Original image: Philadelphia General Hospital Photograph Collection, Historical Medical Library of The College of Physicians of Philadelphia.

The use of intermediary devices such as the stethoscope signaled the slow shift away from traditional and folk medicine, which was personal and patient focused, to a formalized profession based upon a conventional understanding of a body of knowledge.

While there were a handful of medical schools affiliated with universities, such as the one at the University of Pennsylvania, most medical education in the early and middle nineteenth century was provided through autonomous schools. These schools were typically staffed by a small faculty, and offered little in the way of clinical experience. Competition from medical schools in the United Kingdom, France and Germany was fierce, as European schools offered the most ambitious students the chance to be at the forefront of medical trends and theories.

Medical students in the nineteenth century were predominantly male. For these students, dissection became a rite of passage, one that permitted them to develop a common professional identity separate from midwives and other non-professional healers. The emphasis on anatomy in the classroom reinforced the idea that medicine was a scientific and rigorous discipline, to the extent that students would attend private dissection "academies," such as the Philadelphia School of Anatomy. This emphasis helped foster the social recognition that simply having a medical diploma – hanging out a shingle, in other words – might not be sufficient for the education of a physician.

It was not until the latter half of the nineteenth century that medical education began to resemble modern education. The new medical college at Johns Hopkins University, which was founded in 1893, required new students to have a college degree. It offered an annual 9-month term within a 4-year curriculum, and required students to participate in laboratory and clinical "clerkships" staffed by faculty who were both teachers and researchers.