Students applying to medical school today can expect to have grappled with chemistry and organic chemistry, biology, and physics. The MCATs test their knowledge of physical sciences and biological sciences, considered essential for the profession. But 250 years ago, when John Morgan, MD, was presenting his ideas for what would become the first medical school in the nation, he had some recommendations that might puzzle -- and perhaps even terrify -- a modern-day applicant. “Latin and Greek are very necessary to be known by a physician. The latter contains the rich original treasures of original medical science. . . . The former . . . is the vehicle of knowledge in which the learned men of every nation in Europe choose to convey their sentiments, and communicate their discoveries to the world.”
John Morgan, MD
Such comments suggest why Morgan believed a school of medicine should be affiliated not with a hospital but with a college or university: he saw medicine as allied with the liberal arts and a broader outlook on life. Without general knowledge, he said, “we cannot penetrate into those truths that form the rules by which we ought to conduct ourselves in the cure of diseases.” In his lengthy presentation during the 1765 commencement of the College of Philadelphia (as Penn was originally known), Morgan laid out his vision for an American medical school. But his remarks were not universally well received, particularly by some other professionals. Morgan wanted to steer medicine away from the apprentice system of the day, which he felt constituted a dead end: the apprentice was unlikely ever to progress beyond the master. He also made a point of distinguishing between medicine and surgery. Surgery, according to Morgan, was an unintellectual and mechanical art. (This, even though his acquaintance and future associate as professor, the surgeon William Shippen Jr., had earned his MD degree at the same well-regarded institution as Morgan, the University of Edinburgh.)
In the 1760s, Penn’s medical students had to attend at least one course of lectures in anatomy, materia medica (an early form of pharmacology), chemistry, and the theory and practice of physic. They also had to attend one course of clinical lectures, based at Pennsylvania hospital. The students also were required to have served an apprenticeship with a reputable medical practitioner. In the late 1780s, when Caspar Wistar, MD, joined the faculty, he taught a new course, the institutes of medicine -- a forerunner of physiology.
Benjamin Rush, MD, was the burgeoning medical school’s first professor of chemistry. A few years after Morgan’s discourse, Rush posed a rhetorical question suggesting that not all of medicine could be learned from lectures and books: “Would you cross the ocean in a ship built by a carpenter who had heard lectures only upon shipbuilding for two years, without having handled an ax or hammer in the course of his life?” In effect, he was acknowledging the value of clinical practice, the more hands-on approach. Rush had much experience outside the classroom, treating mainly the poor; and he was among the physicians who stayed behind in Philadelphia during the yellow fever epidemic of 1793 to treat those afflicted.
Despite his dedication to clinical practice, however, Rush too saw the virtue of a broad education for those aspiring to be doctors. In 1792, he delivered an introductory lecture called “The Education Proper to Qualify a Young Man to Study Medicine.” The useful background included -- in addition to reading, writing, and arithmetic -- French, German, possibly Italian; natural philosophy and metaphysics; Christian doctrine; history, government, poetry, drawing, and the principles of English grammar. In short, as George W. Corner, author of Two Centuries of Medicine (1965) put it: “the equivalent of a college or, at least, a good secondary school education.”
For Penn’s School of Medicine, views of what constituted the proper education and training of a physician -- and who should be admitted to the school -- have varied over time. And in this regard, Penn was certainly not alone. Indeed, Corner described the general situation: “By the 1870s the state of medical education was a national scandal, demanding a long and costly period of reform led by a few of the better university schools.” Penn, he continued, “could not entirely escape the evil effects of competition and public laxity.” At times, Penn’s medical school “was impelled to reduce the level of general academic preparation required of candidates for its degree.” In the 1880s, applicants to Penn had to have “sufficient command of English to write a one-page essay, correct in grammar and spelling, and must pass a written examination in elementary physics.” But they did not even have to show that they had graduated from high school.
According to Innovation and Tradition at the University of Pennsylvania School of Medicine (1990), “The weakest link in medical education was the recurring shortage of patients for clinical instruction.” William Pepper Jr., MD, one of Penn’s most influential professors in the 19th century, became leader of a move to establish a hospital for the medical school. The Hospital of the University of Pennsylvania opened its doors in 1874, thus allowing greater access to patients.
A few years later, the indefatigable Pepper became provost of the University. In that role, he strongly advocated adding a fourth year to the medical school’s curriculum and sought to establish stricter admission standards. In 1893, the fourth year became mandatory. When classes began that fall, Pepper delivered an opening address, and he did not shy away from raising comparisons to other medical schools. He pointed out that the new medical school in Baltimore, established by Johns Hopkins University, had filled its incoming class exclusively with men and women holding B.A. and B.S. degrees.
Penn’s move toward more rigorous admissions standards was soon to follow. At the same time, what the school offered its students became better. In 1910, Abraham Flexner issued his famous report on medical schools, commissioned by the Carnegie Commission. Many schools eventually closed because of Flexner’s scathing commentary, but Penn’s was one he praised. In particular, Flexner cited Penn’s “five separate well-equipped buildings” for laboratory use.
As was true for other medical schools as well, Penn’s course of studies became structured as two years of classwork (basic science), followed by two years with a more clinical emphasis. A dramatic change came in 1997, with the rolling out of Curriculum 2000, which can be described as the most significant overhaul of the curriculum since the school’s founding. It integrates basic science and clinical education across all four years in a more flexible way that makes use of current technology and encourages team-building among the students. As Gail Morrison, MD, the vice dean of education, stated when the curriculum was launched: “The explosion in medical knowledge has made it more important to teach doctors how to be lifelong learners, how to access information, and how to answer questions.”
Today, applicants to the Perelman School of Medicine do not have to demonstrate familiarity with Latin and Greek, or even metaphysics. Indeed, the classics that Morgan admired have no doubt been translated and are readily available in English. And at the same time, admissions requirements today guarantee that the students who are admitted will have a certain amount of “general knowledge.” Once in medical school, they learn molecular biology and nuclear medicine; and in gross anatomy, they may deal with both real cadavers and cyber cadavers. Their computers, tablets, and smartphones can summon all the relevant learning of the past. What today’s medical school offers exceeds what even John Morgan could ever have imagined.