The concept of “social mission” in medical or health professions education in the United States was not much used before 2010. Academicians, students, and policy leaders did reference ideas such as community oriented primary care, community outreach, minority health, and diversity but these issues rarely enjoyed a common label or a sense of defined mission. The term “social accountability” of medi
cal schools was endorsed by the World Health Organization starting in the 1990’s and has gained some traction in mission statements and policy discussion in Europe and Canada. The term social mission first drew broad attention in 2010 when an article entitled “The Social Mission of Medical Education: Ranking the Schools” (Mullan, Chen, et al, Annals of Internal Medicine, 2010;152:804-811) lit up a national debate about social mission in medical education. The study, conducted by researchers at the George Washington University (GW) and the Robert Graham Center and funded by the Josiah Macy Jr. Foundation, measured the “outcome” of the nation’s allopathic and osteopathic medical schools. It ranked the schools on three core indicators of social mission – 1) what percent of graduates were practicing primary care, 2) what percent were practicing in shortage areas, and 3) what percent were underrepresented minorities. The results indicated that the nation’s three African American schools as well as many rural and public schools far outperformed more research oriented schools – schools which are often ranked highly by the US News and World Report – in social mission. That debate catalyzed the concerns of many educators, students, and policymakers about the lack of attention given to social mission in the programs of medical schools and residency programs. Kellogg Foundation on six schools concentrating on social mission in medical education were carried out by the GW team. That work focused on eight aspects of school activity that were judged to be social mission enhancing — mission statements, pipeline programs, admissions, curriculum, location of clinical experience, tuition management, mentorship, and preparation for residency. The studies at the six schools and the unrest created by the “Rankings” paper led to the convening of the first “Beyond Flexner: Social Mission in Medical Education” Conference in May of 2012 at the University of Oklahoma School of Community Medicine in Tulsa, Oklahoma. The title, Beyond Flexner, was chosen because of its succinct statement of the social mission challenge. Abraham Flexner, author of a 1910 report highly critical of medical schools of the time, called for adherence to science and quality standards in medical education. Flexner’s work is often celebrated as the blueprint for 20th century medical education and, indeed, health professions education in general. Flexner’s contributions, foundational as they were for medical school curricula, were silent on the medical school as an agent of community health or social change. While Flexner’s values supported the development of scientifically sound medical education, they did nothing to address the increasingly evident disparities in health and health care that were then, and are now, omnipresent in US and global populations. The concept of Beyond Flexner, then, is not to dismiss science or rigorous instruction as values in health professions education, but rather, to go beyond those precepts to create a philosophy and curriculum that promote health equity and the challenges that health professionals face in working toward it.
