Lecture 7: The Rise of Medical Education Flashcards
In which century was there finally a formal medical profession?
18th
Prior to the 18th century, was formal education required to practice medicine?
no
What was the standard education for those who practiced medicine prior to the 18th century?
Guild education, apprenticeships
Was there organization of similar practices prior to the 18th century?
no
Was there common renumeration prior to the 18th century (common wage)?
no
fees differed from one practitioner to the next
How was the practice of medicine organized prior to the 18th century?
Organization and regulation was local
What types of groups of practitioners performed medical operations before the profession was recognized?
midwives, barber-surgeons, apothecaries, surgeon-apothecaries
What was the criteria for a barber-surgeon?
fast and strong because there was no pain medication.
What were some of the things that barber-surgeons did?
- tooth extraction
- bleeding
- purging
- provided alcohol
How are barber-surgeons interpreted today?
as heroic and illiterate
What was the barber-surgeon compact considered suitable for?
-considered suitable for teeth and amputations
Was a barber-surgeon high or low class wordK
low class
What did barber-surgeons create to keep others out of the practice who were not as qualified?
they made guilds
Why were barber-surgeons threatened? (who were they threatened by?)
At the same time barber-surgeons made guilds, we start to see physicians being trained and they felt threatened.
Explain the professionalization of the barber-surgeon (guilds)? For example, what did they want, what did they control, what standards did they set?
Guilds expanded in membership, though remained largely urban.
- gained legal recognition
- controll apprenticeships, examinations
- set standards for licensing and practice for various healers
- move towards exclusive control over practice
How did most barber-surgeons develop skills?
through apprenticeships
Which group of people, were excluded from practicing medicine and why? What was the exception?
women, except midwives
partly due to their exclusion from university
Where were there a few female surgical guilds? What did this invite?
- France
- Scrutiny and legal action from male guilds
Where was there a rise in academic medicine especially?
a centres-Salerno (Italy) and Montpellier (France)
What was the rise in medical education due to?
Enlightenment
What practice became central to medical training?
anatomy
What did universities evaluate programs based on?
their inclusion of anatomy
- helped legitimize universities
- universities without anatomy were of a lower standing
What was the creation of medical ‘expertise’? (4 things)?
- jargon
- authority
- restrictions
- medical texts (standardized medical practice)
When did medicine in the university begin?
beginning in the 17th and building into the 19th century
Universities increasingly added medicine to their curricula, for what three groups?
physicians, surgeons, and apprentices
What did top schools focus on alongside clinical training?
medical sciences (anatomy,chemistry, botany).
What was there a flourishing of in the 17th-19th century?
flourishing of specialties–professors were designated to teach specific areas, not the entire field of medicine.
What were some of the specific areas that professors were designated to teach?
anatomy, surgery, chemistry, botany, medical theory (physiology), medical practice (pathology), hygiene, dietetics
___of medicine formed
___of specific systems
- branches
- experts
What were universities closely along with both geographically and theoretically?
hospitals
What type of training becomes an important component of training?
on-the-ward training
What was the transforming effect on the organization of medicine in regards to guilds?
they extended their ‘professional’ authority, but required formal study, lectures, exams, and dissections.
What benefits did the guilds see when getting on board with formal medical education?
the qualities of standards of care and the money they could ask for
When did university-trained practitioners become the norm?
early 1800s
What did university curricula stress in the early 1800s? Examples?
moral and scientific training
- temperance, chastity, meekness, contentedness, honesty, industry, religion
- chemistry, anatomy, materia media, midwifery, surgery
Why was it important to have moral training?
Because a lot of institutions providing health care were religious, elite class (physicians) and had to have the etiquette that went along with that. You want these people who heal to be “pure” in a sense
How did universities begin to offering clinical training?
by linking with hospitals
What brought physicians and surgeons closer together?
emphasis on combining science and skill
By the early 1800s, did licensing depend on a university education? Why?
No because it was too expensive to maintain or enforce and if was too difficult for the state to monitor (lack of civil servants) and it was difficult to tell who was meeting the standards.
Was linking medical training with university education inclusive?
No there was stricter entry to several groups in society. Linking meat that most people couldn’t attend because you had to be part of the elite class.
Was did middle-class women lobbied for access to alongside suffrage movements in the mid-19th century?
access to university (medicine)
Who was Elizabeth Blackwell? What did she complains bout?
First woman to obtain a medical degree (US). She complained that she was treated like a nurse or midwife; not taken seriously.
When and were was the first jurisdiction to offer co-education training in medicine?
1860s Switzerland
What did women for in the US?
their own schools and clinics
When did the Women’s Medical College of Philadelphia open? When did it acquire clinical facilities?
- 1850 opened
- clinical facilties in 1860
What was the medical college to formally recognize women?
Women’s Medical College of Philadelphia
When did the following schools allow women? University of Edinburgh London medical schools University of Pennsylvania Harvard University
Edinburgh- 1889
London- post WWI
Pennsylvania- 1915
Harvard- 1947
When was the US class action suit to forces changes to admissions policy to allow women?
1970s
Who is James Miranda Barry?
Canada’s first female doctor, 1865
- actually a women
- no one knows where and when she got her training
- wasn’t found out until she was laid in her coffin
Who is said to have performed the first Caesarian section in the British Empire?
James Miranda Barry
Who is Emily Stowe? Where was she denied entry and where did she graduate? How long was she denied license in Canada? What restrictions were on her?
- denied entry at the University of Toronto, graduated from private American schoo in 1865
- denied license in Canada until 1880
- was only allowed to have women as patients
Who was the first female medical school graduate in Canada in 1883?
Emily Stowe’s daughter, Augusta Stowe-Gullen
What were Emily Stowe and Augusta Stowe-Gullen advocates for? Did they work together? What did they focus on?
- became advocates for women’s rights and devoted their medical practices to women and children
- worked together out of they home in Toronto
- women’s health (reproductive, midwifery, etc.)
Who was Elinor F.E. Black? What was her focus and where did she go to school and graduate?
- First women lead an academic medical department inCanada
- Obstetrician
- University of Manitoba, 1952
When were there finally female medical deans in Canada? What universities?
- 1999
- Dalhousie University
- University of Western Ontario
Besides women, what other group was denied entry to universities and medical schools? What were they denied even after graduation?
- black students
- medical licenses and interships
In the 1860s, only___US schools admitted black students.
9
What did the black students do because they couldn’t get into medical schools?
Established their own schools and clinical facilities.
What were two medical schools established by black students? Where were they and when were they established?
- Howard University (Washington DC, 1868)
- Meharry University (Tennessee, 1875)
Where the black schools inclusive towards women?
No, only for black males.
What did the 2014 study by Jackie Duffin find?
Restrictions at Queens University on blacks, Jews, and women into the 1990s.
- Official restrictions –> went through admissions records
- Supported by the deans who made the policies
In the 1950s and 1960s, what brought forth legal challenges to admissions policies? What did this involve?
- civil rights movement
- serious protects
What types of movements challenged university restrictions?
social movements
As medical education increasingly embraced medical sciences, what did curricula become dominated by?
scientific pursuits
-research and clinical
__and__restrictions (formal and informal) continued to shape the complexion of the profession.
- social
- cultural
Did surgeons use science?
no
___in who is allowed to practice medicine.
unscientific
