At the beginning of the 20th century, most medical education consisted of a two-year degree followed by two years of professional training in a hospital environment. The standard of education varied widely. In 1910, the Council on Medical Education of the American Medical Association commissioned the Carnegie Foundation to produce a report on medical education. The resulting document was entitled "Medical Education in the United States and Canada" but is often simply called the Flexner Report after its author, Abraham Flexner. It recommended a radical reorganization of medical teaching to equal the rigorous university-based medical education available in Europe. The structure of modern medical education in the United States, with its division into pre-med and medical school, remains based on the Flexner Report.
The basic requirements for entering medical school are set by the Association of American Medical Colleges. Medical schools can impose further requirements but most center around a core of general chemistry, general biology, organic chemistry and general physics. Two semesters or three quarters of each subject are the norm. Advanced math and writing courses are also often required. Some schools may have biochemistry requirements as part of their organic chemistry element or include zoology with biology.
There are a variety of undergraduate degrees in the medical field other than pre-med. For instance, the Bachelor of Science and Associate of Science degrees in Nursing are designed to prepare students for the NCLEX-RN exam, although other nurses approach this exam through graduate degrees. Similarly, some midwives receive their training at the undergraduate level, while others begin with apprenticeships. Bachelor's degrees in pharmacy are also available in some countries, although in the United States, this is a postgraduate specialization.
Unlike the United States, many other countries have specialized undergraduate degrees in medicine. The United Kingdom is one example. These intensive courses qualify students as Bachelors of Medicine and Surgery and are followed by further training. A similar structure exists in Australia, where students can either undertake longer undergraduate medical courses or begin with an undergraduate degree in another subject before moving on to a graduate medical program. In Canada, most students begin medical training following an undergraduate degree in another field. Most medical programs worldwide are based on either the British or American models.