MEDICAL
EDUCATION. BY
C. E. S.
Flemming, M.R.C.S., L.R.C.P., Bradford-on-Avon.
A few years ago Dame Janet Campbell's Report on Maternal Mortality caused much concern among the
profession and the
public, and an official inquiry showed were various causes for the unsatisfactory state of midwifery practice there set out, one of the most lrttportant being defective education. One wonders ^hat would be the result of a similar inquiry with regard to medicine generally; it would probably show, there also, a serious inadequacy with one of
that there
causes
the
system of education of medical
^vith this difference
men,
midwifery it is starvation and neglect, in medicine it is over-anxiety and engorgement. In medicine the errors are, generally
speaking, as m
not
so
:
that while in
obvious, the disasters
not
so
dramatic,
primarily with the Practitioner ; he has to take what is given him. The 0nus lies heavily on those responsible for his training midwifery.
The fault is not
and
We must, however, remember qualification. that with the rapid advance in medicine much more
required, and our system of education properly to accommodate itself to ^6 that have taken place. changes The newly-qualified man of to-day is no doubt rri?re efficient than was his predecessor of forty years
Jslasexpected
and
not been able
19i>
Dr. C. E. S. Flemming
200
ago, but his ability to make use of his knowledge is no better, if as good. Probably, with his greater knowledge at the moment of starting practice, he has use his powers of observation and deduction, and if these fail him as his lately-acquired knowledge
less need to
fades, will his wisdom grow
Unfortunately,
we
?
cannot shut
our
eyes to the
practitioners of to-day, there are yet too many whose ignorance arid incapacity are only cloaked by dogmatism and craft,
fact that excellent
as are
the medical
and others whose want of exercise of their reasoning powers has caused them to fail in professional efficiency.
If,
is the
in the
great majority, proficiency attained, has there not been much waste of money that could ill be afforded, and, worse still? waste of time, waste of too much of the best space of life, time spent in useless compulsory lectures, in acquiring unwanted knowledge, in examinations and as
case
has been
the
preparation
have not
been
opportunities
for them ?
spent
to
Briefly, the
best
time and money
advantage, and
have been lost.
One of the serious faults of medical education is
exaggerated value on mere knowledge from reason, the attempt to learn too many apart facts, to keep pace with new knowledge while failing
the
putting
an
as
to or
up or to defer the teaching of what is not wanted at the moment.
give
obsolete
important defect is the division of study watertight compartments, the want of association
A further into
of one
part with another, so that when the student passes from one compartment to another he is apt to shut out of his mind what he learnt in the first.
For instance? for two
physiology taught practically no reference to clinical
anatomy with
and
the time
a
are
medical student
gets
years
facts ;
by
into the ward, ho'vv
Medical Education
201
much of his examination anatomy does he remember need ? Still more does this apply when he gets mto practice. Knowledge is, of course, essential, but
?r
dry
facts without
Uever be
is to be
a
is
The block
similar
altered,
Unfortunately,
?to
appreciation
interesting.
the result of one
an
of their
import can system of teaching
system of examinations, and
so
must the other be.
examinations have become
fetish,
a
question of training primarily for examination, incidentally for practice, whereas it should be training primarily for practice and now
a
and
for
1Jicidentally studies
The
examination.
result
is
that
designed with the examiner in view and the patient. Remarkable evidence of this is the
not
are
Publication of numberless books written especially for examination purposes.
By encouraging
an
Why is this necessary ? accumulation of facts rather
than methods of observation and deduction, examinations defeat the aim of teaching to think. What
Actually
to-day
is the value of examinations Do
?
c?ttvpetence Questions ls
Why,
they
show
to find out what
it is
anything
we
asked, change
the best in the world
though
us
of the examinee ?
?
Is it
really
as
conducted
of the
possible
practical in
a
few
want to find out ?
system if the British We must change because, our
being perfect, because Medicine is constantly changing and advancing, and education to be effective must keep pace with it, the
best,
it is far from
aild
because there is much systems of other countries,
to
even
every way better than ours. What is the remedy ? We ^vant ?
be learned from the if
they
are
not in
must first know what
practical men, men whom ney can consult on every subject concerning their ealth, who will tell them what they ought to do and The
public
want
Dr. C. E. S. Flemming
202
when it is necessary for them to seek further advice. The public do not want essay writers only ; not, for example, the highly-qualified medical man who could
simple greenstick fracture in the a child, though he became later, in a small body, a specialist of some repute.
not set
a
forearm of area of the
The national medical service of the nation wants
competent practitioners, general practitioners first.
George Newman has told us lately how important is the practitioner in the medical service of the countryThe general practitioner can, if necessary, become a specialist; the man who has been trained only to be a specialist can never become a general practitioner, who is not only a potential specialist but is also, if he has been properly trained, a scientific researcher, a practitioner of preventive medicine, with unique opportunities of studying the earliest stages and the life history of disease. The qualification of a general practitioner lS fundamental to the making of a specialist, that is he is to treat human beings and not merely isolated Sir
bits of their bodies. There is
no
foundation whatever for the idea
that
any one medical man cannot know enough to give his patient the best value of medicine and when t?
apt to forget that the doctor has in his books a long array of consultants ? And, after all, the majority illnesses met with in practice do not require the assistance of a specialist. If we have decided that what we have to train and call in the
qualify to
is
start ?
students. on
expert.
a
general We
Incidentally,
medical
must
are
we
not
practitioner,
how
who
to
consider
are
be
tb?
education abolish the first-class
If it is useless to waste first-class
third-class persons, do not
are
Medical Education
203
education but the third class person. There is no doubt that under the British system some unfit men -
are or
admitted
students,
as
of insufficient
of unsuitable character
men
In America there is
intelligence.
a
regulated system of selection and many are rejected, but it is doubtful whether this practice would suit us 111
Great Britain.
cadetships,
as
The selection of candidates for naval
is done
by
that might be better. survival of the fittest is and
Machinery,
year of
some
study might
a
special Board,
The no
is
a
method
present system of the
doubt wasteful of
educating
form of selection after the first
be
practicable.
Sir George Newman, fourteen years ago, We require a man of high character, able and
wrote
:
willing
maintain the true dignity of a great profession, and to live up to the high ethical traditions of Medicine; of good general education, of interest,
a?tivity
and
knowledge
some
savoir-faire
;
a man
of
learning
and
in his vocation, with technical skill and ; but, above all, a practical man,
Medical experience
"With ideas and able to ment
of medical
Method and
^rords,
application, participate in
a
growth
the scientific
of accurate
experimentation,
the
lruprove
and
sound
of
and
found the
man
his education ?
spirit;
in other
we
Not
ability in judgment and
want, how
by adding already
Practical, economical, physical ls
are
to the
the curriculum, which has out of
looking develop-
observation, of
^terpretation." Having
forward
a
science, trained in the scientific
inspired by
man
with
to
length
reached the
and mental need.
we
limit, and
proportion to the result give up the attempt to do the impossible 111 learning endless facts, remembering, however, at the same time that practical medicine is the application We
must
or
204
Dr. C. E. S. Flemming
of many sciences. There must be constant revision as to what is to be added to and what is to be excised from
undergraduate
studies
decision has to be made
as
;
but trouble
comes
to what shall be
when
omitted.
It will be necessary for some independent body to determine this ; for while all concerned agree that " Not in economy is necessary, each in turn says :
department." a higher standard for entrance, a command of the English language, so that expression may be given clearly to our thoughts by speech or by writingThere must be some knowledge of the fundamentals : physics, chemistry (inorganic and organic), and biology* not only because of their relation to every branch of medicine, but also in order that the training they bring of scientific methods, exact observation and logical deduction may be thoroughly inculcated and colour the whole of the student's professional work both before and after qualifying. In his professional studies, in particular sections of more strictly medical work, attention will naturally be drawn to the importance of those subjects. This continuity and association of subjects must pertain throughout the There must be nothing useless; whole curriculum. each subject must be considered in its proper place and proportion. First will come a study of the body* its form and function?anatomy and physiology? In surgery, medicine and not in too much detail. my
We want
midwifery be
the
learned
as
special
details of these
application become knowledge be appreciated and
their need
and
obvious ; thus will this retained, and for this reason the
sooner some
sort of
begins the better, even in the first year. begins in the w ards it is apt to be forgotten necessary it is to have a knowledge of the body
clinical work When work how
subjects should
Medical Education
205
health, and to realize what wide variations of form ai^d function are consonant with health. There is little doubt that
much time
too
and
attention is given to surgery, not its general principles, "which are essential, but its specialized details. Much time is wasted in the theatre and the lecture-room
acquiring knowledge
and skill of
a
kind that is
only
required by the specialist, and too little, much too little, time is given to medicine, both in the wards a*id the
out-patient departments. Here clinicians are to miss the constant opportunities of teaching study of man as part of the study of disease, and lHustrating by clinical example the reasoned deductions too apt the
books and lectures. There is too great
a*id lecture ?ver the Hot
on
things
only
more
niore difficult to
the less of
daily
a
temptation to demonstrate common things, and to slur
occurrence, which are, in
essential to
practice,
fact,
but often much
explain because of the habit of taking them for granted. Throughout the curriculum it is Necessary to remember that it is a general practitioner that is being made, not a specialist?that specialist study can or should only be made after qualification. The question of lectures is important; there are ^ar too The having to many that are compulsory. attend so many, the signing up, are an evil influence that pervades all study and should undoubtedly be done away with. They are the heritage of an old 0rder that should be dealt with by an iconoclast. Q??d lectures, good demonstrations, clinical or other, need no compulsion for attendance ; if they are not good they are a serious waste of time. Compulsory ectures give the bad lecturer too good a chance. It goes without saying that skill in surgery or eminence 111 Medicine does not necessarily mean skill in teaching.
Dr. C. E. S. Flemming
206
Good lecturers not
are
too common;
none
they are high one.
made, and the birth-rate is not a examinations, as now held, necessary
Are
uniform
qualifying
final examination
distinction
should
be
taken
?
A
hardly be diplomas of
can
abolished, and other examinations for
special
born,
special branches of medicine There is after the qualification. or
not space here to discuss the reason, but it is
probably
accepted generally one-portal system is the vested and local interests stand ideal; unfortunately in the way of its adoption. The examination itself might quite well be held in the various teaching It should be, so far as possible, practical. centres. Also it should be required that all the subjects necessary for qualification be passed at the one time. If the system of examination is satisfactory there need be no hardship. If a man can only pass in three subjects by taking one at a time, it means that he cannot that the
carry in his mind at the same time the other two, so that if the examination is to be a test of his capacity he is, strictly only fit to practise in the
subject
last
speaking, passed ; either
of examination is wrong. It is, no doubt, generally tions
are
unsatisfactory,
wit to find
a
better
this is
so
or
that examina-
recognized
and it should not pass human of testing capacity. An
means
expert obstetrician lately said that in half
practical
method
the
examination he could test the
an
hour
capacity of
s
a
midwife better than with pages of papers. Not enough, if any, consideration is given to the
knowledge
of the teacher of the
capacity, has taught.
in every
Such a respect, of the candidate he practice might allow of favouritism, but that would be checked
body
;
even
by
the final examination
if not, it is
no
more
by
outside objection
an
open to
207
Medical Education
than the element of chance which mto
the
It
present system.
is
enters
the
so
largely
intermediate
examinations that distract the student, waste his time, misdirect his energies and interfere with the that there should be in his studies. ordered
continuity
Is there any reason the school itself ?
why they should
not be held
by
well be the rule that men could only proceed from one period of education to another after local examination, and this should be a
It
might
Passing
c?nducted
experience, ^le
by their practical should know of student know what the For in which he is being examined. the
by
who,
men
subjects
student becomes eligible for work 111 the ward as dresser or clinical clerk he should have Passed an examination in anatomy and physiology as held surgeons, and obstetricians,
Instance,
before
a
by physicians,
professors of anatomy subjects he will require
they
must know better
aild
physiology what of these obstetrics. practice of surgery, medicine and
J*1
than the
the
are education and examination of the men who be entrusted with the lives and health of the nation
*le
|?*ave heen determined to too great
by those ^vho are not in close contact with general practice and c?gnizant of its requirements. not Education, of course, never finishes, certainly of the final examination. But at what period ^ith lls education does a man become efficient enough to Practise alone ? It is the attempt to pass out men ully qualified for practice that causes the curriculum an
extent
*? be so crowded. Most men who have been some not fit ^ ears in practice will say that he is certainly back and ^hen he has many men look
just passed
;
to
without
practise how they had the temerity fonder rst resident job. The right at least
doing
one
to
Medical Education
208
practise
alone should not be
granted
until at least
a
year has been spent in residence at some hospital, where the novitiate may learn the technical application of his recently-acquired knowledge. Against this it is
argued
enough jobs for all, but with municipal hospitals now coming into being be many more opportunities, and, as a
that there
are
not
the numerous there must matter of are
fact, at the present time many institutions
finding considerable difficulty in getting residents. No
system of education
without
can
complete
be considered
and many
for
provision postgraduate study, are being formulated and put into practice to make it generally available ; but none can be more effective than the provision of hospital beds, where the general practitioner can not only treat many of his patients, but also come into contact with colleagues and consultants, and so help to keep himself conversant schemes
with current methods and ideas.
Many whereby does
already discussing the education may be improved,
councils medical
seem
are
desirable that
some
disinterested
means but it
committee
should inquire into the whole question and report to the General Medical Council, which must be the ultimate
authority.
Probably
the
British
Medical
parts of the profession, with its experience and influence, would
Association, in touch be the most
as
appropriate
it is with all
and useful
body
to set up
a
small and authoritative committee. REFERENCES. Sir
George Newman,
Notes
London, 1918, H.M.S.O. Professor Berry, Methods and
on
Medical
Objectives of
Education
in
Engla11^'
Medical Education.
page 247 of present issue). " The Student in Irons," Brit. Med. Jour., C. M. Wilson, 1 485* ? H. S. Souttar, "The Education of the Medical Student, Med. Jour., 1932, ii. 427. St. Mary's Hospital Gazette, April-June, 1932.
(See
^ 1*'?
Brit.
EDUCATION. BY
C. E. S.
Flemming, M.R.C.S., L.R.C.P., Bradford-on-Avon.
A few years ago Dame Janet Campbell's Report on Maternal Mortality caused much concern among the
profession and the
public, and an official inquiry showed were various causes for the unsatisfactory state of midwifery practice there set out, one of the most lrttportant being defective education. One wonders ^hat would be the result of a similar inquiry with regard to medicine generally; it would probably show, there also, a serious inadequacy with one of
that there
causes
the
system of education of medical
^vith this difference
men,
midwifery it is starvation and neglect, in medicine it is over-anxiety and engorgement. In medicine the errors are, generally
speaking, as m
not
so
:
that while in
obvious, the disasters
not
so
dramatic,
primarily with the Practitioner ; he has to take what is given him. The 0nus lies heavily on those responsible for his training midwifery.
The fault is not
and
We must, however, remember qualification. that with the rapid advance in medicine much more
required, and our system of education properly to accommodate itself to ^6 that have taken place. changes The newly-qualified man of to-day is no doubt rri?re efficient than was his predecessor of forty years
Jslasexpected
and
not been able
19i>
Dr. C. E. S. Flemming
200
ago, but his ability to make use of his knowledge is no better, if as good. Probably, with his greater knowledge at the moment of starting practice, he has use his powers of observation and deduction, and if these fail him as his lately-acquired knowledge
less need to
fades, will his wisdom grow
Unfortunately,
we
?
cannot shut
our
eyes to the
practitioners of to-day, there are yet too many whose ignorance arid incapacity are only cloaked by dogmatism and craft,
fact that excellent
as are
the medical
and others whose want of exercise of their reasoning powers has caused them to fail in professional efficiency.
If,
is the
in the
great majority, proficiency attained, has there not been much waste of money that could ill be afforded, and, worse still? waste of time, waste of too much of the best space of life, time spent in useless compulsory lectures, in acquiring unwanted knowledge, in examinations and as
case
has been
the
preparation
have not
been
opportunities
for them ?
spent
to
Briefly, the
best
time and money
advantage, and
have been lost.
One of the serious faults of medical education is
exaggerated value on mere knowledge from reason, the attempt to learn too many apart facts, to keep pace with new knowledge while failing
the
putting
an
as
to or
up or to defer the teaching of what is not wanted at the moment.
give
obsolete
important defect is the division of study watertight compartments, the want of association
A further into
of one
part with another, so that when the student passes from one compartment to another he is apt to shut out of his mind what he learnt in the first.
For instance? for two
physiology taught practically no reference to clinical
anatomy with
and
the time
a
are
medical student
gets
years
facts ;
by
into the ward, ho'vv
Medical Education
201
much of his examination anatomy does he remember need ? Still more does this apply when he gets mto practice. Knowledge is, of course, essential, but
?r
dry
facts without
Uever be
is to be
a
is
The block
similar
altered,
Unfortunately,
?to
appreciation
interesting.
the result of one
an
of their
import can system of teaching
system of examinations, and
so
must the other be.
examinations have become
fetish,
a
question of training primarily for examination, incidentally for practice, whereas it should be training primarily for practice and now
a
and
for
1Jicidentally studies
The
examination.
result
is
that
designed with the examiner in view and the patient. Remarkable evidence of this is the
not
are
Publication of numberless books written especially for examination purposes.
By encouraging
an
Why is this necessary ? accumulation of facts rather
than methods of observation and deduction, examinations defeat the aim of teaching to think. What
Actually
to-day
is the value of examinations Do
?
c?ttvpetence Questions ls
Why,
they
show
to find out what
it is
anything
we
asked, change
the best in the world
though
us
of the examinee ?
?
Is it
really
as
conducted
of the
possible
practical in
a
few
want to find out ?
system if the British We must change because, our
being perfect, because Medicine is constantly changing and advancing, and education to be effective must keep pace with it, the
best,
it is far from
aild
because there is much systems of other countries,
to
even
every way better than ours. What is the remedy ? We ^vant ?
be learned from the if
they
are
not in
must first know what
practical men, men whom ney can consult on every subject concerning their ealth, who will tell them what they ought to do and The
public
want
Dr. C. E. S. Flemming
202
when it is necessary for them to seek further advice. The public do not want essay writers only ; not, for example, the highly-qualified medical man who could
simple greenstick fracture in the a child, though he became later, in a small body, a specialist of some repute.
not set
a
forearm of area of the
The national medical service of the nation wants
competent practitioners, general practitioners first.
George Newman has told us lately how important is the practitioner in the medical service of the countryThe general practitioner can, if necessary, become a specialist; the man who has been trained only to be a specialist can never become a general practitioner, who is not only a potential specialist but is also, if he has been properly trained, a scientific researcher, a practitioner of preventive medicine, with unique opportunities of studying the earliest stages and the life history of disease. The qualification of a general practitioner lS fundamental to the making of a specialist, that is he is to treat human beings and not merely isolated Sir
bits of their bodies. There is
no
foundation whatever for the idea
that
any one medical man cannot know enough to give his patient the best value of medicine and when t?
apt to forget that the doctor has in his books a long array of consultants ? And, after all, the majority illnesses met with in practice do not require the assistance of a specialist. If we have decided that what we have to train and call in the
qualify to
is
start ?
students. on
expert.
a
general We
Incidentally,
medical
must
are
we
not
practitioner,
how
who
to
consider
are
be
tb?
education abolish the first-class
If it is useless to waste first-class
third-class persons, do not
are
Medical Education
203
education but the third class person. There is no doubt that under the British system some unfit men -
are or
admitted
students,
as
of insufficient
of unsuitable character
men
In America there is
intelligence.
a
regulated system of selection and many are rejected, but it is doubtful whether this practice would suit us 111
Great Britain.
cadetships,
as
The selection of candidates for naval
is done
by
that might be better. survival of the fittest is and
Machinery,
year of
some
study might
a
special Board,
The no
is
a
method
present system of the
doubt wasteful of
educating
form of selection after the first
be
practicable.
Sir George Newman, fourteen years ago, We require a man of high character, able and
wrote
:
willing
maintain the true dignity of a great profession, and to live up to the high ethical traditions of Medicine; of good general education, of interest,
a?tivity
and
knowledge
some
savoir-faire
;
a man
of
learning
and
in his vocation, with technical skill and ; but, above all, a practical man,
Medical experience
"With ideas and able to ment
of medical
Method and
^rords,
application, participate in
a
growth
the scientific
of accurate
experimentation,
the
lruprove
and
sound
of
and
found the
man
his education ?
spirit;
in other
we
Not
ability in judgment and
want, how
by adding already
Practical, economical, physical ls
are
to the
the curriculum, which has out of
looking develop-
observation, of
^terpretation." Having
forward
a
science, trained in the scientific
inspired by
man
with
to
length
reached the
and mental need.
we
limit, and
proportion to the result give up the attempt to do the impossible 111 learning endless facts, remembering, however, at the same time that practical medicine is the application We
must
or
204
Dr. C. E. S. Flemming
of many sciences. There must be constant revision as to what is to be added to and what is to be excised from
undergraduate
studies
decision has to be made
as
;
but trouble
comes
to what shall be
when
omitted.
It will be necessary for some independent body to determine this ; for while all concerned agree that " Not in economy is necessary, each in turn says :
department." a higher standard for entrance, a command of the English language, so that expression may be given clearly to our thoughts by speech or by writingThere must be some knowledge of the fundamentals : physics, chemistry (inorganic and organic), and biology* not only because of their relation to every branch of medicine, but also in order that the training they bring of scientific methods, exact observation and logical deduction may be thoroughly inculcated and colour the whole of the student's professional work both before and after qualifying. In his professional studies, in particular sections of more strictly medical work, attention will naturally be drawn to the importance of those subjects. This continuity and association of subjects must pertain throughout the There must be nothing useless; whole curriculum. each subject must be considered in its proper place and proportion. First will come a study of the body* its form and function?anatomy and physiology? In surgery, medicine and not in too much detail. my
We want
midwifery be
the
learned
as
special
details of these
application become knowledge be appreciated and
their need
and
obvious ; thus will this retained, and for this reason the
sooner some
sort of
begins the better, even in the first year. begins in the w ards it is apt to be forgotten necessary it is to have a knowledge of the body
clinical work When work how
subjects should
Medical Education
205
health, and to realize what wide variations of form ai^d function are consonant with health. There is little doubt that
much time
too
and
attention is given to surgery, not its general principles, "which are essential, but its specialized details. Much time is wasted in the theatre and the lecture-room
acquiring knowledge
and skill of
a
kind that is
only
required by the specialist, and too little, much too little, time is given to medicine, both in the wards a*id the
out-patient departments. Here clinicians are to miss the constant opportunities of teaching study of man as part of the study of disease, and lHustrating by clinical example the reasoned deductions too apt the
books and lectures. There is too great
a*id lecture ?ver the Hot
on
things
only
more
niore difficult to
the less of
daily
a
temptation to demonstrate common things, and to slur
occurrence, which are, in
essential to
practice,
fact,
but often much
explain because of the habit of taking them for granted. Throughout the curriculum it is Necessary to remember that it is a general practitioner that is being made, not a specialist?that specialist study can or should only be made after qualification. The question of lectures is important; there are ^ar too The having to many that are compulsory. attend so many, the signing up, are an evil influence that pervades all study and should undoubtedly be done away with. They are the heritage of an old 0rder that should be dealt with by an iconoclast. Q??d lectures, good demonstrations, clinical or other, need no compulsion for attendance ; if they are not good they are a serious waste of time. Compulsory ectures give the bad lecturer too good a chance. It goes without saying that skill in surgery or eminence 111 Medicine does not necessarily mean skill in teaching.
Dr. C. E. S. Flemming
206
Good lecturers not
are
too common;
none
they are high one.
made, and the birth-rate is not a examinations, as now held, necessary
Are
uniform
qualifying
final examination
distinction
should
be
taken
?
A
hardly be diplomas of
can
abolished, and other examinations for
special
born,
special branches of medicine There is after the qualification. or
not space here to discuss the reason, but it is
probably
accepted generally one-portal system is the vested and local interests stand ideal; unfortunately in the way of its adoption. The examination itself might quite well be held in the various teaching It should be, so far as possible, practical. centres. Also it should be required that all the subjects necessary for qualification be passed at the one time. If the system of examination is satisfactory there need be no hardship. If a man can only pass in three subjects by taking one at a time, it means that he cannot that the
carry in his mind at the same time the other two, so that if the examination is to be a test of his capacity he is, strictly only fit to practise in the
subject
last
speaking, passed ; either
of examination is wrong. It is, no doubt, generally tions
are
unsatisfactory,
wit to find
a
better
this is
so
or
that examina-
recognized
and it should not pass human of testing capacity. An
means
expert obstetrician lately said that in half
practical
method
the
examination he could test the
an
hour
capacity of
s
a
midwife better than with pages of papers. Not enough, if any, consideration is given to the
knowledge
of the teacher of the
capacity, has taught.
in every
Such a respect, of the candidate he practice might allow of favouritism, but that would be checked
body
;
even
by
the final examination
if not, it is
no
more
by
outside objection
an
open to
207
Medical Education
than the element of chance which mto
the
It
present system.
is
enters
the
so
largely
intermediate
examinations that distract the student, waste his time, misdirect his energies and interfere with the that there should be in his studies. ordered
continuity
Is there any reason the school itself ?
why they should
not be held
by
well be the rule that men could only proceed from one period of education to another after local examination, and this should be a
It
might
Passing
c?nducted
experience, ^le
by their practical should know of student know what the For in which he is being examined. the
by
who,
men
subjects
student becomes eligible for work 111 the ward as dresser or clinical clerk he should have Passed an examination in anatomy and physiology as held surgeons, and obstetricians,
Instance,
before
a
by physicians,
professors of anatomy subjects he will require
they
must know better
aild
physiology what of these obstetrics. practice of surgery, medicine and
J*1
than the
the
are education and examination of the men who be entrusted with the lives and health of the nation
*le
|?*ave heen determined to too great
by those ^vho are not in close contact with general practice and c?gnizant of its requirements. not Education, of course, never finishes, certainly of the final examination. But at what period ^ith lls education does a man become efficient enough to Practise alone ? It is the attempt to pass out men ully qualified for practice that causes the curriculum an
extent
*? be so crowded. Most men who have been some not fit ^ ears in practice will say that he is certainly back and ^hen he has many men look
just passed
;
to
without
practise how they had the temerity fonder rst resident job. The right at least
doing
one
to
Medical Education
208
practise
alone should not be
granted
until at least
a
year has been spent in residence at some hospital, where the novitiate may learn the technical application of his recently-acquired knowledge. Against this it is
argued
enough jobs for all, but with municipal hospitals now coming into being be many more opportunities, and, as a
that there
are
not
the numerous there must matter of are
fact, at the present time many institutions
finding considerable difficulty in getting residents. No
system of education
without
can
complete
be considered
and many
for
provision postgraduate study, are being formulated and put into practice to make it generally available ; but none can be more effective than the provision of hospital beds, where the general practitioner can not only treat many of his patients, but also come into contact with colleagues and consultants, and so help to keep himself conversant schemes
with current methods and ideas.
Many whereby does
already discussing the education may be improved,
councils medical
seem
are
desirable that
some
disinterested
means but it
committee
should inquire into the whole question and report to the General Medical Council, which must be the ultimate
authority.
Probably
the
British
Medical
parts of the profession, with its experience and influence, would
Association, in touch be the most
as
appropriate
it is with all
and useful
body
to set up
a
small and authoritative committee. REFERENCES. Sir
George Newman,
Notes
London, 1918, H.M.S.O. Professor Berry, Methods and
on
Medical
Objectives of
Education
in
Engla11^'
Medical Education.
page 247 of present issue). " The Student in Irons," Brit. Med. Jour., C. M. Wilson, 1 485* ? H. S. Souttar, "The Education of the Medical Student, Med. Jour., 1932, ii. 427. St. Mary's Hospital Gazette, April-June, 1932.
(See
^ 1*'?
Brit.
