In the 1700s, medicine had no standards as a practice. It required no formal education or certification. Anyone could be a physician through self proclamation. The closest thing to training in the profession was apprenticeship with an established physician. The effectiveness of the apprenticeship would be contingent on the ability of the physician serving as the teacher. In the 1800s, medical schools began to develop, some of which provided licensure. But these schools were often poorly staffed, and training was inconsistent. Even prestigious schools, such as Harvard, only provided an eight month course to become a physician. When the Carnegie Foundation contracted Abraham Flexner to evaluate medical schools, it resulted in a criticism of the poorly operated schools and an upgrading of standards for schools that wished to continue offering medicine as a course of study. The result was fewer medical schools operating in the U.S. and fewer doctors, but a higher quality of service and the professionalization of the discipline.