Foreword

The scale of the Snapshot project was daunting from the beginning. The earliest discussions made clear that the supplement would require unusually complex planning and scheduling. And it would be four times larger than our usual supplements. My early discussions with Brownie Anderson had convinced me, however, that a successful Snapshot supplement would be a major contribution and therefore well worth the effort. Snapshot is an unprecedented collection of reports on curricular structure and change in North American medical education. First, it covers almost all of the accredited medical schools in the United States and in Canada (118 of the 125 in the United States and 12 of the 16 in Canada). Second, the reports have the same basic structure, so that the information can be more readily compared institution to institution. Third, they emphasize process and change rather than quantitative data. Fourth, the information was collected and distilled by a uniquely knowledgeable person. The last time that such a complete picture of U.S. medical education was presented was when Abraham Flexner published the results of his famous survey in 1910. His work is often misunderstood—Flexner did not undertake a dispassionate survey and afterwards make recommendations for reform. Instead, he had a strong agenda of promoting the path of reform already under way at some institutions, and he surveyed U.S. medical schools as a way to highlight the differences between the good schools, the ordinary schools, and the disgracefully bad ones. His report was so successful that the reform movement is associated with him, even though it predated him. Decades later, when the Flexnerian curriculum in its turn needed reform, again the changes were introduced piecemeal, at different speeds, in different surroundings and with widely different outcomes. Despite the commonalities brought about by accreditation and licensure standards, there is great and stimulating variety of educational approaches in our medical schools. However, the variety is difficult to comprehend. This time, unlike 1910, we do not need to know the number of hours that students study particular subjects or whether schools have entrance requirements. Instead, we need to understand the structures of curriculum governance and administration, the approach to curriculum organization, the philosophy of teaching and learning as expressed in the curriculum. The Snapshot collection gives us that. The collection can be used as a reference, to find information about a particular school or about an aspect of the medical curriculum across schools or about an innovation. It gives a general mile marker for how curricula are organized and governed. Most important, it may allow us to create schema, rather than only rank orders, of medical education programs and thus to better understand the structures and systems that can best educate physicians.

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