852 



SCIENCE 



[N. S. Vol. XXXVII. No. 962 



not defensible. The same can be said of pathol- 

 ogy, or any other siibjeet in the curriculum. The 

 ultimate aim of medical education is to make good 

 practitioners of medicine. Another thing that con- 

 fronts us at the start of any consideration of the 

 medical curriculum is : What kind and what amount 

 of knowledge can the student acquire during the 

 four years of his medical education? The most 

 you expect is to give to the student a fair knowl- 

 edge of the principles of the fundamental subjects 

 in medicine, and the power to use the instruments 

 and methods of his profession; the right attitude 

 toward his patients and toward his fellow mem- 

 bers in the profession ; above all, to put him in 

 the position to carry on his education, because his 

 education is only begun in the medical school. 

 The student does not go out a trained practi- 

 tioner, a trained pathologist, or a trained anat- 

 omist or a surgeon. 



President Pritchett in the introduction 

 to the "Bulletin on Medical Education in 

 Europe" says: 



Even if one may assume that students enter the 

 study of medicine properly trained in the funda- 

 mental sciences, the problem of the curriculum is 

 a serious one. The report shows a general tend- 

 ency toward overburdening. The question nat- 

 urally arises. What ought the course of study of 

 a technical or professional school to accomplish? 

 The medical school can not turn out finished doc- 

 tors. It can not teach all that it is important for 

 the practitioner to know. Under these circum- 

 stances it does best to accept frankly certain lim- 

 itations, and so to train its students that they will 

 be disposed subsequently to remedy their own 

 deficiencies. Inclination of this kind appears most 

 likely to result from a training that prescribes 

 only the indispensable minimum, requiring in addi- 

 tion more thorough performance in a few direc- 

 tions and leaving opportunity for still further 

 effort to those of greater energy, interest or ability. 



Is not some of the overload due to our 

 having ignored the above facts, because we 

 have tried to teach all the sciences and all 

 the art and science of medicine, to turn out 

 specialists in medical sciences, in research 

 work, and in medicine and surgery. 



The past decade has seen a most marvel- 

 ous improvement in the teaching of medical 

 sciences and opportunities for laboratory 



work. Gone, never to return, are the purely 

 pi'ofessional courses in anatomy, chemistry 

 and physiology, given by busy practition- 

 ers or recent graduates, whose knowledge 

 of the subject was but little in advance of 

 the students, and who were able to repeat 

 a few simple experiments. To-day the 

 laboratory courses in the medical sciences 

 are far more extensive than even the Ger- 

 man schools. In this country the labora- 

 tory courses are paramount and the lecture 

 courses subordinate; in Germany it is the 

 reverse. The development of these courses 

 has been so rapid that the necessity for 

 setting limitation on them has not been ob- 

 served. President Pritchett says: 



The medical curriculum, extended as it is in 

 Europe, over five years, has reached the limits of 

 its capacity; it can contain no more. Exactly the 

 same process has occurred in medicine as has taken 

 place in the training of engineers. In fact, ex- 

 perience in these two kinds of technical education 

 during the last fifty years has been strikingly 

 similar. Most naturally the medical school and 

 the engineering school have endeavored to include 

 in their teaching some knowledge of the new sci- 

 ences developed in the last half century and of 

 their application. As a result, the burden de- 

 volved upon students of medicine and of engineer- 

 ing has grown enormously. The respective cur- 

 ricula have been formed almost altogether by 

 accretion, something being put in, little or nothing 

 taken out. As a result, both the medical student 

 and the engineering student are called upon to 

 carry, not only a heavier load, but a load made 

 up of more parts. 



As students come to the medical schools 

 with better preparation in the sciences, 

 there is a tendency to add more and more 

 detail; to extend the laboratory courses 

 and insist on all the precision, the rigor 

 and the abstraction of the research labora- 

 tory; to teach the subjects as pure science 

 and not as applied ; to lose sight of the abil- 

 ity of the student; to go beyond the need 

 of the future practitioners of medicine, 

 and plan the course as if all were to be 



