Episode notes

Today, becoming a doctor means years of formal education, licensing examinations, clinical rotations, and residency training. In colonial America, the process could be considerably simpler: find a physician willing to take you as an apprentice, read his books, accompany him on patient visits, and eventually receive his blessing to practice medicine yourself.

There was no standardized curriculum, no uniform examination, and little guarantee that one physician’s training looked anything like another’s.

Over the nineteenth century, that system began to change. Medical schools proliferated, apprenticeship gradually declined, ambitious Americans traveled to Paris and Germany for better training, laboratory science transformed the understanding of disease, and universities began building a new kind of medical education around science, research, hospitals, and direct experience with patients.

In this episode of Beyond Ether Dome, we examine the origins of American medical education and how the United States began the long transformation from apprenticeship to the modern medical school.

We discuss:

• How physicians were trained through apprenticeship in colonial and early America
• What a good apprenticeship might provide, and how spectacularly bad an unregulated one could be
• The first American medical schools and why they initially supplemented rather than replaced apprenticeship
• The rise of proprietary, physician-owned medical schools in the nineteenth century
• Why for-profit medical education expanded so rapidly
• The remarkably limited requirements for earning an early American medical degree
• How financial incentives could conflict with educational standards
• Why ambitious American physicians traveled to Paris for medical training
• The Paris school’s emphasis on bedside observation, physical examination, autopsy, and pathological anatomy
• Pierre Charles Alexandre Louis and the “numerical method” for evaluating treatments such as bloodletting
• Why Germany replaced Paris as the leading destination for American physicians after the Civil War
• The German model of university-based medicine, laboratory science, research, and teaching hospitals
• How scientific discoveries in physiology, pathology, microscopy, and bacteriology changed what physicians needed to know
• William Osler, William Stewart Halsted, and the European influences that helped reshape American medical training
• The rise of the American research university after the Civil War
• Early reforms at Harvard, Michigan, and Pennsylvania
• The opening of Johns Hopkins School of Medicine in 1893 and the emergence of a recognizably modern medical curriculum
• Clinical clerkships, residency training, research, and the growing importance of the teaching hospital
• Mary Garrett and the admission of women to Johns Hopkins
• Why American medical education entered the twentieth century with radically different kinds of schools granting essentially the same medical degree

By 1900, the United States had developed many of the essential ingredients of modern medical education. The problem was that they were anything but universal.

Elite university medical schools were embracing laboratory science, research, rigorous admissions, clinical clerkships, and teaching hospitals. At the same time, weaker proprietary schools continued operating under educational standards that could differ enormously from one institution to another.

Part 1 ends with American medicine confronting that contradiction. Part 2 asks how reformers tried to solve it, and what America gained and lost when they did.