In 1910 Abraham Flexner, who was not a doctor, published his massive report on the education of doctors for the Carnegie Foundation in response to a growing concern at poor quality doctors being produced. This triggered major change and perhaps intuitively recognised the core routes for doctors to produce useful advice for patients. These are three in number and presented in order of increasing efficacy (and, at the time, decreasing accessibility)
Rationale "What should be worthwhile"
Experience "What has seemed to be worthwhile in previous similar situations"
Evidence "What has on average been shown to be worthwhile in controlled studies of similar situations "
In 1910 a programme of education could only be securely based on the first of these. There was no structure to gather and analyse and disseminate clinical experience and no established methods of clinical science to mount prospective inquiry.
There was however a burgeoning biody of bioscientific findings such that suitably armed a doctor could construct a logical argument to support specific conclusions in a given clinical situation. Such conclusions had no guarantee of being correct but we're likely better than what had gone before.
Flexners report was widely adopted and this model of clinical practiced dominated unchallenged until 1985.
