The medical school and the community.

The "revolution" initiated by Flexner established a firm foundation for the physical and biological sciences in medical education and introduced the concepts of the scientific method into medical practice.' As a result, medicine's scientific achievements are phenomenal; its social accomplishments are more modest. This "revolution" is over, and the next is upon us, heralded, if not initiated, by Flexner. In the post-Flexner era, the politicians and popular press are asking the medical establishment, "What have you done for the community lately?" The statesmen and the scholars are asking, "How can the university and its medical school accelerate the application of medical science in medical service?" Can the medical school concern itself with the medical problems in the community without being engulfed by the problems of the community? This is the dilemma facing contemporary medical schools; it was clearly foreseen by Flexner in a volume, less celebrated by medical academicians than the "report," but more enduring as wise counsel for academic administrators.2 In discussing the interaction between the university and society, Flexner distinguishes between "what universities do not now touch and what they have no business to touch." "Let me concede," he wrote, "for the purpose of argument (and for that only), that all things that universities do are in themselves worth doing-a very large concession. Does it follow that universities should do them? Does it follow that universities can do them ?" Flexner answered both these questions in the negative. "As the world has changed," he wrote, "new faculties have been needed; new subjects have from time to time been created. But even in the most modern university a clear case must be made out [for expansion] . . . and, the case, as I see it, must rest on the inherent and intellectual value of the proposed faculty or the proposed subject. Practical importance is not a sufficient title to academic recognition: if that is the best that can be said, it is an excellent reason for exclusion." How then, Flexner asked, could he urge: