“Forgetting” after an exam might not be a bad thing
– Written by: Dr. Claudio Violato –
The Flexner Report
In 1910, Abraham Flexner produced the now famous Flexner Report, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of
Teaching that was commissioned by the Carnegie Foundation [1]. At that time there were approximately 157 medical schools that were loosely affiliated with educational institutions and the education of physicians was primarily a for-profit business. The knowledge and skills of the graduating physicians was highly variable, resulting in an over-production of poorly educated medical practitioners.
Flexner provided a review of medical education and medical institutions and reviewed the economic and social factors that had an impact on the delivery of medicine of that era. He concluded that the situation was untenable and that medical education needed to be radically transformed. Today, with a few rare exceptions, medical school organization in the United States and Canada consist of 4 years, the first two pre-clinical or laboratory sciences consisting of foundational knowledge in anatomy, physiology, pharmacology, and pathology, followed by two years of clinical sciences experiences. The Flexner Report also contained arguments for evidence-based and scientific-based medicine. It has had an impact on the medical school admissions process, the learning environment, the qualifications and expectations of medical teachers and the need for standardized licensure exams. The Flexner Report has been pivotal to most of modern medical education including the development of standardized testing and assessment in medicine.
Meanwhile developments in large scale standardized testing were taking place in Europe and the United States largely as a consequence of World War I. Large scale testing in Germany for army inductees had been in progress since 1905. Alfred Binet and Theodore Simon had discussed the application intelligence testing for the French army in 1910. In the United States Lewis Terman had completed the revision and standardization of the Binet scales in 1917 and these principles of mass testing were soon applied to the American military effort resulting in the Army Alpha and Beta Tests of intelligence . Nearly two million recruits were tested with these instruments before the end of WWI [2]. This testing was seen as so successful, that after the war large scale standardized testing swept the American school systems. The major types of test used throughout the 20th century were pencil-and-paper multiple choice questions (MCQ).
Statistical and Mathematical Theories
Another important development that underlay this widespread testing was the development of modern statistics. The large databases that were generated from this prodigious testing required improvements in statistical methods. Beginning in the late 19th century, there were a series of statistical and mathematical initiatives. Major contributors to the field have been Sir Francis Galton (polymath, correlation), Sir Ronald Fisher (analysis of variance), Karl Pearson (mathematical statistics, correlation), Charles Spearman (measurement of intelligence, factor analysis), E.L. Thorndike (educational measurement), Fredrick Kuder (reliability), Lee J Cronbach (reliability, generalizability theory), George Rasch (item response theory), Fredric M Lord (item response theory), Karl Joreskog (confirmatory factor analysis), and Peter Bentler (structural equation modelling) as well as many others.
Sources:
[1] Flexner, A (1910) Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching, Bulletin No. 4., New York City: The Carnegie Foundation for the Advancement of Teaching
[2] McArthur DL (1983). Educational Testing and Measurement: A Brief History, Center for the Study of Evaluation Report #216, University of California, Los Angeles.
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