In recent months a great deal of attention has been focused on diversity in the medical school profession and the idea of what a doctor looks like in the public consciousness. This motivated me to share my reflections on the video “I am a Doctor” produced by the American Medical Association in the 1950s. In this first piece, I will provide some of the background contexts of the work before examining its contents in later posts.
On March 4th, 1956, Dr. Loyd Judd Jr. of Prague Oklahoma died of leukemia. Between April 1955 when he diagnosed himself and his passing Dr. Judd poured his soul into a number of audio recordings allowing his passion and frustration with regard to his profession to live on and inspire the next generation of American medicos. These recordings were eventually used by the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC) to produce “I am a Doctor” a two-part series of videos calling upon the next generation to don the physician’s white coat. These videos offer valuable insight into mid-century American society, the lives of physicians, and the state of American medicine at the time they were produced.
The central mission of the American Medical Association since its founding in 1846 has been to define and safeguard what it holds to be the “correct” way to practice medicine in the USA. Among the most enduring and key aspects of this effort has been exerting control over American medical education. The dawning of the 20th century ended the long-held ambivalence of America’s citizenry and regulatory bodies regarding the varied approaches to medical practice and training that pervaded 19th century America. Clinical and laboratory research exposed the irrationality of “heroic” treatments (such as blistering, bleeding, and purging) and proved the therapeutic efficacy and rational scientific basis of modern practices, such as antiseptic surgery, vaccination, and public sanitation. At the same time educators at leading US medical schools determined that the path toward mastering the analytical skills required to practice scientific medicine lay with the systematic application of the scientific method throughout medical training. The AMA took the lead in eliminating medical schools that failed to adopt this new paradigm of systematized and scientific medical education.
In 1904, AMA created the Council on Medical Education (CME) to promote the restructuring of US medical education. At the heart of the CME’s agenda were 2 major reform initiatives: standardization of preliminary education requirements for entry into medical school and national implementation of an “ideal” medical curriculum, consisting of 2 years of training in laboratory sciences followed by 2 years of clinical rotations in a teaching hospital. This is still the structure of medical education today. Still more significantly, in 1908, the CME in collaboration with the Carnegie Foundation for the Advancement of Teaching appointed Abraham Flexner to evaluate the state of American medical education. Over the course of 18 months, Flexner visited all 155 US medical schools examining 5 principal areas at each school: entrance requirements, size and training of the faculty, size of endowment and tuition, quality of laboratories, and availability of a teaching hospital whose physicians and surgeons would serve as clinical teachers. In the wake of the now-famous Flexner Report, state licensing boards began to force medical schools across the United States to implement heightened admission standards and stricter curriculum requirements. These licensing bodies based their accreditation policies on academic standards determined by the AMA’s CME. Consequently, the AMA’s decisions “came to have the force of law.”