Goodbye to all that: Centennial cycles in academic medicine

In the 1990s, medicine and medical education face great changes and dislocations both traumatic and transforming. But similar crises and upheavals were faced by physicians and medical educators in the 1790s and 1890s. As each of these centuries drew to a close, great changes took place in medicine. The author describes these centennial cycles, concentrating on the last 200 years of academic medicine as it faced the vicissitudes of change in ''the nineties.'' He focuses first on the 1790s and the influence of the French Revolution on medicine, then discusses the reforms in the 1890s and that led to the so-called Flexnerian reforms early in the twentieth century. Finally, he considers the 1990s, drawing parallels between the crises of earlier centuries and the situation of American medicine on the cusp of the twenty-first century. He argues that today's leaders in academe ignore the narratives of past medical metamorphoses at their peril, and that while having an understanding of the past will not enable leaders to forestall the future, it can prepare them for it.