NATURE 



573 



THURSDAY, JULY 8, 1920. 



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Medical Education. 



DURING the last thirty years the feeling has 

 become increasingly insistent, both in this 

 country and in America, that certain radical re- 

 forms were needed in the methods of education in 

 medicine. But our American colleagues have 

 been fortunate in having the opportunity and the 

 means for building new schools of medicine to 

 meet the new circumstances and for making drastic 

 changes in their methods of teaching which a 

 variety of circumstances has hitherto prevented us 

 from attempting in Britain. Now that the 

 Rockefeller Foundation, by its magnificent 

 generosity, has made it possible for us to embark 

 upon the diflkult sea of reform, it is particularly 

 interesting and instructive to study the policy 

 adopted in the more advanced schools of America 

 during the twenty-seven years since the Johns 

 Hopkins Medical School gave the study of 

 medicine in America a new aim and a higher ideal. 

 Though we are a quarter of a century behind our 

 American colleagues in making a start, our delay 

 has given us the advantage that we can profit by 

 the experiments made on the other side of the 

 Atlantic. 



It is not generally recognised here how 

 thoroughly the leaders of medical education in 

 America explored every possible method of educa- 

 tion throughout the world, and how much devo- 

 tion and thought they have expended on experi- 

 ments to discover, by truly scientific methods, 

 how best to employ the few years that the medical 

 student can devote to the training for his pro- 

 fession. Those who want to understand some- 

 thing of the spirit and the high ideals that have 

 inspired the American leaders in this great reform 

 movement should read the account of their work 

 and aims in the volume " Medical Research and 

 Education," issued by the Science Press in New 

 York in 191 3. Briefly expressed, the matters upon 

 NO. 2645. VOL. 105] 



which chief insistence is placed are as follows : 

 The absolute necessity of (a) an adequate prelim- 

 inary education and a serious University training 

 in the basal sciences, physics, chemistry, and 

 biology, without which foundation it is impossible 

 for the student really to profit from his training 

 in medical science ; and (6) a method of 

 practical teaching in all branches of professional 

 work, whereby the student can, so far as possible, 

 investigate for himself the facts and theories of 

 each subject under the direction of men who are 

 themselves engaged in research work, and not rely 

 mainly upon lectures and demonstrations to give 

 him merely the results of other people's work. In 

 other words, the aim of the reform is to train the 

 student in scientific methods rather than to 

 " cram " him with traditional lore. 



So Impressed were certain American teachers 

 with the evils of the lecture system of instruction 

 that the attempt was made to eliminate lectures 

 altogether. On this side of the Atlantic (and in 

 most American schools also) it is recognised that 

 some lectures are essential to give the student 

 guidance and a right perspective in his work, and 

 that demonstrations are an invaluable means of 

 instruction, provided the student can really see 

 the objects and appreciate the significance of the 

 experiments. No impartial observer will, how- 

 ever, refuse to admit that in most British schools 

 an altogether undue amount of the medical 

 student's and his teacher's time is wasted in the 

 attendance upon lectures and demonstrations of 

 a useless or distracting kind. Several circum- 

 stances make it difficult to break with this vicious 

 system. The financial arrangements in most of 

 our schools are based upon payments for certain 

 courses of lectures or demonstrations : the require- 

 ments of most institutions and examining boards 

 are for attendance at so many lectures : and the 

 method of awarding the Board of Education 

 grants for some time helped still further to stereo- 

 type this system. In the American schools the 

 student pays for his instruction, and the teacher 

 is free to decide how best the required instruction 

 is provided ; in other words, the method of admin- 

 istration of the department is so arranged that the 

 perpetuation of obsolete and vicious methods is 

 not made compulsory for a teacher who has his 

 own ideas as to how to educate his students to the 

 best advantage. 



The other great reform in American medical 

 educational practice has been to bring the methods 

 of teaching and research in the clinical subjects 

 into line with those of the intermediate subjects. 



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