of the 400 medical schools established, the majority did not have control of hospital facilities, such as wards, to be used for teaching and research.  efforts to establish these teaching hospitals in boston, new york and st. louis required the collective efforts on the part of the universities and their medical schools. in 1913, for example, drake university college of medicine dropped from the highest class of medical schools as the ama noted that they were not strongly affiliated with a large, local hospital. this greater knowledge in science and technology was not only valuable to their clinical practice, but it also helped medical scientists garner more respect in the eyes of the public.
 in the initial design of the teaching hospital, universities were given autonomy to appoint medical staff of the hospital and hospital trustees gave consent to physicians and medical students for using their hospital for both clinical and scientific work. they answer to the head of their department. as the data used to compare quality of care is mainly observational, it is nearly impossible to compare the quality of care between teaching hospitals and non-teaching hospitals. medical dramas taking place in teaching hospitals are said to be medically inaccurate, simplified, and exaggerated, but they succeed in capturing the dedication of doctors and trainees.
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