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135-630: Many aspects of the present-day American medical profession stem from the Flexner Report and its aftermath. While it had many positive impacts on American medical education, the Flexner report has been criticized for introducing policies that encouraged systemic racism and sexism . The Report , also called Carnegie Foundation Bulletin Number Four, called on American medical schools to enact higher admission and graduation standards, and to adhere strictly to

270-628: A "state racism" under the French Third Republic , a notable example being that the 1881 Indigenous Code applied in Algeria. Replying to the question "Isn't it excessive to talk about a state racism under the Third Republic?", he replied: "No, if we can recognize 'state racism' as the vote and implementation of discriminatory measures, grounded on a combination of racial, religious and cultural criteria, in those territories. The 1881 Indigenous Code

405-498: A binding document. The living standard of indigenous peoples in Canada falls far short of those of the non-indigenous, and they, along with other 'visible minorities' remain, as a group, the poorest in Canada. There continue to be barriers to gaining equality with other Canadians of European ancestry. The life expectancy of First Nations people is lower; they have fewer high school graduates, much higher unemployment rates, nearly double

540-471: A century its colonial rule in the territory that has been described as "quasi- apartheid ". The colonial law of 1865 allowed Arab and Berber Algerians to apply for French citizenship only if they abandoned their Muslim identity ; Azzedine Haddour argues that it established "the formal structures of a political apartheid". Camille Bonora-Waisman writes, "In contrast with the Moroccan and Tunisian protectorates",

675-523: A long morning of dissection or a series of quiz sections, they might sit wearily in the afternoon through three or four or even five lectures delivered in methodical fashion by part-time teachers. Evenings were given over to reading and preparation for recitations. If fortunate enough to gain entrance to a hospital, they observed more than participated." The Report became notorious for its harsh description of certain establishments. For example, Flexner described Chicago's fourteen medical schools as "a disgrace to

810-540: A medical career in child health, occupational health, and maternal health. Today, it is speculated that consequences of the Report are implicated as many female physicians specialize in pediatrics, obstetrician and gynecologist. When Flexner researched his report, "modern" medicine faced vigorous competition from several quarters, including osteopathic medicine , chiropractic medicine , electrotherapy , eclectic medicine , naturopathy , and homeopathy . Flexner clearly doubted

945-599: A pass from their farming instructors permitting them to do so. While the Indian Act did not give him such powers, and no other legislation allowed the Department of Indian Affairs to institute such a system, and it was known by crown lawyers to be illegal as early as 1892, the Pass System remained in place and was enforced until the early 1930s. As Natives were not permitted at that time to become lawyers, they could not fight it in

1080-409: A philanthropic group called " General Education Board " (GEB). In the nineteenth century, it was relatively easy to not only receive a medical education, but also to start a medical school. When Flexner researched his report, many American medical schools were small "proprietary" trade schools owned by one or more doctors, unaffiliated with a college or university, and run to make a profit . A degree

1215-426: A police record and were twice as likely to use illicit drugs . The only notable advantage "removed" Aboriginal people possessed was a higher average income, which the report noted was most likely due to the increased urbanisation of removed individuals, and hence greater access to welfare payments than for Aboriginal people living in remote communities. In his 2008 address to the houses of parliament apologising for

1350-554: A population of a million people. By 1901, they had been reduced by two-thirds to 93,000. In 2011, First Nations Australians (including both Aboriginal Australians and Torres Strait Islander people) comprised about 3% of the total population, at 661,000. When Captain Cook landed in Botany Bay in 1770, he was under orders not to plant the British flag and to defer to any native population, which

1485-725: A precursor to the Ohio State University College of Medicine . In 1852, the medical school became the second in the U.S. to graduate a woman, Nancy Talbot Clark . 1854 MD alumna, Emily Blackwell became the third woman in the US to receive a regular medical degree. Six of the first seven women in the United States to receive medical degrees from recognized allopathic medical schools graduated from Western Reserve University between 1850 and 1856, which included Marie Zakrzewska . In 1909, Abraham Flexner surveyed and evaluated each of

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1620-489: A primary role to protect white Americans from disease. Flexner stated in the Report : "A well-taught negro sanitarian will be immensely useful; an essentially untrained negro wearing an M.D. degree is dangerous." Furthermore, along with his adherence to germ theory , Flexner argued that, if not properly trained and treated, African-Americans posed a health threat to middle and upper-class whites. Flexner argued that African American physicians should be educated in order to stop

1755-559: A process of reform and renewal. The vision for medical education described in the Flexner Report narrowed medical schools' interests to disease, moving away from an interest on the system of health care or society's health beyond disease. Preventive medicine and population health were not considered a responsibility of physicians, bifurcating "health" into two separate fields: scientific medicine and public health . The Flexner Report has been criticized for introducing policies that encouraged systemic racism . Flexner advocated for

1890-519: A reform effort in 1947, the French created a bicameral legislature with one house for French citizens and another for Muslims, but it made a European's vote worth seven times a Muslim's vote. It is estimated that the population of Aboriginal peoples prior to the European colonisation of Australia (starting in 1788) was about 314,000. It has also been estimated by ecologists that the land could have supported

2025-464: A report on the status of the mixed race stated "... the physical infrastructure of missions, government institutions and children's homes was often very poor and resources were insufficient to improve them or to keep the children adequately clothed, fed, and sheltered". In reality, during this period, removal of the mixed-race children was related to the fact that most were offspring of domestic servants working on pastoral farms, and their removal allowed

2160-502: A significant decrease in infant mortality, but it was still 2.5 times higher than for the non-indigenous population. Much of the health woes of the First Nations Australians could be traced to the availability of transport. In remote communities, the report cited 71% of the population in those remote Fist Nations communities lacked access to public transport, and 78% of the communities were more than 80 kilometres (50 miles) from

2295-535: A small number of Muslims along with European students in the French school system as part of France's "civilising mission" in Algeria. The curriculum was entirely French and allowed no place for Arabic studies, which were deliberately downgraded even in Muslim schools. Within a generation, a class of well-educated, gallicized Muslims, the évolués (literally "evolved ones"), had been created. Following its conquest of Ottoman Algeria in 1830, France maintained for well over

2430-521: A state-operated madrasa often had French faculty members. Attempts to institute bilingual and bicultural schools, intended to bring Muslim and European children together in the classroom, were a conspicuous failure, and were rejected by both communities and phased out after 1870. According to one estimate, fewer than 5% of Algerian children attended any kind of school in 1870. As late as 1954, only one Muslim boy in five and one girl in sixteen received formal schooling. Efforts were begun by 1890 to educate

2565-643: A staunch advocate of medical school reform, chose Abraham Flexner to conduct the survey. Neither a physician, a scientist, nor a medical educator, Flexner held a Bachelor of Arts degree and operated a for-profit school in Louisville, Kentucky . He visited every one of the 155 North American medical schools that were in operation at the time, all of which differed greatly in their curricula, methods of assessment, and requirements for admission and graduation. Summarizing his findings, he wrote: "Each day students were subjected to interminable lectures and recitations. After

2700-490: A study conducted in Melbourne and cited in the official report found that there was no tangible improvement in the social position of "removed" Aboriginal people as compared to "non-removed", particularly in the areas of employment and post-secondary education . Most notably, the study indicated that removed Aboriginal people were actually less likely to have completed a secondary education, three times as likely to have acquired

2835-476: A time, but eventually most schools for alternative medicine complied with the Report or shut their doors. While almost all the alternative medical schools listed in the Flexner Report were closed, the American Osteopathic Association (AOA) brought a number of osteopathic medical schools into compliance with Flexner's recommendations to produce an evidence-based approach and practice. Today,

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2970-583: A whole society or organization that result in and support a continued unfair advantage to some people and unfair or harmful treatment of others. It manifests as discrimination in areas such as criminal justice , employment, housing, healthcare, education and political representation . The term institutional racism was first coined in 1967 by Stokely Carmichael and Charles V. Hamilton in Black Power: The Politics of Liberation . Carmichael and Hamilton wrote in 1967 that, while individual racism

3105-629: A wide suite of powers over Aboriginal and " half-caste " persons, including the forcible removal of children, especially "at risk" girls. By 1950, similar policies and legislation had been adopted by other states and territories, such as the Aboriginals Protection and Restriction of the Sale of Opium Act 1897 (Qld), the Aborigines Ordinance 1918 (NT), the Aborigines Act 1934 (SA) and

3240-449: Is a monument of this genre! Considered by contemporary prestigious jurists as a 'juridical monstruosity', this code planned special offenses and penalties for 'Arabs'. It was then extended to other territories of the empire. On one hand, a state of rule of law for a minority of French and Europeans located in the colonies. On the other hand, a permanent state of exception for the "indigenous" people. This situation lasted until 1945". During

3375-436: Is a motivation for structural changes . Substantive equality with equality of outcomes for people of different races and ethnicity could be one way of preventing institutional racism. Diversity, equity, and inclusion can be applied to diminish institutional racism. In the past, the term "racism" was often used interchangeably with "prejudice", forming an opinion of another person based on incomplete information. In

3510-454: Is absolutely nothing to prevent us treating Europeans as if they were on their own, as the rules established for them will only ever apply to them". Following the defeats of the resistance in the 1840s, colonisation continued apace. By 1848, Algeria was populated by 109,400 Europeans, only 42,274 of whom were French. The leader of the Colons delegation, Auguste Warnier (1810–1875), succeeded in

3645-468: Is five years, including a dedicated year for research. The Cleveland Clinic established the school in 2002 with a $ 100 million gift from Norma and Al Lerner , and CCLCM accepted its first class of students in 2004. Physician researcher Eric Topol played an important role in securing the donation from the Lerner family. Topol served as Provost and Chief Academic Officer at CCLCM until 2006, when his position

3780-467: Is largely refuted by Thomas N. Bonner , a scholar referred to as a “distinguished historian” by the AAMC . Bonner contended that Flexner worked to save the two black medical schools that were graduating most of the black physicians at that time. The Flexner Report has also been criticized for introducing policies that encouraged sexism. Before the publication of the Flexner Report , in the mid-to-latter part of

3915-1060: Is often identifiable because of its overt nature, institutional racism is less perceptible because of its "less overt, far more subtle" nature. Institutional racism "originates in the operation of established and respected forces in the society, and thus receives far less public condemnation than [individual racism]". Institutional racism was defined by Sir William Macpherson in the UK's Lawrence report (1999) as: "The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin. It can be seen or detected in processes, attitudes and behaviour that amount to discrimination through prejudice, ignorance, thoughtlessness, and racist stereotyping which disadvantage minority ethnic people." Individual or formal equality of opportunity typically disregards systemic or institutional aspects of inequality and racism. Institutional racism could be caused by power imbalance . Combating institutional racism

4050-640: Is the medical school of Case Western Reserve University , a private research university in Cleveland, Ohio . It is the largest biomedical research center in Ohio. CWRU SOM is primarily affiliated with University Hospitals Cleveland Medical Center , Cleveland Clinic , and the MetroHealth System . On November 1, 1843, under President George Edmond Pierce , five faculty members including Jared Potter Kirtland and John Delamater , and sixty-seven students began

4185-589: The 1936 Native Administration Act (WA). The child-removal legislation resulted in widespread removal of children from their parents and exercise of sundry guardianship powers by Protectors of Aborigines up to the age of 16 or 21. Policemen or other agents of the state were given the power to locate and transfer babies and children of mixed descent from their mothers or families or communities into institutions. In these Australian states and territories , half-caste institutions (both government Aboriginal reserves and church-run mission stations ) were established in

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4320-487: The British North America Act made land reserved for Indians a Crown responsibility. In 1876 the first of many Indian Acts passed, each successive one leeched more from the rights of the indigenous as was stated in the first. The sundry revised Indian Acts (22 times by 2002) solidified the position of Natives as wards of the state, and Indian agents were given discretionary power to control almost every aspect of

4455-527: The Liaison Committee on Medical Education . The CWRU School of Medicine School is divided into six societies named after famous CaseMed alums. Upon matriculation, students in the University Program and MSTP are assigned to a society. Each has a Society Dean who serves as an academic and career adviser to the students. The societies are: Every year, the six societies compete in "ISC Picnic" for

4590-442: The Report , Flexner noted that there were few women in medical education. Flexner believed that the small numbers of female medical students and female physicians was not due to a lack of opportunity because, as he saw it, there were ample opportunities for women to be educated in medicine. Thus, he believed that the low numbers were due to a decreased desire and tendency to enter medical school. “Now that women are freely admitted to

4725-523: The Report , there were only 85 MD-granting institutions, educating only 13,800 students. By 1935, there were only 66 medical schools operating in the United States. Between 1910 and 1935, more than half of all American medical schools merged or closed. The dramatic decline was in some part due to the implementation of the Report's recommendation that all "proprietary" schools be closed and that medical schools should henceforth all be connected to universities. Of

4860-543: The "colonial apartheid society" was unique to Algeria. Under the French Fourth Republic , Muslim Algerians were accorded the rights of citizenship , but the system of discrimination was maintained in more informal ways. Frederick Cooper writes that Muslim Algerians "were still marginalized in their own territory, notably the separate voter roles of 'French' civil status and of 'Muslim' civil status, to keep their hands on power." The "internal system of apartheid"

4995-629: The 155 medical schools then extant in North America, with his results published the following year in what came to be known as the Flexner Report . The results proved shocking: most "medical schools," for example, had entrance requirements no more stringent than either high school diploma or "rudiments or the recollection of a common school education." Only sixteen schools required at least two years of college as an entrance requirement, and of these, Johns Hopkins , Harvard , and Western Reserve were

5130-519: The 1870s in modifying or introducing legislation to facilitate the private transfer of land to settlers and continue Algeria's appropriation of land from the local population and distribution to settlers. Europeans held about 30% of the total arable land, including the bulk of the most fertile land and most of the areas under irrigation. In 1881, the Code de l'Indigénat made the discrimination official by creating specific penalties for indigenes and by organising

5265-493: The 1920s is given in a report by Walter Baldwin Spencer that many mixed-descent children born during construction of The Ghan railway were abandoned at early ages with no one to provide for them. This incident and others spurred the need for state action to provide for and protect such children. Both were official policy and were coded into law by various acts. They have both been rescinded and restitution for past wrongs addressed at

5400-631: The 20th century. That it was policy and kept secret for over 60 years is a mystery that no agency has solved to date. In the 1930s, the Northern Territory Protector of Natives, Cecil Cook , perceived the continuing rise in numbers of "half-caste" children as a problem. His proposed solution was: "Generally by the fifth and invariably by the sixth generation, all native characteristics of the Australian Aborigine are eradicated. The problem of our half-castes will quickly be eliminated by

5535-461: The 66 surviving MD-granting institutions in 1935, 57 were part of a university. An important factor driving the mergers and closures of medical schools was the national regulation and enforcement of medical school criteria: All state medical boards gradually adopted and enforced the Report 's recommendations. In response to the Flexner Report , some schools fired senior faculty members as part of

Flexner Report - Misplaced Pages Continue

5670-584: The Arabs must accept." He also advocated that "all political freedoms must be suspended in Algeria". Marshal Bugeaud , who was the first governor-general and also headed the civil government, was rewarded by the King for the conquest and having instituted the systemic use of torture, and following a " scorched earth " policy against the Arab population. The French colonial state, as he conceived it and as it took shape in Algeria,

5805-537: The Australian Aboriginal peoples, whose children were removed from their families by Australian federal and state government agencies and church missions, under acts of their respective parliaments. The removals occurred in the period between approximately 1909 and 1969, resulting in what later became known as the Stolen Generations . An example of the abandonment of mixed-race (" half-caste ") children in

5940-517: The Crown devised a system of enfranchisement whereby an indigenous person could become a "person" in Canadian law. Indigenous people could gain the right to vote and become Canadian citizens, "persons" under the law, by voluntarily assimilating into European/Canadian society. Case Western Reserve University School of Medicine Case Western Reserve University School of Medicine ( CWRU SOM, CaseMed )

6075-472: The Flexner Report, "The State Boards," offers a scathing critique of the medical regulatory landscape at the time, particularly focusing on the inefficacy and inconsistency of state medical boards. Flexner identifies the critical role these boards were intended to play in upholding medical education standards, both legally and ethically, but argues that they had largely failed in this responsibility. "In 1906,

6210-731: The GP, use a private doctor, or apply for residence in an old age facility. Childhood mortality rates , the gap in educational achievement and lack of employment opportunities were made goals that in a generation should halve the gap. A national " Close the Gap " day was announced for March of each year by the Human Rights Commission . In 2011, the Australian Institute of Health and Welfare reported that life expectancy had increased since 2008 by 11.5 years for women and 9.7 years for men along with

6345-659: The Indians tribes as First Nations living under Crown protection. It was after the treaty of Paris in 1763 , whereby France ceded all claims in present-day Canada to Britain, that King George III of Great Britain issued a Royal Proclamation specifying how the Indigenous in the crown colony were to be treated. It is the most significant pieces of legislation regarding the Crown's relationship with Aboriginal people. This Royal Proclamation recognized Indian owned lands and reserved to them all use as their hunting grounds. It also established

6480-525: The Kabyle, or Berbers, of Arab descent in North Africa. The Dey of Algiers had insulted the monarchy by slapping the French ambassador with a fly-whisk , and the French used that pretext to invade and to put an end to piracy in the vicinity. The unofficial objective was to restore the prestige of the French crown and gain a foothold in North Africa, thereby preventing the British gaining advantage over France in

6615-567: The Mabo case had the side effect of throwing the media spotlight on all issues related to Aboriginal people and Torres Strait Islanders in Australia, and most notably the Stolen Generations. The social impacts of forced removal have been measured and found to be quite severe. Although the stated aim of the "resocialisation" program was to improve the integration of Aboriginal people into modern society,

6750-501: The Mediterranean. The July Monarchy , which came to power in 1830, inherited that burden. The next ten years saw the indigenous population subjected to the might of the French army . By 1840, more conservative elements gained control of the government and dispatched General Thomas Bugeaud , the newly appointed governor of the colony, to Algeria , which marked the real start of the country's conquest. The methods employed were atrocious;

6885-566: The Native populations. This led to an emphasis on the acquisition of Aboriginal lands in exchange for the putative benefits of European society and their associated Christian religions. British control of Canada (the Crown ) began when they exercised jurisdiction over the first nations and it was by Royal Proclamation that the first piece of legislation the British government passed over First Nations citizens assumed control of their lives. It gave recognition to

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7020-458: The Negro himself suffer from hookworm and tuberculosis; he communicates them to his white neighbors, precisely as the ignorant and unfortunate white contaminates him. Self-protection not less than humanity offers weighty counsel in this matter; self- interest seconds philanthropy . The Negro must be educated not only for his sake, but for ours. He is, as far as the human eye can see, a permanent factor in

7155-476: The North-West, which established the reserves for the Indigenous, the protection of Métis lands was not secured by the scrip policy instituted in the 1870s, whereby the crown exchanged a scrip in exchange for a fixed (160–240 acres) grant of land to those of mixed heritage. Although Section 3 of the 1883 Dominion Lands Act set out this limitation, this was the first mention in the orders-in-council confining

7290-500: The State whose laws permit its existence . . . indescribably foul . . . the plague spot of the nation." Nevertheless, several schools received praise for excellent performance, including Western Reserve (now Case Western Reserve), Michigan , Wake Forest , McGill , Toronto , and particularly Johns Hopkins , which was described as the 'model for medical education'. The Report ultimately produced many unintended consequences, and many of

7425-487: The U.S. His plan relied on the boards acting as ethical watchdogs for public health and safety, but the failures of these boards to fulfill their role were highlighted as a significant barrier to achieving widespread reform. Many aspects of the medical profession in North America changed following the Flexner Report . Medical training adhered more closely to the scientific method and became grounded in human physiology and biochemistry . Medical research aligned more fully with

7560-425: The United States, and that too many doctors were being trained. A repercussion of the Flexner Report , resulting from the closure or consolidation of university training, was the closure of all but two black medical schools and the reversion of American universities to male-only admittance programs to accommodate a smaller admission pool. In Chapter 11, Flexner stressed that the success of medical education reform and

7695-415: The United States, was fundamentally dependent on state medical boards functioning as effective gatekeepers to the profession. He insisted that state boards must rigorously ensure that only those who completed proper, standardized training could enter medical practice. From a legal standpoint, state boards were to have the authority to license practitioners, while ethically, they were responsible for maintaining

7830-415: The United States. A majority of American institutions granting MD or DO degrees as of the date of the Report (1910) closed within two to three decades. (In Canada, only the medical school at Western University was deemed inadequate, but none was closed or merged subsequent to the Report.) In 1904, before the Report , there were 160 MD-granting institutions with more than 28,000 students. By 1920, after

7965-694: The army deported villagers en masse , massacred the men and raped the women, took the children hostage, stole livestock and harvests and destroyed orchards. Tocqueville wrote, "I believe the laws of war entitle us to ravage the country and that we must do this, either by destroying crops at harvest time, or all the time by making rapid incursions, known as raids, the aim of which is to carry off men and flocks." Tocqueville added: "In France I have often heard people I respect, but do not approve, deplore [the army] burning harvests, emptying granaries and seizing unarmed men, women and children. As I see it, these are unfortunate necessities that any people wishing to make war on

8100-478: The best in the country." A little over 40 years later, in 1952, the Western Reserve University School of Medicine revolutionized medical education with the "new curriculum of 1952" and more advanced stages in 1968. This was the most progressive medical curriculum in the country at that time, integrating the basic and clinical sciences. L. O. Krampitz chaired the subcommittee which implemented

8235-442: The boards are sometimes weak, and either unwilling to antagonize the schools or legally incapable of so doing; again, well meaning but incompetent; in some cases unquestionably neither weak nor well meaning, but cunning, powerful, and closely aligned with selfish and harmful political interests." Flexner lamented that this patchwork regulatory system undermined his vision for a unified, scientific, and ethical medical profession across

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8370-512: The closing of all but two of the historically black medical schools. As a result, only Howard University College of Medicine and Meharry Medical College were left open, while five other schools were closed. Flexner emphasized his view that black doctors should treat only black patients and should play roles subservient to those of white physicians. Flexner promoted the idea that African American medical students should be trained in "hygiene rather than surgery" and be employed as "sanitarians," with

8505-582: The colonization of Algeria. In several speeches on France's foreign affairs, in two official reports presented to the National Assembly in March 1847 on behalf of an ad hoc commission, and in his voluminous correspondence, he repeatedly commented on and analyzed the issue. In short, Tocqueville developed a theoretical basis for French expansion in North Africa. He even studied the Quran , sharply concluding that Islam

8640-542: The complete disappearance of the black race, and the swift submergence of their progeny in the white". He did suggest at one point that they be all sterilised. Similarly, the Chief Protector of Aborigines in Western Australia, A. O. Neville , wrote in an article for The West Australian in 1930: "Eliminate in future the full-blood and the white and one common blend will remain. Eliminate the full-blood and permit

8775-467: The contextual information is stereotype-consistent. Other examples sometimes described as institutional racism are racial profiling by security guards and police, use of stereotyped racial caricatures, the under- and misrepresentation of certain racial groups in the mass media, and race-based barriers to gainful employment and professional advancement. Additionally, differential access to goods, services and opportunities of society can be included within

8910-510: The courts. Thus was institutional racism externalized as official policy. When Aboriginals began to press for recognition of their rights and to complain of corruption and abuses of power within the Indian department, the Act was amended to make it an offence for an Aboriginal person to retain a lawyer for the purpose of advancing any claims against the crown. Unlike the effect of those Indian treaties in

9045-433: The curricula of DO- and MD-awarding medical schools are now nearly identical , the chief difference being the additional instruction in osteopathic schools of osteopathic manipulative medicine . Institutional racism Institutional racism , also known as systemic racism , is a form of institutional discrimination based on race or ethnic group and can include policies and practices that exist throughout

9180-668: The curriculum reform. In 2019, the School of Medicine relocated to the Samson Pavilion Health Education Campus on the campus of the Cleveland Clinic, a $ 515 million building project, amid a multi-million dollar joint fundraising campaign between CWRU and the Cleveland Clinic. The campus houses students Case Western Reserve School of Medicine (CCLCM and traditional MD programs), Frances Payne Bolton School of Nursing and Case School of Dental Medicine, all of which—with

9315-470: The distribution of scrip. While this does not necessarily preclude a malicious intent by the federal government to consciously 'cheat' the Métis, it illustrates their apathy towards the welfare of the Métis, their long-term interests, and the recognition of their Aboriginal title. But the point of the policy was to settle land in the North-West with agriculturalists, not keep a land reserve for the Métis. Scrip, then,

9450-638: The early decades of the 20th century for the reception of these separated children. Examples of such institutions include Moore River Native Settlement in Western Australia, Doomadgee Aboriginal Mission in Queensland, Ebenezer Mission in Victoria and Wellington Valley Mission in New South Wales. In 1911, the Chief Protector of Aborigines in South Australia, William Garnet South , reportedly "lobbied for

9585-502: The economic impact of the School of Medicine and its affiliates on the State of Ohio equaled $ 5.82 billion and accounted for more than 65,000 Ohio jobs. The role of Case Western Reserve University in the Cleveland economy has been reported on by The Economist magazine. †Six of the first seven women in the United States to receive medical degrees from recognized allopathic medical schools graduated from Western Reserve University (as it

9720-504: The electoral rolls. The Commonwealth Franchise Act 1902 excluded "Aboriginal natives of Australia, Asia, Africa and Pacific Islands except for New Zealand" from voting unless they were on the roll before 1901. In 1981, a land rights conference was held at James Cook University , where Eddie Mabo , a Torres Strait Islander, made a speech to the audience in which he explained the land inheritance system on Murray Island . The significance of this in terms of Australian common law doctrine

9855-438: The exception of CCLCM—had previously held classes on the campus of CWRU and University Hospitals Cleveland Medical Center . The move, announced in 2013, was a major contributing factor for University Hospitals to shift its name from University Hospitals Case Medical Center to University Hospitals Cleveland Medical Center in 2016, as well as renegotiate its affiliation agreement with CWRU that same year. Prospective students have

9990-573: The expectation of postgraduate training. Furthermore, many physicians who traveled to Europe to receive postgraduate training were impressed with the German dedication to research, innovation, and teaching. In effect, Flexner demanded that American medical education conform to prevailing practice in continental Europe. By and large, medical schools in Canada and the United States followed many of Flexner's recommendations. However, schools have increased their emphasis on matters of public health . Chapter 11 of

10125-520: The fact that black students were not admitted to many U.S. medical schools for the 50 years following the Flexner Report , has contributed to the low numbers of American-born physicians of color as the ramifications are still felt, more than a century later. Tens of thousands of African American physicians disappeared as a result of the Flexner Report . In relation to the national Census , physicians belonging to minority groups, including African Americans, remain underrepresented in medicine. In response to

10260-635: The first medical lectures at the Medical Department of Western Reserve College (also known as the Cleveland Medical College) in Hudson, Ohio. Kirtland and Delamater had previously been instructors at a medical college started in 1834, the Medical Department of Willoughby University of Lake Erie, which had closed in 1843 due to faculty disagreements. Other faculty from that Medical Department went on to found Willoughby Medical College of Columbus,

10395-502: The first medical school program in the United States not to charge students tuition. The Cleveland Clinic, rather than CWRU, is responsible for all financial aspects of the school. Administration of the school, including deans, administrative staff, and admissions, is separate from the School of Medicine, which provides oversight over academic affairs at CCLCM. The Medical Scientist Training Program awards MD and PhD degrees upon graduation. Case Western Reserve University School of Medicine

10530-599: The goals of "Closing the Gap" had been cut, and the national group monitoring the conditions of the First Nations population was not optimistic that the promises of 2008 will be kept. In 2012, the group complained that institutional racism and overt discrimination continued to be issues, and that, in some sectors of government, the UN Declaration on the Rights of Indigenous Peoples was being treated as an aspirational rather that

10665-493: The high standards of German medical education, while keeping the American standard of high respect for patients by physicians. In his efforts to ensure that Hopkins was the standard to which all other medical schools in the United States were compared, Flexner went on to claim that all the other medical schools were subordinate in relation to this "one bright spot." In addition to Johns Hopkins School of Medicine, Flexner also considered

10800-546: The highest levels of government. The treatment of the First Nations Australians by the colonisers has been termed cultural genocide . The earliest introduction of child removal to legislation is recorded in the Victorian Aboriginal Protection Act 1869 . The Central Board for the Protection of Aborigines had been advocating such powers since 1860, and the passage of the Act gave the colony of Victoria

10935-493: The infamous Society Cup in a series of events (e.g. soccer, flag football, relay races etc.). Every year, students at Case Western Reserve SOM write, direct and perform a full-length musical parody, lampooning Case Western Reserve, their professors, and themselves. It is a longstanding tradition that began in the 1980's and in recent years, the show has been a benefit for the Student Run Health Clinic. During 2007,

11070-827: The integrity of the profession by enforcing these standards. "The power that validates the diploma with its license must have the strength to protect its issues against either debasement or infringement." However, Flexner's report critiques the widespread corruption and lack of uniformity among state boards, which allowed substandard medical schools to continue operating. The boards were often controlled by political forces rather than by educational or professional considerations, leading to inconsistency in their enforcement of licensing standards. Some states maintained high standards, while others allowed almost anyone with minimal training to practice medicine. "In many states appointments are regarded as political spoils; quite generally teachers are ineligible for appointment. It happens, therefore, that

11205-1111: The intentions of others according to their race), discrimination (the differential actions and behaviours towards others according to their race), stereotyping , commission, and omission (disrespect, suspicion, devaluation, and dehumanization). Internalized racism is the acceptance, by members of the racially stigmatized people, of negative perceptions about their own abilities and intrinsic worth, characterized by low self-esteem , and low esteem of others like them. This racism can be manifested through embracing "whiteness" (e.g. stratification by skin colour in non-white communities), self-devaluation (e.g., racial slurs, nicknames, rejection of ancestral culture, etc.), and resignation, helplessness and hopelessness (e.g., dropping out of school, failing to vote , engaging in health-risk practices, etc.). Persistent negative stereotypes fuel institutional racism and influence interpersonal relations . Racial stereotyping contributes to patterns of racial residential segregation and redlining , and shapes views about crime, crime policy and welfare policy, especially if

11340-460: The interplay between the biology of disease and the social and behavioral context of illness, between the care of the individual patient and the health of the public, and between clinical medicine and population medicine. The Cleveland Clinic Lerner College of Medicine (CCLCM) is an educational program within the CWRU School of Medicine administered in conjunction with Cleveland Clinic . The program

11475-510: The jurisdiction of scrip commissions to ceded Indian territory. However, a reference was first made in 1886 in a draft letter of instructions to Goulet from Burgess. In most cases, the scrip policy did not consider Métis ways of life, did not guarantee their land rights, and did not facilitate any economic or lifestyle transition. Most Métis were illiterate and did not know the value of the scrip, and in most cases sold them for instant gratification due to economic need to speculators who undervalued

11610-616: The last quarter of the 20th century, racism became associated with systems rather than individuals. In 1977, David Wellman defined racism as "a system of advantage based on race" in his book Portraits of White Racism , illustrating this definition through countless examples of white people supporting racist institutions while denying that they are prejudiced. White people can be nice to people of color while continuing to uphold systemic racism that benefits them, such as lending practices, well-funded schools, and job opportunities. The concept of institutional racism re-emerged in political discourse in

11745-688: The latter upon the interactions among institutions, which interactions produce racialized outcomes against non-white people. An important feature of structural racism is that it cannot be reduced to individual prejudice or to the single function of an institution. D. C. Matthew has argued in favor of "distinguishing between 'intrinsic institutional racism', which holds that institutions are racist in virtue of their constitutive features, and 'extrinsic institutional racism', which holds that institutions are racist in virtue of their negative effects." The French political thinker Alexis de Tocqueville (1805–1859) supported colonization in general, and particularly

11880-639: The life expectancy of the Aboriginal people. Committees that followed up on this outlined broad categories to redress the inequities in life expectancy , educational opportunities and employment. The Australian government also allocated funding to redress the past discrimination. First Nations Australians visit their general practitioners (GPs) and are hospitalised for diabetes , circulatory disease, musculoskeletal conditions, respiratory and kidney disease , mental, ear and eye problems and behavioural problems yet are less likely than non-Indigenous Australians to visit

12015-556: The lives of the indigenous. It then became necessary to have permission from an Indian agent if Native people wanted to sell crops they had grown and harvested, or wear traditional clothes off the reserves. The Indian Act was also used to deny Indians the right to vote until 1960, and they could not sit on juries. In 1885, General Middleton after defeating the Metis rebellion introduced the Pass System in western Canada, under which Natives could not leave their reserves without first obtaining

12150-487: The medical profession, it is clear that they show a decreasing inclination to enter it. More schools in all sections are open to them; fewer attend and fewer graduate.” Flexner also emphasized women's particular role in medicine throughout the Report : "Woman has so apparent a function in certain medical specialties…". [1] While some people thought that women were intellectual equals of men, more people thought that women were naturally nurturing and loving, so they should pursue

12285-553: The medical schools at Harvard , University of Michigan , and the University of Pennsylvania to be strong schools. He said that medical schools that did not meet these high standards must change their approach to medical education or close their doors. Flexner also believed that admission to a medical school should require, at minimum, a high school diploma and at least two years of college or university study, primarily devoted to basic science . When Flexner researched his report, in

12420-489: The mid and late 1990s, but has remained a contested concept. Institutional racism is where race causes a different level of access to the goods, services, and opportunities of society. Professor James M. Jones theorised three major types of racism: personally mediated, internalized , and institutionalized. Personally mediated racism includes the deliberate specific social attitudes to racially prejudiced action ( bigoted differential assumptions about abilities, motives, and

12555-511: The mothers to continue working as help on the farm while at the same time removing the whites from responsibility for fathering them and from social stigma for having mixed-race children visible in the home. Also, when they were left alone on the farm they became targets of the men who contributed to the rise in the population of mixed-race children. The institutional racism was government policy gone awry, one that allowed babies to be taken from their mothers at birth, and this continued for most of

12690-498: The nation." Flexner's findings also restricted opportunities for African-American physicians in the medical sphere. Even the Howard and Meharry schools struggled to stay open following the Flexner Report , having to meet the institutional requirements of white medical schools, reflecting a divide in access to health care between white and African-Americans. Following the Flexner Report, African-American students sued universities, challenging

12825-463: The nearest hospital. Although English was the official language of Australia, many First Nations Australians did not speak it as a primary language, and the lack of printed materials that were translated into the Australian Aboriginal languages and the non-availability of translators formed a barrier to adequate health care for Aboriginal people. By 2015, most of the funding promised to achieve

12960-536: The nineteenth century, American medicine was neither economically supported nor regulated by the government. Few state licensing laws existed, and when they did exist, they were weakly enforced. There were numerous medical schools, all varying in the type and quality of the education they provided. In 1904, the American Medical Association (AMA) created the Council on Medical Education (CME), whose objective

13095-465: The nineteenth century, only 16 out of 155 medical schools in the United States and Canada required applicants to have completed two or more years of university education. By 1920, 92 percent of U.S. medical schools required this prerequisite of applicants. Flexner also argued that the length of medical education should be four years, and its content should be what the CME agreed to in 1905. Flexner recommended that

13230-478: The nineteenth century, universities had just begun opening and expanding female admissions as part of both women's and co-educational facilities with the founding of co-educational Oberlin College in 1833 and private all-women's colleges such as Vassar College and Pembroke College . Furthermore, many women opened their own medical schools for women as a response to other medical schools refusing to admit them. In

13365-603: The number of infant deaths and significantly greater contact with law enforcement. Their incomes are lower, they enjoy fewer promotions in the workplace and as a group, the younger members are more likely to work reduced hours or weeks each year. Many in Europe during the 19th century (as reflected in the Imperial Report of the Select Committee on Aborigines), supported the goal put forth by colonial imperialists of 'civilizing'

13500-465: The ongoing practice of evidence-based medicine in the rapidly changing healthcare environment of the 21st century. The goal of this program is to challenge students so that they affect positive change through treating disease, promoting health, and understanding the social and behavioral context of illness. The four-year curriculum unites the disciplines of medicine and public health into a single, integrated program that trains future physicians to consider

13635-540: The only schools to require an undergraduate degree. Although Johns Hopkins represented his ideal, Flexner also singled out the Medical Department of Western Reserve University for its praiseworthy admission standards and facilities. Flexner referred to Western Reserve as "already one of the substantial schools in the country." In a letter to Western Reserve president Charles Franklin Thwing he said, "The Medical Department of Western Reserve University is, next to Johns Hopkins ...,

13770-688: The option of three degree paths leading to a medical degree at the School of Medicine: the University Program, the College Program, or the Medical Scientist Training Program . The University Program is a traditional four-year Doctor of Medicine program designed to train well-rounded physicians in a curriculum called the Western Reserve2 (WR2) which is built on four cornerstones of clinical mastery, research and scholarship, leadership, and civic professionalism to prepare students for

13905-465: The paper. Needless to say, the process by which they applied for their land was made deliberately arduous. There was no legislation binding scrip land to the Métis who applied for them, Instead, Métis scrip lands could be sold to anyone, hence alienating any Aboriginal title that may have been vested in those lands. Despite the evident detriment to the Métis, speculation was rampant and done in collusion with

14040-546: The population but produced 20% of Algeria's income, paid 70% of direct taxes and 45% of the total taxes collected. Also, Colons controlled how the revenues would be spent and so their towns had handsome municipal buildings, paved streets lined with trees, fountains and statues, but Algerian villages and rural areas benefited little, if at all, from tax revenues. The colonial regime proved severely detrimental to overall education for Muslims, who had previously relied on religious schools to learn reading, writing and religion. In 1843,

14175-463: The power to remove Aboriginal children without a court hearing because the courts sometimes refused to accept that the children were neglected or destitute". South argued that "all children of mixed descent should be treated as neglected". His lobbying reportedly played a part in the enactment of the Aborigines Act 1911 ; this made him the legal guardian of every Aboriginal child in South Australia, including so-called "half-castes". Bringing Them Home ,

14310-413: The precedent set by Plessy v. Ferguson . However, those students were met by opposition from schools that remained committed to segregated medical education. It was not until 15 years after Brown v. Board of Education in 1954 that the AAMC ensured access to medical education for African-Americans and minorities by supporting the diversification of medical schools. The closure of the five schools, and

14445-445: The process by which the Crown could purchase their lands, and also laid out basic principles to guide the Crown when making treaties with the First Nations. The Proclamation made Indian lands transferred by treaty to be Crown property, and stated that indigenous title is a collective or communal rather than a private right so that individuals have no claim to lands where they lived and hunted long prior to European colonization. In 1867,

14580-411: The professionalization of medicine relied heavily on the effective legal and ethical functioning of state medical boards. However, he noted that these boards were failing in their mission, stalling progress and allowing substandard medical practices to continue, thereby jeopardizing public health. This problem persists as a significant issue in the current practice of medicine in the United States. During

14715-399: The proprietary medical schools should either close or be incorporated into existing universities. Furthermore, he stated that medical schools needed to be part of a larger university since a proper stand-alone medical school would have to charge too much in order to break even financially. Less known is Flexner's recommendation that medical schools appoint full-time clinical professors. During

14850-701: The protocols of mainstream science principles in their teaching and research. The report talked about the need for revamping and centralizing medical institutions. Many American medical schools fell short of the standard advocated in the Flexner Report and, subsequent to its publication, nearly half of such schools merged or were closed outright. Colleges for the education of the various forms of alternative medicine, such as electrotherapy , were closed. Homeopathy , traditional osteopathy , eclectic medicine , and physiomedicalism (botanical therapies that had not been tested scientifically) were derided. The Report also concluded that there were too many medical schools in

14985-401: The protocols of scientific research. Average physician quality significantly increased. Flexner wanted to improve both the admissions standards of medical school and the quality of medical education itself. He recognized that many of the medical schools had inadequate admissions requirements and a lack of adequate education. Consequently, Flexner sought to reduce the number of medical schools in

15120-581: The quality of medical students, looking to draw from the society of upper-class, educated students. In 1908, seeking to advance its reformist agenda and hasten the elimination of schools that failed to meet its standards, the CME contracted with the Carnegie Foundation for the Advancement of Teaching to survey American medical education. Henry Pritchett , president of the Carnegie Foundation and

15255-455: The racist writings of the Flexner Report , the AAMC decided to rename the prestigious Abraham Flexner award in 2020. David Acosta, M.D., the chief diversity and inclusion officer of AAMC, stated, "We must not ignore medicine's racist history and make every effort toward reparation when this history is identified." However, the view that Flexner and the Report were detrimental to black medical schools

15390-505: The repercussions of the Report are still seen in American medicine today. Minority groups, such as African Americans and women, faced fewer opportunities as a result of the publishing of the Flexner Report. Additionally, many medical schools for alternative medicine and osteopathic medicine eventually closed as a result of the Report . To help with the transition and change the minds of other doctors and scientists, John D. Rockefeller gave many millions to colleges, hospitals and founded

15525-435: The research of his report, Flexner noted a lack of dedicated, full-time professors. American medical education needed committed professors to teach the next generations of physicians. Holders of these appointments would become "true university teachers, barred from all but charity practice, in the interest of teaching." Flexner pursued this objective for years, despite widespread opposition from existing medical faculty. Flexner

15660-594: The scientific validity of all forms of medicine other than that based on scientific research, deeming any approach to medicine that did not advocate the use of treatments such as vaccines to prevent and cure illness as tantamount to quackery and charlatanism. Medical schools that offered training in various disciplines including electromagnetic field therapy , phototherapy , eclectic medicine , physiomedicalism, naturopathy , and homeopathy , were told either to drop these courses from their curriculum or lose their accreditation and underwriting support. A few schools resisted for

15795-538: The seizure or appropriation of their lands. By 1900, Europeans produced more than two-thirds of the value of output in agriculture and practically all of the agricultural exports. The colonial government imposed more and higher taxes on Muslims than on Europeans . The Muslims, in addition to paying traditional taxes dating from before the French conquest, also paid new taxes from which the Colons were normally exempted. In 1909, for instance, Muslims, who made up almost 90% of

15930-586: The state appropriated the habus lands, the religious foundations that constituted the main source of income for religious institutions, including schools, but colonial officials refused to allocate enough money to maintain schools and mosques properly and to provide for enough teachers and religious leaders for the growing population. In 1892, more than five times as much was spent for the education of Europeans as for Muslims, who had five times as many children of school age. Because few Muslim teachers were trained, Muslim schools were largely staffed by French teachers. Even

16065-443: The term "institutional racism", such as unpaved streets and roads, inherited socio-economic disadvantage and standardized tests (each ethnic group prepared for it differently; many are poorly prepared). Some sociological investigators distinguish between institutional racism and " structural racism " (sometimes referred to as "structured racialization "). The former focuses upon the norms and practices within an institution, and

16200-457: The transmission of diseases among African Americans and to prevent the contamination of white people from those same diseases. "The practice of the Negro doctor will be limited to his own race, which in its turn will be cared for better by good Negro physicians than by poor white ones. But the physical well-being of the Negro is not only of moment to the Negro himself. Ten million of them live in close contact with sixty million whites. Not only does

16335-452: The treatment of the First Nations population , Prime Minister Kevin Rudd made a plea to the health services regarding the disparate treatment in health services. He noted the widening gap between the treatment of First Nations and non-Indigenous Australians, and committed the government to a strategy called " Closing the Gap ", admitting to past institutional racism in health services that shortened

16470-583: The white admixture and eventually, the race will become white". Official policy then concentrated on removing all black people from the population, to the extent that the full-blooded Aboriginal people were hunted to extinguish them from society, and those of mixed race would be assimilated with the white race so that in a few generations they too would become white. By 1900, the recorded First Nations Australian population had declined to approximately 93,000. Western Australia and Queensland specifically excluded Aboriginal and Torres Strait Islander people from

16605-555: The word " quack " was in common use. Flexner carefully examined the situation. Using the Johns Hopkins School of Medicine as the ideal medical school, he issued the following recommendations: Flexner expressed that he found Hopkins to be a "small but ideal medical school, embodying in a novel way, adapted to American conditions, the best features of medical education in England, France, and Germany." To Flexner, Hopkins incorporated

16740-603: The worst of the Chicago schools a school with no entrance requirement, no laboratory teaching, no hospital connections made before state boards the best record attained by any Chicago school in that year. This school, essentially the same now as then, has only recently been declared "not in good standing" with the state board of Illinois. Everywhere in Canada and the United States wretched institutions refute criticism by pointing to their successful state board records." Flexner's broader reform plan, which aimed to elevate medical education in

16875-449: Was "the main cause of the decadence... of the Muslim world". His opinions are also instructive about the early years of the French conquest and how the colonial state was first set up and organized. Tocqueville emerged as an early advocate of "total domination" in Algeria and subsequent "devastation of the country". On 31 January 1830, Charles X capturing Algiers made the French state thus begin what became institutional racism directed at

17010-417: Was a major undertaking in Canadian history, and its importance as both an Aboriginal policy and a land policy should not be overlooked as it was an institutional 'policy' that discriminated against ethnic indigenous to their continued detriment. Until 1951, the various Indian Acts defined a 'person' as "an individual other than an Indian", and all indigenous peoples were considered wards of the state. Legally,

17145-648: Was a two-tiered organization, quite unlike the regime in Mainland France . It introduced two different political and legal systems that were based on racial, cultural and religious distinctions. According to Tocqueville, the system that should apply to the Colons would enable them alone to hold property and travel freely but would deprive them of any form of political freedom, which should be suspended in Algeria. "There should therefore be two quite distinct legislations in Africa, for there are two very separate communities. There

17280-454: Was eliminated amid controversy regarding his criticism of Vioxx and disagreements with other Cleveland Clinic leaders, including then-CEO Toby Cosgrove . The class size each year is 32 students, and the curriculum is notable for its lack of class rank, pre-clinical or clinical grading, or end-of-course examinations. In 2008, Cleveland Clinic announced that all students entering the program would receive full-tuition scholarships, representing

17415-527: Was largely ignored. Torres Strait Islander people are indigenous to the Torres Strait Islands , which are in the Torres Strait between the northernmost tip of Queensland and Papua New Guinea . Institutional racism had its early roots here due to interactions between these islanders, who had Melanesian origins and depended on the sea for sustenance and whose land rights were abrogated, and later

17550-495: Was met with considerable resistance by the Algerian Muslims affected by it, and it is cited as one of the causes of the 1954 insurrection . There was clearly nothing exceptional about the crimes committed by the French army and state in Algeria from 1955 to 1962. On the contrary, they were part of history repeating itself . Following the views of Michel Foucault , the French historian Olivier Le Cour Grandmaison spoke of

17685-491: Was taken note of by one of the attendees, a lawyer, who suggested there should be a test case to claim land rights through the court system. Ten years later, five months after Eddie Mabo died, on 3 June 1992, the High Court announced its historic decision, namely overturning the legal doctrine of terra nullius , which was the term applied by the British relating to the continent of Australia – "empty land". Public interest in

17820-479: Was the child of German immigrants, and he had studied and traveled in Europe extensively. He was well aware that one could not practice medicine in continental Europe without having undergone an extensive specialized university education. There were many aspects of German medical education that Flexner, along with other medical educators and physicians who had traveled to Germany, admired, such as their national standards for students and universities, academic freedom, and

17955-469: Was the first medical school to offer the dual degree MD-PhD program to its students in 1956, nearly a decade before the National Institutes of Health developed the first Medical Scientist Training Program. In 2002, the School of Medicine became the third institution in history to receive the highest review possible from the body that grants accreditation to U.S. and Canadian medical degree programs,

18090-417: Was to restructure American medical education. At its first annual meeting, the CME adopted two standards: one laid down the minimum prior education required for admission to a medical school; the other defined a medical education as consisting of two years training in human anatomy and physiology followed by two years of clinical work in a teaching hospital . Generally speaking, the council strove to improve

18225-518: Was typically awarded after only two years of study with laboratory work and dissection optional. Many of the instructors were local doctors teaching part-time. There were very few full-time professors, dedicated to medical education. Medical schools did not receive funding , and their only money came from the students' tuitions. Regulation of the medical profession by state governments was minimal or nonexistent. American doctors varied enormously in their scientific understanding of human physiology , and

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