate
of
other
proprietary
schools
of
the
day.
Specifically,
lax
entrance
requirements,
lack
of
academic
rigor,
poorly
qualified
faculty
and
inadequate
physical
plants
contributed
to
its
demise
in
1896,
seven
years
after
opening.4
Chattanooga
National
Medical
College
Chattanooga
Medical
College
(CNMC),
a
propri-
etary
school,
was
established
in
Chattanooga,
TN,
by
a
graduate
of
an
earlier
proprietary
black
medical
school.
Thomas
William
Haigler,
a
graduate
of
Louisville
National
Medical
College,
founded
CNMC
in
1899.
Although
the
school
probably
graduated
at
least
16
stu-
dents,
it
failed
to
ever
become
a
viable
institution
and
closed
abruptly
in
its
fifth
year
of
operation.4
Louisville
National
Medical
College
Louisville
National
Medical
College
(LNMC)
was
a
propriety
medical
college
established
in
1888
by
William
Henry
Fitzbutler.
Fitzbutler
was
the
first
black
graduate
of
the
University
of
Michigan
College
of
Medicine.
Fitzbut-
ler
and
two
other
African-American
physicians
were
the
founding
faculty.
Among
the
proprietary
medical
schools,
LNMC
was
one
of
the
most
successful
but
suffered
from
increasing
financial
pressure
brought
on
by
requirements
for
equipment,
etc.
The
school
had
no
campus,
inadequate
study
spaces
and
poor
library
facilities.
With
little
ability
to
improve
its
financial
state,
the
final
blow
came
in
1910,
with
the
Flexner
Report.
Flexner
felt
that
schools
such
as
LNMC
were
of
little
value.
The
school
closed
in
1912,
after
graduating
over
100
physicians.4
University
of
West
Tennessee
College
of
Physician
and
Surgeons
The
University
of
West
Tennessee
was
established
in
Jackson,
TN
in
1900
and
later
moved
to
Memphis
in
1907.
The
school
founder
was
Miles
Vandahurst
Lynk,
an
1891
graduate
of
Meharry
Medical
College.
Lynk
was
also
instrumental
in
the
founding
of
the
National
Medical
Association,
a
professional
organization
that
served
black
physicians
who
were
not
allowed
the
join
its
white
coun-
terpart,
the
American
Medical
Association.
In
1914,
the
school
accepted
advanced-standing
stu-
dents
from
another
black
medical
school.
Thirty junior
and
senior
students
transferred
from
Leonard
Medical
School,
which
eventually
closed
in
1918.
Of
note,
nei-
ther
Howard
University
nor
Meharry
Medical
College
would
accept
Leonard
students.
The
school
suffered
from
low
educational
standards
and
student
achieve-
ments.
Such
was
the
case
that
46
states
plus
Tennessee
refused
to
recognize
graduates
from
the
University
of
West
Tennessee.
The
school
closed
in
1923,
having
granted
155
medical
diplomas.4
Medico-Chirurgical
and
Theological
College
of
Christ's
Institution
This
school
was
organized
in
1910
and
probably
dis-
banded
in
1908.
However,
very
little
information
exists
on
its
fate.2
CONCLUSION
Flexner's
goal
was
to
reduce
the
number
of
medical
schools
and
increase
the
quality
of
teaching.
After
the
report,
there
was
a
broad-scale
closure
of
medical
schools.
These
included
majority
medical
schools,
female
medical
schools
and
most
of
the
black
medical
schools.
Only
Howard
University
College
of
Medicine
and
Meharry
Medical
College
survived.
Two
additional
black
medical
schools
have
since
been
established-
Charles
R.
Drew
Medical
School
in
Los
Angeles
and
Morehouse
Medical
College
in
Atlanta,
GA.
These
schools
have
maintained
their
academic
standards
but
face
some
of
the
same
pressures
that
lead
to
the
closure
of
earlier
black
medical
institutions.
Charles
Epps
Jr.,
MD,
former
dean
of
Howard
Univer-
sity
College
of
Medicine,
asserts
for
the
continued
exis-
tence
and
strengthening
of
our
four
black
medical
schools.
These
schools
tend
to
train
primary
physicians
in
higher
percentages
who
tend
to
practice
among
the
underserved.14
One
of
the
greatest
challenges
of
today's
black
medical
schools
is
economics.
Black
medical
schools
find
it
diffi-
cult
to
compete
with
well-funded
majority
universities
with
a
long-standing
commitment
to
train
African
Americans,
such
as
the
University
of
Michigan.1I
The
result
may
be
the
siphoning
of
well-qualified,
highly
competitive
African-
American
students
who
choose
"rich"
schools
for
pragmat-
ic
economic
reasons.
This
places
an
extra
burden
on
today's
black
medical
schools
of
appealing
to
a
higher
social
calling
as
they
seek
to
fulfill
their
historic
missions.
While
they
search
for
greater
endowments
to
become
more
attractive,
they
must
continue
to
position
themselves
as
the
training
grounds
for
those
who
will
serve
the
underserved.
In
summary,
with
black
medical
schools
under
siege
today
and
facing
a
crisis
of
adequate
funding
and
endowments
to
attract
the
best
and
the
brightest
African
Americans,
it
is
vitally
important
that
we
remember
the
history
of
those
failed
medical
schools
and
heed
the
les-
sons
of
their
failures.
ACKNOWLEDGEMENTS
I
would
like
to
thank
Linda
Robinson,
associate
librari-
an
at
Howard
University
Louis
Stokes
Health
Sciences
Library,
for
her
invaluable
assistance
and
encouragement.
I
would
also
like
to
thank
Crystal
Smith,
reference
librari-
an
in
the
History
of
Medicine
Division
at
the
National
Library
of
Medicine,
for
her
assistance
in
obtaining
the
1428
JOURNAL
OF
THE
NATIONAL
MEDICAL
ASSOCIATION
VOL.
98,
NO.
9,
SEPTEMBER
2006
DEFUNCT
BLACK
MEDICAL
SCHOOLS
AND
THE
FLEXNER
REPORT
Flexner
Report.
I
would
also
like
to
extend
a
special
thanks
to
Todd
L.
Savitt,
PhD
in
the
History
of
Medicine
Department
at
East
Carolina
University,
The
Brody
School
of
Medicine
for
his
encouragement
and
making
available
resource
material
from
some
of
his
original
research
on
the
subject
of
black
medical
schools.
REFERENCES
1.
Flexner
A.
Medical
Education
in
the
United
States
and
Canada:
a
Report
to
The
Carnegie
Foundation
for
the
Advancement
of
Teaching.
New
York,
NY;
1910.
2.
Savitt
TL.
Abraham
Flexner
and
the
Black
Medical
Schools.
In:
Baransky
B
and
Gevitz
N,
eds.
Beyond
Flexner:
Medical
Education
in
the
20th
Century.
Baransky
B
and
Gevitz
N,
eds.
New
York,
NY:
Greenwood
Press;
1992:5-218.
3.
Charlotte
Observer,
Monday,
February
12,
1990.
4.
Savitt
TL.
Four
African-American
Proprietary
Medical
Colleges:
1888-
1923.
J
Hist
Med
Allied
Sci.
2000;55:203-255.
5.
Cobb
WM.
Progress
and
Portents
for
the
Negro
in
Medicine.
National
Association
for
the
Advancement
of
Colored
People.
New
York;
1948.
6.
Curtis
JL.
Blacks,
Medical
Schools,
and
Society.
Ann
Arbor,
Ml:
The
Univer-
sity
of
Michigan
Press;
1971.
7.
Epps
CH,
Johnson
DG,
Vaughn
AL.
African-American
Medical
Pioneers.
Rockville,
MD:
Betz
Publishing
Co.;
1994.
8.
Savitt
TL.
The
Education
of
Black
Physicians
at
Shaw
University,
1882-1918.
In:
Hatley
FJ,
ed.
Black
Americans
in
North
Carolina
and
the
South.
Chapel
Hill,
NC:
University
of
North
Carolina
Press;
1984.
9.
Savitt,
TL.
Training
the
"Concentrated,
Skillful,
Chnstian
Physician:"
Docu-
ments
Illustrating
Student
Life
at
Leonard
Medical
School,
1882-1918.
North
Carolina
Hist
Rev.
1
998;LXXV:250-276.
10.
Savitt
TL.
Lincoln
University
Medical
department-a
Forgotten
19th
Cen-
tury
Black
Medical
School.
J
Hist
Med
Allied
Sci.
1985;40:42-65.
11.
Savitt
TL.
Straight
University
Medical
Department:
the
Short
Life
of
a
Black
Medical
School
in
Reconstruction,
New
Orleans.
Louisiana
History.
Spring
2000;vol
XLI.
12.
Savitt
TL.
Entering
a
White
Profession:
Black
Physicians
In
the
New
South
1880-1920.
Bull
Hist
Med.
1987;61:507-540.
13.
Savitt
TL.
Money
Versus
Mission
at
an
African-American
Medical
School:
Knoxville
College
Medical
Department,
1895-1900.
Bull
Hist
Med.
2001;
75:680-716.
14.
Epps
CH.
Perspectives
From
the
Historic
African
American
Medical
Insti-
tutions.
Clin
Orthop.
1999;362:95-101.
15.
Markel
H.
The
University
of
Michigan
Medical
School,
1850-2000:
an
Example
Worthy
of
Imitation.
JAMA.
2000;283:915-920.
1
We
Welcome
Your
Comments
The
Journal
of
the
National
Medical
Association
welcomes
your
Letters
to
the
Editor
about
articles
that
appear
in
the
JNMA
or
issues
relevant
to
minority
healthcare.
Address
correspondence
to
ktaylor@nmanet.org.
STANFORD
UNIVERSITY
MEDICAL
CENTER
CYTOPATHOLOGIST/SURGICAL
PATHOLOGIST
The
Department
of
Pathology
at
Stanford
University
School
of
Medicine
seeks
an
academic
Cytopathologist/Surgical
Pathologist
for
appointment
as
Assistant
Professor
in
the
Medical
Center
Professoriate.
The
predominant
criterion
for
appointment
in
the
Medical
Center
Line
is
a
major
commitment
to
clinical
teaching
and
clinical
care
with
appropriate
scholarly
contributions
in
the
field.
The
Department
handles
approximately
22,500
gynecologic
and
4,500
non-gynecologic
cytology
specimens
and
42,000
surgical
specimens
annually.
Candidates
must
be
board
certified
in
Anatomic
Pathology
and
are
required
to
hold
or
obtain
a
license
to
practice
medicine
in
the
State
of
Califomnia.
Completion
of
a
Cytopathology
Fellowship
program
and
board
eligibility
or
certification
in
Cytopathology
is
required.
Additional
subspecialty
training,
in
fields
such
as
general
surgical
pathology,
hematopathology,
molecular
pathology,
cytogenetics
or
immunohistochemistry
is
desirable.
Sign-out
responsibilities
will
include
cytopathology,
general
surgical
pathology
and
frozen
section
analysis.
The
successful
candidate
will
be
expected
to
contribute
to
clinical,
translational
and/or
basic
research
projects
and
to
participate
in
training
clinical
residents
and
fellows.
Departmental
support
is
available
for
suitable
research
projects
by
faculty
whose
main
responsibilities
are
in
cytopathology
and
surgical
pathology.
Applicants
should
submit
curriculum
vitae,
as
well
as
a
brief
description
of
research
accomplishments
and
plans
for
future
research.
These,
with
the
names
of
three
references,
should
be
sent
to:
Stephen
J.
Galli,
M.D.
Professor
and
Chair
c/o
Cynthia
Llanes
Department
of
Pathology
Stanford
University
School
of
Medicine
Stanford,
Ca
94305
E-mail:
cllanes(Astanford.edu
Stanford
University
is
an
equal
opportunity
employer
and
is
committed
to
increasing
the
diversity
of
its
faculty.
It
welcomes
nominations
of
and
applications
from
women
and
members
of
minority
groups,
as
well
as
others
who
would
bring
additional
dimensions
to
the
university's
research,
teaching
and
clinical
missions.
JOURNAL
OF
THE
NATIONAL
MEDICAL
ASSOCIATION
VOL.
98,
NO.
9,
SEPTEMBER
2006
1429
... Organizations such as the AMA insisted in advocating for higher standards across medical schools, ultimately leading to standardizing curricular structure, licensing requirements for medical practice, and publicizing board exam failure rates (Markowitz & Rosner, 1973;Miller & Weiss, 2012;Savitt, 2006). This era culminated in the influential 1910 Flexner Report, which emphasized admission and curricular standards (including laboratory-based and hospitalbased training), and the closure of any school that could not meet these expectations (Harley, 2006;Miller & Weiss, 2012). Prior to this era of reform, only a handful of Black students were admitted to large, established medical schools in North America (Harley, 2006). ...
... This era culminated in the influential 1910 Flexner Report, which emphasized admission and curricular standards (including laboratory-based and hospitalbased training), and the closure of any school that could not meet these expectations (Harley, 2006;Miller & Weiss, 2012). Prior to this era of reform, only a handful of Black students were admitted to large, established medical schools in North America (Harley, 2006). Prospective Black medical students therefore had limited options, including a small number of medical schools dedicated to Black individuals and small proprietary schools that were limited in terms of faculty, infrastructure, and financial resources (Miller & Weiss, 2012;Savitt, 2006). ...
... Prospective Black medical students therefore had limited options, including a small number of medical schools dedicated to Black individuals and small proprietary schools that were limited in terms of faculty, infrastructure, and financial resources (Miller & Weiss, 2012;Savitt, 2006). These institutions were poorly equipped to meet the new standards for medical training and most ultimately had to close, with only two (out of seven) Black medical schools surviving, further constricting already scarce education opportunities for prospective Black doctors (Harley, 2006;Savitt, 2006). Flexner also articulated a narrow, limited role for the Black physician in society (Sullivan & Suez, 2010). ...
Article
Full-text available
In 2021, the American Association for Anatomy (AAA) Board of Directors appointed a Task Force on Structural Racism to understand how the laws, rules, and practices in which the Association formed, developed and continues to exist affect membership and participation. This commentary is the first public report from the Task Force. We focus on African Americans with some comments on Jews and women, noting that all marginalized groups deserve study. Through much of its 130 year history, some members were an essential part of perpetuating racist ideas, the Association largely ignored racism and had some practices that prevented participation. The Task Force concluded that individual and structural racism within the AAA, combined with the broader social context in which the Association developed, contributed to the current underrepresentation of African Americans who constitute 4.1% of the membership even though 13.4% of the U.S. population is Black. Intentional efforts within the AAA to reckon with racism and other forms of bias have only begun in the last 10–20 years. These actions have led to more diverse leadership within the Association, and it is hoped that these changes will positively affect the recruitment and retention of marginalized people to science in general and anatomy in particular. The Task Force recommends that the AAA Board issue a statement of responsibility to acknowledge its history. Furthermore, the Task Force advocates that the Board commit to (a) sustaining ongoing projects to improve diversity, equity, and inclusion and (b) dedicating additional resources to facilitate novel initiatives.
... In addition to segregation and lack of access to quality education, the Flexner report led to the closure of historically Black medical schools which has continued impact today. 12 As such, a passive approach toward righting this problem will not solve it. Just as policies have created the current inequities that we see today, it is imperative that support for new programs to correct the issue be generated. ...
... Standards set by the Flexner Report (1910) resulted in the closing of many medical training institutions for Black people. 45 In the latter part of the nineteenth century and early twentieth century, Black physicians helped to establish institutions where Black patients could obtain medical care and Black people could be trained to become physicians. The values expressed in the report were not only in line with the "separate but equal" 1896 decision of the Supreme Court (Plessy v. Ferguson) that legitimated segregation but also supported an elitist white superiority agenda consistent with mainstream values of the day, especially in the south. ...
Article
In order to create a more just and equitable medical culture for racial and ethnic minorities, all stakeholders in the medical system must acknowledge and learn lessons from past and ongoing mistakes toward minorities. The Federation of State Medical Boards (FSMB), in its leadership position, can influence state medical boards to recognize systemic racism and take steps to combat racism and promote racial diversity. This article reviews current and historical examples of medical racism toward Black or African Americans that are largely invisible to the white community; offers ethical guidelines to ensure fairness; provides guidelines for medical boards to reduce implicit bias in disciplinary proceedings; and suggests educational approaches to increase understanding and empathy for the experience of Black physicians and Black patients in the medical system. Eight fundamental questions, outlined in this article, provide a road map for the FSMB and medical boards to increase racial diversity and reduce inequity
... 7 Unfortunately, a disproportionate casualty of the closures were the predominantly Black medical schools, with only two surviving after the Flexner report (Howard University College of Medicine and Meharry Medical College). 26,27 And although Flexner did recommend the coeducation of women and men, he accepted segregation in medical schools and noted that Black physicians should be trained differently. 28 Over the next few years until around WWI, the model of the "modern American medical school" was born with the combination of securing a solid financial base with an outpouring of philanthropy, 25 the maturation of academic medicine, a drive for research, and the establishment of teaching hospitals. ...
Article
Full-text available
In just over 100 years, surgical education in the United States has evolved from a disorganized practice to a refined system esteemed worldwide as one of the premier models for the training of physicians and surgeons. But in the changing environment of health care, new challenges have arisen that could warrant a reform. To design our future, we must understand our past. The present work is not intended to be a comprehensive account of the history of American surgery. Instead, it tells the abridged history of surgical education in our country: the evolution from apprenticeships to residencies; the birth of hospital-based teaching; the impact of key historical events on training; the marks left by some preeminent characters; the conception of regulatory entities that steer our education; and, finally, how our process of training surgeons might need to be refined for the continued progress of our profession. Told in chronological order in a manner that will be memorable to readers, this story weaves together the key events that explain how our current surgical training models came to be. We conclude with a timely invitation to draw from these past lessons to redesign the future of graduate medical education, making a case for the transition to time-variable, competency-based medical education for surgical residency programs in America.
... Structural (or systemic) racism refers not to the impact of individual biases, but instead to the overt and insidious ways that racism has been woven into the policies, management, and practices of American institutions. For example, medical apartheid, a term coined by Harriet Washington, established a hierarchical system by which people of color, and especially Black and Indigenous people of color (BIPOC) were denied health care, experimented upon, and excluded from medical education (11). Several leading health care organizations including the American Heart Association (AHA) have acknowledged that people of color face social conditions that perpetuate inequities in quality of care, health care outcomes, and representation in the health professions and in medical science (12,13). ...
Article
This review summarizes racial and ethnic disparities in the quality of cardiovascular care—a challenge given the fragmented nature of the health care delivery system and measurement. Health equity for all racial and ethnic groups will not be achieved without a substantially different approach to quality measurement and improvement. The authors adapt a tool frequently used in quality improvement work—the driver diagram—to chart likely areas for diagnosing root causes of disparities and developing and testing interventions. This approach prioritizes equity in quality improvement. The authors demonstrate how this approach can be used to create interventions that reduce systemic racism within the institutions and professions that deliver health care; attends more aggressively to social factors related to race and ethnicity that affect health outcomes; and examines how hospitals, health systems, and insurers can generate effective partnerships with the communities they serve to achieve equitable cardiovascular outcomes.
... This fusion of culturally adapted group reminiscence therapy with community activism for racial justice is an example of a clinical solution to racism in es and Disorders. Our group reminiscence therapy helped to overcome the erasure of The Ville's history of black excellence in medicine and other domains through facilitation of participants' civic and social by Allahar (2005, p.125) as "the act of neglecting, looking past, minimizing, ignoring or rendering invisible an other", applies to the systematic dismissal of African American history beyond a restricted set of key moments (Bumpus, 2020;Harley, 2006;Johnson, 2017). "Erasure" captures our group participants' oft-expressed dismay at the prospect of future generations' ignorance of their neighborhood as a vibrant incubator of black talent and achievement, of their venerated community, we incorporated culturally relevant events such as the release of "The Color of Medicine: The Story of Homer G. Phillips Hospital" into our clinical activities, and we connected our group with local community advocates such as 4TheVille. ...
Article
Full-text available
In this clinical report, we describe our adaptation of group reminiscence therapy to suit the specific cultural characteristics of a group of low-income community-dwelling African American elders in St. Louis who were at risk for dementia. Our setting for addressing the accumulation of a lifetime of racial health disparities experienced by our participants was the historic all-black Homer G. Phillips Hospital in North St. Louis, a legendary symbol of their community’s response to racial health disparities. We connected its history to the current socio-political climate in St. Louis, to empower our participants to assume control of their brain health as they age while facilitating their involvement in their community’s racial justice endeavors. Two highlights of our interventions were a screening of the award-winning documentary film “The Color of Medicine: The Story of Homer G. Phillips Hospital”, and a visit by the non-profit organization 4TheVille to involve our participants in a fundraising art project for restoration of neighborhood landmarks cherished by the local African American community. This fusion of culturally adapted group reminiscence therapy with community activism for racial justice is an example of a clinical solution to racism in geriatric care in the field of Communication Sciences and Disorders.
Chapter
A diverse health professions workforce is critical to healthcare access and quality, but nurturing interest and recruiting students from underrepresented backgrounds into health science careers remain a challenge. Pipeline programs commonly target students who are underrepresented in health professions, including those from racially and ethnically minoritized groups as well as those from rural areas, low socioeconomic backgrounds, first-generation college students, and other marginalized subgroups. The work of a variety of institutions in developing pipeline programs provides many successful models for enhancing diversity in health professions programs. This chapter describes the roles institutions and pre-health advisors can play in connecting underrepresented pre-health students with well-designed pipeline programs.
Article
The historically African American medical schools have been at the center of medical education for African American physicians in the United States since the Howard University College of Medicine opened in 1868. Although there were more than a dozen African American medical schools established during the next few decades, as propriety or church affiliated schools, only two survived the Flexner Report in 1910. Howard University (1868) and Meharry (1876) survived and trained generations of African Americans. These two schools educated approximately 85% of all African American physicians whereas the majority medical schools educated 15% for more than half of the twentieth century. As the result of a series of lawsuits filed by the National Association for the Advancement of Colored People, civil rights legislation and affirmative action programs, the numbers of the schools that now admitted African Americans increased and the total numbers of African American medical students increased when discrimination was prohibited in 1966. The percentage of African American medical students attending predominantly white institutions increased by 25% in 1948, by 47% in 1968, by 61% in 1983 and to 84% in 1990. Two additional predominantly African American medical schools were established: the Charles R. Drew Medical School, Los Angeles (affiliated with the University of California, Los Angeles) in 1966, and Morehouse Medical School, Atlanta, which admitted its first class in 1978. Recent court decisions prohibiting schools from considering race as factor in admission and the end of affirmative action programs have resulted in a drop in total minority enrollment. The historically African American medical schools, that admitted approximately 15% of the African American medical students during the era of affirmative action programs, will see this percentage decrease as the majority institutions admit fewer African American medical students and minority students. In the United States this trend already has been observed in admission data and graduation data for 1996 and 1997.
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The 150th anniversary of the University of Michigan Medical School affords occasion for both celebration and reflection, not just in Ann Arbor but throughout the world, as we consider its contributions to medical education, research, and health care over the past century and a half. This article explores the medical school's origins as a frontier medical outpost and describes the vital reforms in medical education implemented in Ann Arbor long before the landmark Flexner Report on Medical Education of 1910. It also depicts how and why the medical school developed as it did and what features are distinctive or typical about the school during this period.
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Apres la guerre civile, peu d'universites du nord des Etats-Unis acceptaient les noirs americains. L'A. decrit quatre facultes de medecine du sud, creees soit par des medecins noirs-americains, soit par des institutions missionnaires et compare leurs enseignements
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Knoxville College Medical Department (KCMD) was, to all appearances, a missionary medical school established in 1895 by a small black Presbyterian college in the Tennessee mountains to train African-American physicians. In reality, it functioned as a proprietary medical school organized and operated by a group of local white physicians who were more interested in making money than in furthering the school's mission of educating black Christian physicians. KCMD limped along until 1900 when the college's new president reported to the trustees about the white faculty's greed, irreligious behavior, poor teaching, and bad medical reputation, and about how the presence of the medical school on campus undermined the college's overall mission. KCMD graduated two students before closing its doors in 1900. A group of faculty then reopened the school off-campus as the Knoxville Medical College. That school closed in 1910.