Lessons From Flexner: The Struggle of Small Radiology Residency Programs in the United States

Abstract

In the early 20th century, Abraham Flexner visited and evaluated all medical schools in the United States and Canada, an ambitious campaign aimed at raising medical school standards and eliminating the then popular model of for-profit proprietary medical education in the United States [1]. Although the level of evidence-based inquiry in American medical schools greatly improved as a result of Flexner's efforts, his findings also produced collateral changes in the culture of medicine that many scholars view as regrettable. Some claim that the very ethos of medicine was lost in Flexner's spirited quest for scientific inquiry, leaving us to this day underdeveloped in many vital areas of professionalism and patient engagement [1]. Indeed, even Flexner himself later lamented that because of his reform efforts, the practice of medicine was being so consumed by the scientific approach that it neglected the more human aspects of patient care, such as trust, compassion, and empathy [2-5].

Point: Losing the Zero-Sum Game: It’s Time to Eliminate Required Research in Radiology Residency

“…To complicate matters, the research missions and resources of programs are highly variable, and as such, the ability to stimulate scientific interest and foster investigative thought in trainees may be limited in programs in which the culture itself emphasizes clinical productivity over inquiry. Among the myriad struggles inherent to smaller programs [7] is a relative lack of scientific pedigree, hospital research coordinators, and statistical support staff members enjoyed by programs sponsored by research-intensive universities. Just as referencing a personal interest in research may serve to please the admissions committee of an academically focused radiology program [6], participating in research at many programs may be viewed simply as a mechanism to satisfy an ACGME requirement [3] or to earn a reimbursed trip to a conference [8].…”