Loss of laboratory instruction in American medical schools: erosion of Flexner's view of "scientific medical education.".

There has been a steep decline in the number of hours devoted to laboratory instruction in American medical schools. Medical students attending 1 of the 3 Washington DC medical schools now spend less than 10% of their first 2 basic science years in a laboratory. The paucity of laboratory instruction represents a reversal of the gains made in American medical education after the Flexner report and may partly account for our nation's missing physician-scientists. This situation is not expected to improve anytime soon, given the expenses that would be required to divert research-intensive faculty to laboratory instruction. The expenses would be particularly onerous for medical schools under intensive managed care pressures. Because it is unlikely that many American medical schools have either the will or means to make substantive changes in their laboratory-based curricula, novel solutions to restoring laboratory-based medical education may be required.