Applying to medical school today is a demanding and highly structured process. Prospective students must first complete a bachelor’s degree, take the Medical College Admission Test (MCAT), gather letters of recommendation, and be reviewed by an admissions committee. The process is designed to identify candidates most likely to succeed in medical school. However, the path to becoming a doctor wasn’t always so difficult.

Formal medical education dates back to 13th-century Europe, but it wasn’t until the mid-1700s that medical schools began integrating classroom lectures with clinical instruction. This model was eventually adopted in the United States, but early American medical schools operated under a vastly different structure. Admission was not based on academic merit but rather on the ability to pay for lecture and laboratory fees.

For over a century, American medical schools, both private and university-affiliated, operated as proprietary institutions. Instead of a tuition system, students purchased lecture and lab tickets from professors. The professors, in turn, paid a portion of their earnings to the dean or to cover operating costs and kept the rest as profit. With few exceptions, most medical schools operated this way, giving faculty significant control over admissions, curriculum, and graduation standards.

Each year, medical schools published an Announcement book listing the course requirements for completing a typical three-year program. Students purchased lecture and lab tickets based on this schedule and attended classes largely at their own discretion. With little oversight or enforcement, this system often led to inconsistent training and significant differences in the knowledge and skill levels of medical practitioners.

By the late 19th century, concern over the quality of medical education prompted reform, and in 1870, efforts began to standardize curriculum, admissions, and teaching. In 1910, the Flexner Report pushed for significant changes that led to the closure of substandard schools and the end of the lecture ticket system. From then on, medical training would become more standardized and academically grounded, laying the foundation for the system we know today.

CU Medical School

Established in 1883, the University of Colorado School of Medicine began as a tuition-free institution. Because medical education was open to all, there was no need for lecture tickets, possibly explaining why the Health Sciences Library does not hold any examples of them in its collection.

Notably, the University also admitted women to its medical school, a progressive move that stood in contrast to the norms of the time. This decision drew criticism from some, including the Journal of the American Medical Association, which voiced strong disapproval of the program. The opinion appeared on page 183 of Volume I, published in 1883.

Visit CU Anschutz Digital Collections

The lecture tickets in the Strauss Health Sciences Library's collection are part of a large donation from Dr. Robert Shikes, professor emeritus of pathology at the University of Colorado School of Medicine. A dedicated collector of medical artifacts, Dr. Shikes donated thousands of items, including lecture tickets, pamphlets, postcards, and medical advertising ephemera. He also co-authored two histories of the University of Colorado School of Medicine with Dr. Henry Claman. Additional medical lecture tickets can be viewed in the CU Anschutz Digital Collections.