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Iconoclast: Abraham Flexner and a Life in Learning Hardcover – November 1, 2002
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From The New England Journal of Medicine
Iconoclast is a thoughtful, wonderfully crafted, solidly researched account of an uncommon life that far exceeds Abraham Flexner's association with reform in medical education. Born in Louisville, Kentucky, in 1866, Flexner (Figure) was one of nine children of German-Jewish immigrants who expected extraordinary achievement from each of their children. By 19 years of age, he was a graduate of Johns Hopkins and passionate about learning; he was a firm believer that education should be marked by small classes, personal attention, and hands-on teaching -- characteristics that he would reproduce throughout his lifetime in many settings. After graduation, he returned to Louisville and developed a school that came to be known as "Mr. Flexner's School." There, he tested his ideas and found that they worked: his graduates were accepted at leading colleges and entered college at very young ages. He soon gained national attention, and in 1908, he published his first book, The American College, an "unrelievedly critical attack on American higher education," as Bonner describes it. One of his fiercest critiques focused on the lecture mode, which enabled colleges to "handle cheaply by wholesale a large body of students that would be otherwise unmanageable and [to give] the lecturer time for research." Flexner's writing attracted the attention of Henry Pritchett, president of the Carnegie Foundation, who was looking for someone to lead a series of studies of professional education. Flexner was his first choice, despite the fact that he had never been inside a medical school. At that time, there were 155 medical schools in North America with wildly diverse admissions, curricular, evaluative, and graduation requirements. Flexner visited all of them; in one month alone, he inspected 30 schools in 12 cities. Some of his descriptions still ring true: "Each day students were subjected to interminable lectures and recitations. After a long morning of dissection or a series of quiz sections, they might sit wearily in the afternoon through three or four or even five lectures delivered in methodical fashion by part-time teachers. Evenings were given over to reading and preparation for recitations. If fortunate enough to gain entrance to a hospital, they observed more than participated." Although the 1910 report became famous for its stinging description of particular medical schools -- he referred to Chicago and its 14 medical schools, for example, as "a disgrace to the State whose laws permit its existence . . . indescribably foul . . . the plague spot of the nation" -- it was largely successful in creating a single model of medical education characterized by a philosophy that is still current. "An education in medicine," wrote Flexner, "involves both learning and learning how; the student cannot effectively know, unless he knows how." Although the report is more than 90 years old, many of its recommendations are still relevant -- particularly those concerning the physician as a "social instrument . . . whose function is fast becoming social and preventive, rather than individual and curative." A less well-known recommendation, but one that Flexner promoted unrelentingly, was for the creation of full-time clinical appointments in medical schools. Under this system, faculty members would become "true university teachers, barred from all but charity practice, in the interest of teaching." This was a campaign that Flexner pursued for years, despite opposition from "virtually all clinicians across the country." The remainder of Flexner's professional life was no less accomplished. Soon after the release of the 1910 Carnegie report, he set off to Europe to conduct a similar study of medical education there, and by the time of its publication, his work was, according to Bonner, "nearly as well known in Europe as in America." Working for the Rockefeller Foundation's General Education Board, he developed the Lincoln School in 1916 in cooperation with the faculty at Teachers College of Columbia University. Next, with funding from the Rockefeller Foundation, he worked toward restructuring the nation's medical schools, which enabled him, writes Bonner, "to exert a decisive influence on the course of medical training and to leave an enduring mark on some of the nation's most renowned schools of medicine," including Johns Hopkins, Yale, the University of Chicago, Columbia, Vanderbilt, and Washington University. In this second round of critique, he was concerned that "the imposition of rigid standards by accrediting groups was making the medical curriculum a monstrosity," with medical students moving through it with "little time to stop, read, work or think." In the mid-1920s, Flexner left medical education and renewed his interest in the "direction and purpose of the American college and university," which resulted in Universities: American, English, German, published in 1930. The book, which, says Bonner, "provoked the most intense debate on the purposes of a university since the late 19th century," railed against the "growth of big-time athletics, student governments, and other activities that made a mockery of serious learning." "Intellectual inquiry," Flexner argued again and again, "not job training, [is] the purpose of the university." One of his final projects was the establishment of the Institute for Advanced Studies at Princeton, which would be a "graduate university in the highest possible sense" and would "elevate the status of faculty members in America." Bonner's labors have produced a critical, insightful portrait of Abraham Flexner as a brilliant, tireless, extraordinarily persuasive visionary. In addition to detailed portraits of the man "at the vortex of swiftly moving scientific, educational, and philanthropic currents" in higher education in the United States, Bonner also provides an account of Flexner's personal life with his remarkable family of origin and the family he and his wife Anne created even as they both pursued demanding careers that were often challenging to family life. For all of us in academic medicine, Iconoclast offers a learned portrait of the distance traveled in medical education during the past 100 years, along with consideration of the curricular and pedagogical problems that persist. Flexner was, and perhaps continues to be, "the severest critic and the best friend American medicine ever had." Delese Wear, Ph.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Iconoclast is a thoughtful, wonderfully crafted, solidly researched account of an uncommon life that far exceeds Abraham Flexner's association with reform in medical education... Bonner's labors have produced a critical, insightful portrait of Flexner as a brilliant, tireless, extraordinarily persuasive visionary. In addition to detailed portraits of the man 'at the vortex of swiftly moving scientific, educational, and philanthropic currents' in higher education in the United States, Bonner also provides an account of Flexner's personal life... For all of us in academic medicine, Iconoclast offers a learned portrait of the distance traveled in medical education during the past 100 years, along with consideration of the curricular and pedagogical problems that persist.(Delese Wear New England Journal of Medicine)
Bonner's great achievement in this scholarly and captivating book is to model Flexner's critical appraisal skills in writing about him. Even Flexner himself lacked critical awareness in his autobiography... Bonner, on the other hand, offers a gentle and thoughtful appraisal. The elements that contribute to Flexner's greatness―perseverance, vision, clear thinking, and fair mindedness―are all balanced with his weaknesses―an obstinate unwillingness to retract and clouded political insight... Bonner dissects Flexner's contribution with meticulous scholarship, avoiding all cheap adulation or debunking. This is an outstanding book.(Ed Peile British Medical Journal)
The book offers historical insights about philanthropy, educational reform, and institutional governance and decision making... In Bonner's capable hands, Flexner emerges an interesting figure whose successes are combined with contradictions and shortcomings.(Amy E. Wells Academe)
An outstanding and thorough study of this remarkable American educator who, more than anyone before or since, defined what a medical school should be, left indelible marks on public education, and founded one of the most innovative centers of advanced study in the world. Bonner adroitly portrays in this masterful biography what America and the world owes to Flexner for his vision, creativity, tenacity, and advocacy of progressive education.(John S. Haller, Jr. Journal of American History)
Few nonphysicians have had as profound and long-lasting an effect on modern American medicine as Abraham Flexner... An excellent book about a highly significant and neglected figure.(Janet A. Tighe, Ph.D. Journal of the American Medical Association)
Not only fills a major void but also provides an important evaluation of an individual whose contributions to education and a variety of social problems have generally been overlooked... Bonner's biography restores Flexner to the position of importance that he merits... This biography is a major addition to American historiography.(Gerald N. Grob Journal of the History of Medicine)
Excellent... Deeply researched, carefully presented... This thorough, creative biography adjusts our view of this powerful man so engaged in an astounding array of twentieth-century educational developments.(Linda Eisenmann H-Education, H-Net Reviews)
Thanks to Thomas Bonner's Iconoclast, we finally have the biography Flexner deserves and readers seek.(John R. Thelin Journal of Higher Education)
If you want to know why more than half of the Nobel Prizes in medicine and science since 1945 have gone to Americans, you must read Thomas Bonner's book. Abraham Flexner was the architect of a revolution in medical education in the United States that explains how this country became the medical mecca of the world. Bonner brings Flexner's remarkable story to life with clarity, sympathy, and verve.(James H. Jones, author of Bad Blood and Alfred C. Kinsey: A Public/Private Life)
At last we have a life of one of the most powerful shapers of medicine, science, and higher education. This beautifully crafted life of Flexner will rescue a giant of his times from fragmentation and, sometimes, misunderstanding. Bonner has written not only a very important book but a deeply thoughtful and searching interrogation of recurrent social and moral problems that take on life and meaning in a concrete, historical setting.(John C. Burnham, Ohio State University)
Abraham Flexner was one of the great innovators in education of the twentieth-century. Thomas N. Bonner, a distinguished historian as well as an educator/manager, is the biographer Flexner deserves.(Daniel M. Fox, President, Milbank Memorial Fund)
This biography is a solid, well-researched study of a towering figure in American biomedical research.(Darwin Stapleton, Rockefeller Archive Center)
This is a brilliant, beautifully crafted, and much needed biography of one of the legendary figures in American medicine and higher education. Once again Thomas Bonner has shown that he is one of the great medical historians of our time.(Kenneth M. Ludmerer, Washington University)
Though [Abraham] Flexner wrote an autobiography, until now we have had no comprehensive biography. Fortunately, Thomas Bonner has filled that gap with Iconoclast: Abraham Flexner and a Life in Learning. As a former university president with significant experience working with donors, Bonner is well qualified to understand his subject.(Martin Morse Wooster Philanthropy)
As Thomas Bonner relates in his excellent biography, [Abraham] Flexner initiated several... significant developments in American secondary and higher education over some three-quarters of a century.(David Mitch History of Education Quarterly)
Iconoclast captures the boldness as well as the sweeping impact of Flexner's work in the field of American education in the first half of the twentieth century.(Adam R. Nelson Paedagogica Historica)
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