Chapter 02: Medical School and a Brief History of Medical Education in the U.S.
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Description
In this chapter, Dr. Alexanian briefly talks about his classes and then explains the accelerated program at the Dartmouth Medical School (MD '53). Dr. Alexanian also sketches the history of medical education and explains the impact of the Flexner Report in closing down a number of programs. He then compares the medical training at Dartmouth and at Harvard University and briefly discusses his internship at the University of Washington.
Identifier
Alexanian_R_01_20140415_S02
Publication Date
4-15-2014
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - Educational Path; Personal Background; Inspirations to Practice Science/Medicine; Understanding Cancer, the History of Science, Cancer Research; Character, Values, Beliefs, Talents
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey A. Rosolowski, Ph.D:
Yeah. So tell me about the balance. So you created this liberal education for yourself. What were the classes that helped you develop your interests in the direction that they would go in, in terms of your research or your understanding of yourself as a doctor focused on patients?
Raymond Alexanian, MD:
Well, as I mentioned, even as I began high school, I intended to become a doctor or try to become a doctor, so that I followed the requirements to do that, which were in many ways interesting and challenging, but also part of my overall educational goals, so that many times the requirements were just secondary. I did not like all my science subjects.
Tacey A. Rosolowski, Ph.D:
What were your favorites?
Raymond Alexanian, MD:
Well, I think in college I liked comparative anatomy, where the anatomy of different creatures, birds, reptiles, snakes, and all that are evaluated. I found that challenging. I didn't like botany. I found that boring. And I think botany was probably required because of the ancient requirements to understand all the plants and chemicals that they were the only source of in the old days, that my faculty advisors felt were important but really not important. (laughs)
Tacey A. Rosolowski, Ph.D:
Mm-hmm, yeah, so it was kind of a holdover. (laughter) Interesting. So tell me about going to medical school, when, how did you decide? So you ended up going to-you continued at Dartmouth for your MD.
Raymond Alexanian, MD:
Yes, at Dartmouth, Dartmouth had a two-year medical school in those days-
Tacey A. Rosolowski, Ph.D:
Oh, really?
Raymond Alexanian, MD:
-so that you could enter in your fourth year of undergraduate. So as a senior in college, it was combined with my first year in medical school. Now, we had had a small medical school class of twenty-four, twenty-four men, boys, and after two years, we were all required to transfer to a four-year medical school that would absorb us into their third year.
Tacey A. Rosolowski, Ph.D:
Why did they set it up that way?
Raymond Alexanian, MD:
In the history of medical education in this country, there was a more or less major change in medical school standards at the turn of the century, where several hundred medical schools were evaluated and many of them were considered to be well short of the standards required for medical school education, and so they-
Tacey A. Rosolowski, Ph.D:
Is this the Flexner Report?
Raymond Alexanian, MD:
The Flexner Report. So many of those were dropped from the roster of medical schools, but a small number, approximately six, were retained as two-year schools because they were usually in rural areas without access to a large clinical population, and their undergraduate students were well qualified for medical education. Since all my classmates were Dartmouth graduates, usually above-average graduates, they qualified as students almost anywhere in the country, so that for many years between maybe 19-I'm guessing now-1920 and 1955, that was a two-year medical school. Then as the facilities expanded and patients-the problem was that there weren't sufficient numbers of patients with a broad range of disorders to fulfill the requirements for third- and fourth-year medical education. You had to have a lot of sick people-
Tacey A. Rosolowski, Ph.D:
Right.
Raymond Alexanian, MD:
-to show students.
Tacey A. Rosolowski, Ph.D:
Strange needs, but- (laughs)
Raymond Alexanian, MD:
There was a Veterans Hospital in a nearby town, but that was not sufficient.
Tacey A. Rosolowski, Ph.D:
So you ended up transferring to-
Raymond Alexanian, MD:
To Harvard.
Tacey A. Rosolowski, Ph.D:
And just for the record, you left Dartmouth in '53, and then in 1955, received your MD from Harvard Medical School. Raymond Alexanian, PhD Harvard, yes.
Tacey A. Rosolowski, Ph.D:
So was there a big difference between the two schools? Tell me about your training. What was your evaluation of your training through those programs?
Raymond Alexanian, MD:
Well, as you can imagine, the medical school training is kind of in stages for basic science and then clinical training so that, of course, the environment from a rural, small agricultural area in New Hampshire to a big city was a geographic change, but I don't think the scholastic demands were any different. I think the clinical rotations through multiple teaching hospitals required a different schedule. Harvard in those days-I'm not sure now-every day there was a morning lecture, and then in the morning and afternoons you had rotations through the different clinical facilities in the different specialties: pediatrics, surgery, medicines, so on and so on.
Tacey A. Rosolowski, Ph.D:
What did you gravitate toward during that time as a specialty?
Raymond Alexanian, MD:
At that time I had the notion, with my friends, that it was important to become a well-rounded physician, so I thought at that time that I would be the best possible general practitioner that could be attained. And within a few years, it was obvious that that was not logical, because as you-even through my internship, I felt that that was a good idea, because I-in those days you could elect a rotating internship, which would mean you rotated among the different specialties, you know, gynecology, obstetrics, surgery, medicine, so on, and that's what I did at the University of Washington in Seattle, the King County Hospital. In those days, choices of internships were as random as they are now, I think, but you had a wider choice. You could have rotating internships or specialty internships. Most of them at that time were rotating internships because there was still the notion that primary care, rather than specialty care, was the dominant future for physicians. But shortly after I began my internship, I also wanted to do something constructive in medicine, so I then proceeded into a medical residency.
Recommended Citation
Alexanian, Raymond MD and Rosolowski, Tacey A. PhD, "Chapter 02: Medical School and a Brief History of Medical Education in the U.S." (2014). Interview Chapters. 92.
https://openworks.mdanderson.org/mchv_interviewchapters/92
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