Change Without Reform: The Case of Stanford University School of Medicine, 1908–1990

Abstract

Since the late 19th century, medical education has become standardized into 2 years of preclinical schooling followed by 2 years of clinical work in hospitals and clinics. This 2 × 2 model of medical education has turned out to be sturdy in both the official curriculum and pedagogy that characterize the vast majority of medical schools today. Yet reformers have constantly sought major changes in this model throughout the 20th century. Why are there recurring curricular and instructional reforms, and why do these reforms seemingly leave untouched this 2 × 2 model? This article answers these questions by first turning to the 9-decade history of one seldom studied elite private medical school and its recurring reforms in curriculum and instruction. To ground the intersection between content and pedagogy, I inquire into the teaching of one perennial subject in the preclinical curriculum, human anatomy. Ideological issues about teaching anatomy to medical students and the entire preclinical phase of the 2 × 2 curriculum itself emerge as a central political struggle between competing views of what kinds of doctors Stanford University—and other medical schools—should produce. This political struggle among faculty, administration, and students over the kinds of future physicians is marked by periodic curricular and pedagogical treaties that maintain the overall stability of the 2 × 2 model, thus providing answers to the above questions.