History of the School of Medicine
The Past Is A Prologue
The University of Pennsylvania School of Medicine was the first and only medical school in the thirteen American colonies when, in the fall of 1765, students enrolled for "anatomical lectures" and a course on "the theory and practice of physick." They enrolled at the College of Philadelphia, which was the name of the University of Pennsylvania in pre-Revolutionary times.
The founder of the School of Medicine was a young Philadelphia physician, John Morgan. The early faculty, including Morgan, had earned medical degrees at the University of Edinburgh and supplemented Edinburgh's courses with further study in London. London offered advanced training in anatomy in private schools owned by men who had become famous in this field. The clinical practice of medicine was taught by eminent preceptors in the great city hospitals.
Because of their training abroad, the University's founding faculty introduced two important elements in American medical education. With the University of Edinburgh as their model, they chose to build their medical school within an institution of higher learning. With the background of their hospital experience in London, they chose to emphasize the need to supplement medical lectures with bedside teaching, which for some time had been provided to apprentice physicians by practitioners at the Pennsylvania Hospital. Founded by Benjamin Franklin, this hospital was located within a few blocks of the college.
For more than a century, the pattern of medical education established in 1765 remained relatively unchanged. Not all medical schools, it is true, followed Pennsylvania's lead in forming academic ties; in fact, the growth of non-academic proprietary schools became something of a scandal. It is also true that bedside teaching under a preceptor was a traditional practice rather than a requirement. But, though often violated, the standards and procedures introduced by Pennsylvania remained the guiding force in medical education throughout most of the nineteenth century.
During this period, Pennsylvania enjoyed an unchallenged eminence as the grand old father of them all. The School of Medicine's faculty was famous throughout the country-Benjamin Rush in medicine, Philip Syng Physick in surgery, Robert Hare in chemistry and, around mid-century, William Pepper in medicine and Joseph Leidy in anatomy. In 1847, when a group of physicians organized the American Medical Association, they acted to ensure the new organization's prestige by naming the Professor of Medicine at Pennsylvania, Nathaniel Chapman, as first president.
More Rigid Standards
Toward the end of the nineteenth century, changes in American medical education were stimulated by the scientific activities in European medical centers. Although the work of such men as Pasteur, Koch, and Ehrlich inaugurated the era of modern medicine, the medical schools in America were still largely tied to eighteenth-century teaching methods. The new era called for the introduction of full-time teachers and investigators in the developing sciences of bacteriology, biochemistry, pharmacology, and others. It called for a program of study in scientific medicine which required additional years of training and higher academic standards for admission and graduation.
For a brief period in the 1880's, William Osler established on the campus an exciting investigative approach to medicine. He left behind him a small group of Pennsylvania disciples who formed the nucleus of those faculty pressing for needed reform.
Penn Builds Hospital
In the 1870's, when the University of Pennsylvania moved from downtown Philadelphia to its present campus west of the Schuylkill River, the medical faculty persuaded the trustees to build a teaching hospital-one to be owned by the University and staffed by the medical faculty. The Hospital of the University of Pennsylvania was the first such teaching hospital built for a medical school. Some decades later, general reforms in American medical schools were adopted following the Flexner Report of 1910. One of the recommendations was to have a bedside teaching program specifically conducted by appointed clinical faculty. The University played a pioneering role in promoting this important aspect of medical education. During the late nineteenth and early twentieth centuries, the School of Medicine was one of the earliest to encourage the development of the emerging medical specialties-neurosurgery, ophthalmology, dermatology, and radiology.
Within the three decades that preceded World War II, American medicine had caught up with European medicine and was making impressive contributions in the biomedical sciences. This medical school is among the small group of institutions whose alumni provide the greatest number of investigators and teachers in academic medicine. Probably the most important figure in the ultimate development of the University as a center of medical science was Alfred Newton Richards. His leadership was strongly felt during his long years as chairman of the Department of Pharmacology from 1910 to 1939.
In recent years, it has been charged that medical education has remained satisfied with a curriculum designed for a bygone era. Critics point to the changing face of America and question whether medical schools are educating doctors to participate knowledgeably in community decisions affecting health. As subjects almost untouched in the education of a physician, they cite problems such as environmental pollution and the socio-economic aspects of delivering medical care. They deplore the narrowing influence of the traditional fact-packed medical curriculum. They criticize the rigid requirements that send all medical students through all subjects, regardless of the particular medical career the individual student plans to pursue.
Medical Education
The need for a change in curriculum has been recognized throughout many generations at the School of Medicine. Since 1968, the school has undertaken several major curricular innovations. In 1970, 1981 and 1987, curricular redesigns were implemented that emphasized flexibility, early exposure to clinical medicine, increased integration between physiology, pathophysiology and pathology, increased ambulatory exposure, bioethics and nutrition education.
The most recent curricular revision, Curriculum 2000® (CU2000®) was implemented in 1997. CU2000® is an integrated, multidisciplinary curriculum which emphasizes small group instruction, self directed learning and flexibility. CU2000® was developed by focus groups comprised of department chairs, course directors, and students and is based on three themes; Science of Medicine, Art and Practice of Medicine and Professionalism and Humanism. Each component of CU2000® was developed simultaneously and collaboratively, thus providing for significant integration between clinical medicine and the basic science disciplines. During the basic science period, there is significant amount of unscheduled time during which students may pursue optional opportunities both within the medical school and with the University of Pennsylvania.
Clinical experiences begin the first day of school and continue throughout the program. Required clinical clerkships are a mix of inpatient and ambulatory experiences and basic science is reinforced throughout the clinical curriculum. Following the required clinical clerkships, significant time is available for electives and scholarly experiences.
On July 1, 1993, the University of Pennsylvania Medical Center officially became a part of the University of Pennsylvania Health System. The introduction of this system represents the University of Pennsylvania's response to the rapidly changing national scene in health care. The scene will demand coordinated health care that is highly responsive to cost containment. For patients, the change means some predictability about health care expenses and perhaps government-guaranteed access to certain levels of care. For health care providers, the challenge is to provide cost-effective care, top quality service, and a full range of clinical services that are geographically distributed. For medical schools, the changes require the development of new educational experiences which will prepare medical students to deliver health care services in ways that are responsive to the future needs of our society and which will expose them to evolving attitudes towards professional responsibility for the twenty-first century.
The components of the new system are the Medical Center (including the School of Medicine and the Hospital of the University of Pennsylvania), a new integrated provider network (the Clinical Care Associates of the University of Pennsylvania), a managed care office, a management services organization and other provider entities. The system creates a regional network that provides patients with access to primary care providers, both physicians and nurses.
The development of the new components of the University of Pennsylvania Health System provides the faculty of the School of Medicine with opportunities to address, through the educational process, the changes in health care delivery which will be in place when current medical students begin their medical careers. The development of the Clinical Care Associates provides new sites for educating students in primary care medicine and allows the students exposure to alternative practice environments.
CU2000® emphasizes many themes, such as preventive medicine, nutrition and clinical epidemiology to provide as many opportunities as possible for synergistic learning. The curriculum also emphasizes that medical education is a lifelong process and not an end in itself. CU2000® continues and enhances Penn's tradition of educating and training the world's next generation of academic medical leaders.
