This essay stresses that at the end of the century America still struggled to resolve the problems of its medical education. It is clear there was a realization that changes should be brought in order to remedy the situation in order to transform American medical education along the lines of European medical schools. However, real reform of American medical education did not start until Carnegie Foundation published famous report of Abraham Flexner Medical education in the United States and Canada
This report entailed huge reforms in the quality of education that American medical schools provided. The fact that these reforms were not implemented in the USA at the end of 19th century can be explained by several reasons. First the USA was a comparatively young country and could not provide as much opportunities for the research as Western European countries could. Few doctors were among the first settlers of the USA (partly due to the limited possibilities for their practice in the continent), and the social status of those who settled in America was comparatively low. Most of the medical schools that were founded relied on the fees of their students, whereas in Western European countries Government took active part in financing of medical educational institutions. As the medical schools were struggling in the USA to find adequate finances they had to take into account the wishes and desires of the students, who wanted to receive their medical diplomas as quickly as possible, which certainly in turn entailed the lowering of quality standards of medical education.