Applying to medical school is a rigorous process. After receiving a baccalaureate, potential students are required to take the Medical College Admissions Test (MCAT), they must obtain several letters of recommendation, and an Admissions Committee reviews their credentials. It’s an involved process that ensures the students who get into medical school will succeed. Medical education requirements were not always so arduous.   

Formal medical education began in Europe as early as the 13th century. It wasn’t until the mid-1700s, however, that medical schools began to pair lecture and clinical instruction. The system of linking a medical school with a hospital was the model that American medical schools adopted. Regardless of this advance, the process medical students go through today did not exist. Anyone who could pay the matriculation, lecture, and laboratory fees could go to medical school. 

Rather than pay tuition, medical students purchased lecture tickets. The tickets could be purchased by anyone, and would be presented to the professor at the time of the lecture. The professor’s salaries were often tied to the sale of tickets. A schedule of classes and the requirements needed to graduate were published in an Announcement book each year. Students could then purchase the tickets for the lectures and laboratories they would need to complete a three year medical apprenticeship.

The lecture ticket system was meant to make medical education accessible to anyone who had the desire to learn. However, in some places, this somewhat lax system led to poorly trained doctors. Since there were no regulations, often schools did not require lecture attendance, and there was not strict adherence of the curriculum. Although medical lecture tickets were used into the 20th Century, the reforms that began in the 1870s would eventually phase them out. By 1910, when the Flexner Report was published, they had disappeared.