The professionalization of academic medicine occurred in the clinical as well as the basic science curriculum. Full-time clinical faculty members replaced part-time faculty members in the wealthier schools. Medical specialties, many of which were rare outside the medical school, dominated the clinical courses. Clinical teaching, which was improved by more student contact with patients, occurred primarily in hospitals, whose patients were atypical of those seen in community practice. The growing importance of hospitals in medical education led to the construction of university hospitals. Early in the century, some leading basic medical scientists called for full-time faculty members in the clinical fields. They noted that full-time faculty members in the basic sciences had produced great scientific discoveries in Europe and had improved American basic science departments. In 1907, William Welch proposed that “the heads of the principal clinical departments, particularly the medical and the surgical, should devote their main energies and time to their hospital work and to teaching and investigating without the necessity of seeking their livelihood in a busy outside practice” Few clinicians endorsed this proposal. They found the costs prohibitive and disliked the German system of medical research and education on which it was based. Medical research in Germany was carried on, not in medical schools, but in government research institutes headed by medical school professors and staffed by researchers without faculty appointments. All of the researchers were basic medical scientists who were interested in basic research, not practical problems like bacteriology. Although the institutes monopolized the available laboratory and hospital facilities, they were not affiliated with medical schools, had no educational programs, and did not formally train students, although much informal training occurred. For these reasons, their research findings were seldom integrated into the medical school curriculum, and German medical students were not trained to do research. German medical schools had three faculty ranks. Each discipline was headed by one professor, who was a salaried employee of the state and also earned substantial amounts from student fees. Most professors had no institute appointments and did little or no research.
What can we learn from each other about undergraduate medical education in general practice/family medicine?
