After Flexner

We have seen how Abraham Flexner structured his view of medical education's future predicated principally on  the idea that doctors possessed of a fair grounding in assorted scientific disciplines would on clinical occasions be best able to derive and deliver a useful response for the patient. That was an implementation of the principle of rationale, the notion that, having considered what we know, we believe that this is likely to be a useful response.  While it is an integral part of current medical practice it is incomplete.  The second stage that was addressed in the years following the  Flexner report is the quantitative measurement of our past activities. We need to  know or have a record of what clinical decisions were made and recorded and what their outcomes were. Thee task was then to construct the methodologies and implement them to review past performance to discover successes and failures and to use that as an additional dimension of future practice. The idea that we should rely only on the individual experience of the clinician was to be supplemented by the accumulated communal experience of past activity. This activity was known as clinical epidemiology and was growing as we added the third element.