570 
text-book, and lowest of all in the scale is the 
formal lecture. Curiously enough, the lec- 
ture is-also the easiest method, by which ap- 
parently the greatest amount of information 
is gained with the least expenditure of energy, 
at least on the part of the student. But this 
is a delusion. The knowledge thus gained is 
unreal and transient. It is “in at one ear, 
and out at the other.” As we should natu- 
rally expect from the principle of self-activ- 
ity, the ease of the method is apt to be in- 
versely proportional to the efficiency of the 
instruction. In order therefore to train our 
students most efficiently in self-activity, we 
should use the maximum amount of the more 
dificult but more effective methods and the 
minimum of those easier but relatively in- 
efficient. 
This will perhaps be. made clearer by a 
brief illustration from personal experience. 
To learn, for example, the normal histology 
of any given organ by means of a stained and 
mounted section, this should first be studied 
by original observation. The students observe 
the structure with naked eye, low power and 
high power of the microscope, and without 
previous description by teacher, book or labor- 
atory outline. They record their observations 
by sketches and brief notes. The aid of the 
teacher at this stage should be restricted to 
questioning the individual students so as to 
recall related facts previously studied and pre- 
vent the student from going too far astray. 
At first, students are apt to be utterly helpless 
when thus thrown largely upon their own re- 
sources, but they soon develop surprising 
powers of observation. This “ investigation ” 
occupies the first part of the laboratory period. 
The teacher then informs the class regarding 
the section they have studied, and discusses 
briefly their mistakes of observation. He 
directs them in restudying the section, and 
in correcting their mistakes. The students 
now extend their knowledge by verifying the 
statements found in their text-books. Dem- 
onstrations are made to furnish additional 
data and elucidate the more difficult points. 
Drawings are finally made by the students, to 
fix the corrected impressions upon their 
SCIENCE 
[N.S. Vou. XXXV. No. 902 
minds. At a later class-conference, the stu- 
dents are led to review the facts learned, to 
correlate and interpret them and to reason 
out general conclusions or laws of structure. 
These laws they utilize and apply in the sub- 
sequent work. Brief written reviews are also 
frequently held. Occasional lectures by the 
teacher elucidate the more difficult phases, 
and indicate the relations of histology to 
physiology, pathology and clinical medicine. 
The results are satisfactory as shown by final 
examination, both written and practical, and 
by the extent to which the students are able 
to retain and utilize their knowledge in later 
work. 
The foregoing method illustrates how stu- 
dents may be trained to self-activity in ob- 
servation and reasoning, and to a certain ex- 
tent in application. The application of the 
generalizations reached by observation plus 
reasoning, while essential in every subject, is 
especially characteristic of the clinical work. 
That the student should be self-active in his 
clinical work, that to acquire skill in the 
practical application of his previous lknowl- 
edge he must “learn by doing,” is universally 
recognized. It is therefore unnecessary to 
dwell upon this phase of the subject. It may 
be worth while, however, to remember that, 
above all, in the clinics, “the main business 
of the teacher is to render his services unnec- 
essary ” (Strayer). 
To summarize the foregoing: it has been 
maintained that in medical education there is 
great need of more effective methods of teach- 
ing. Efficient teaching requires a clear view 
of the ultimate aim, which in medicine is to 
train efficient practitioners. To accomplish this 
aim, rational methods of teaching should de- 
velop in the student self-activity in observa- 
tion, reasoning and action. While some may 
be unable to accept fully the ideas here pre- 
sented, all will surely agree that great im- 
provement would result if medical teachers 
would study more carefully their educational 
methods. The younger teachers who are so 
fortunately located could greatly improve 
their efficiency by taking work in the schools 
of education connected with the various uni- 
