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The great German universities with their strong research departments were being copied in this country, thus bringing about the modern university. This raised the question inevitably that medicine here as in Germany should be part of a university with clear expectations for research and scholarship. The model was being evolved at Harvard, Pennsylvania, and Michigan, finally reaching its culmination with the establishment of the Johns Hopkins Medical School in 1893, where college graduates were taught by full-time research faculty. In addition, the advent of progressive education by John Dewey enforced the Hopkins model that students should learn by doing. Sir William Osler's ideal curriculum was what he called self-education under guidance, with the guide (professor) just further along in the process of learning. This, of course, sounds very much like problem-based learning, with which we are now finishing this century.

The story of medical education in the 20th century is a rich one involving dedicated and innovative teachers, some famous, some now forgotten, and above all the perseverance of bright, dedicated students who at times have displayed a profound capacity to learn medicine despite the teachers and the curriculum, for there were times when the former were not very attentive and the latter was uncoordinated drudgery. Just as the development of medical education in the 19th century was shaped and molded by other forces in society, so also in the 20th century, progress, lack of progress, and reform often were strongly influenced by what was going on around us.

While the modern medical school was taking shape at the beginning of the 20th century, proprietary schools still existed in large numbers. These were schools with very short terms of instruction in which almost anyone could enroll, and in which the faculty of practicing physicians anticipated making a profit from tuition. The early decades of the 20th century were times of reform, and the reformers were working also in medicine. The American Medical Association (AMA) from its origins in the 19th century had been very much concerned about the quality of education for doctors, and in 1906 established the Council on Medical Education (COME), which for many years was dominated by six professors from "modern" medical schools. The Association of American Medical Colleges (AAMC), was established when sixty-six schools banded together in 1890, began inspection of medical schools in 1903. Both the AAMC and the COME pushed the primacy of research in medical schools as well as the dogma that full-time faculty were the best teachers. This, of course, is not necessarily true, but you have to remember that they were out fighting the Philistines of the proprietary schools. . .

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