Osler, Flexner, apprenticeship and 'the new medical education'.

These are bewildering times for doctors who teach medical students. The UK General Medical Council (GMC) has reminded them they have a duty to teach,1 yet stirred up such radical change that their task is unrecognizably different from what they themselves experienced as students.2,3 This essay draws on biographies of two people who changed the face of medical education in the 20th century to trace the origins of this bewilderment and suggest a direction for the 21st century.4,5 Most of today's doctors just associate the name of William Osler with nodes they were taught about but never see. In Michael Bliss's biography, he comes to life as a master clinician, apprentice-master, and humanist role model. I first became aware of Abraham Flexner as the author of a century-old report that got medical education into the mess it is in today. Wrong. He was a visionary educationalist who raised standards of medicine round the world by wedding it with biomedical science. After vignettes of these two men, I describe what the GMC has recommended and read between the lines of its recommendations. To finish, I suggest the wheel has come full circle. Apprenticeship, central to Osler and Flexner's educational visions, needs to be revitalized.

[1]  S. Ramani,et al.  Whither Bedside Teaching? A Focus‐group Study of Clinical Teachers , 2003, Academic medicine : journal of the Association of American Medical Colleges.

[2]  E. Wenger Communities of Practice: Learning, Meaning, and Identity , 1998 .

[3]  W. Levinson,et al.  Mission critical--integrating clinician-educators into academic medical centers. , 1999, The New England journal of medicine.

[4]  O. Harlem,et al.  TOMORROW'S DOCTORS , 1972 .

[5]  K. Skeff,et al.  Role models--guiding the future of medicine. , 1998, The New England journal of medicine.

[6]  K. Ludmerer Instilling professionalism in medical education. , 1999, JAMA.

[7]  L. Baillie Factors affecting student nurses' learning in community placements: a phenomenological study. , 1993, Journal of advanced nursing.

[8]  Janet Grant,et al.  The effectiveness of continuing professional development , 2001 .

[9]  M. Elzubeir,et al.  Identifying characteristics that students, interns and residents look for in their role models. , 2001 .

[10]  Tim Dornan,et al.  A technology using feedback to manage experience based learning , 2004, Medical teacher.

[11]  J C Wyatt,et al.  10. Management of explicit and tacit knowledge , 2001, Journal of the Royal Society of Medicine.

[12]  S. Hider,et al.  Evaluation of self‐directed clinical education: validation of an instrument , 2004, Medical education.

[13]  T. Dornan,et al.  Child Health and Obstetrics‐Gynaecology in a problem‐based learning curriculum: accepting the limits of integration and the need for differentiation , 2002, Medical education.

[14]  London,et al.  General Medical Council , 1920 .

[15]  Henry S. Pritchett,et al.  THE CARNEGIE FOUNDATION FOR THE ADVANCEMENT OF TEACHING. , 1912, Science.

[16]  M. Hannafin,et al.  Situated cognition and learning environments: Roles, structures, and implications for design , 1995 .

[17]  T. Dornan,et al.  What can experience add to early medical education? Consensus survey , 2004, BMJ : British Medical Journal.

[18]  H. Schmidt Foundations of problem‐based learning: some explanatory notes , 1993, Medical education.

[19]  Cees P M van der Vleuten,et al.  Does problem‐based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy , 2003, Medical education.

[20]  Stephen Brookfield,et al.  Self-directed learning : from theory to practice , 1985 .

[21]  Etienne Wenger,et al.  Communities of Practice: Learning, Meaning, and Identity , 1998 .

[22]  Wim H. Gijselaers,et al.  Connecting problem‐based practices with educational theory , 1996 .

[23]  David E. Kern,et al.  Attributes of Excellent Attending-Physician Role Models , 1998 .

[24]  G R Norman,et al.  The adult learner: a mythical species. , 1999, Academic medicine : journal of the Association of American Medical Colleges.

[25]  D. M. Elnicki,et al.  Third‐Year Medical Students' Perceptions of Effective Teaching Behaviors in a Multidisciplinary Ambulatory Clerkship , 2003, Academic medicine : journal of the Association of American Medical Colleges.

[26]  Abraham Flexner,et al.  MEDICAL EDUCATION IN THE UNITED STATES AND CANADA. , 1910, Science.

[27]  W. Larrabee A life in medicine. , 2005, Archives of otolaryngology--head & neck surgery.

[28]  John Patrick,et al.  Training: Research and practice. , 1992 .