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SCIENCE 



[Vol. LV, No. 1426 



much property nor throw out many professors. 

 To-day the conditions are entirely different. 

 The financial situation has changed so that the 

 school is no longer a recipient but a donor. 

 The students are better trained both in be- 

 havior and intellect and are more eager for 

 instruction. Many teachers are on a voca- 

 tional basis and are able to give more time to 

 instruction. Moreover, the medical school no 

 longer looks to a single product, but to many 

 products. The fixed curriculum of half a cen- 

 tury ago will not meet the conditions of to-day, 

 yet, in principle, it has remained unchanged. 

 Our national organizations dealing with med- 

 ical education have recognized and emphasized 

 the need of a more liberal curriculum but have 

 not adopted measures that materially assist the 

 medical school in the development of such a 

 curriculum. The fixed curriculum is so deeply 

 rooted, so widely spread and so thoroughlj' 

 fostered by standardizing bodies and educa- 

 tional institutions that state examining boards 

 are rapidly adopting or creating such curricu- 

 lums as the basis for medical licensure. "Eight 

 months in each of four separate calendar 

 years," devised for the improvement of medical 

 education became a serious obstacle to patri- 

 otic service during the late war, and is no less 

 an obstacle to education at the present time. 

 A curriculum covering 4,000 prescribed hours 

 is another mechanism to protect and advance 

 medical education but it has defeated thinking. 

 Medicine and medical specialties, 900 hours; 

 surgery and surgical specialties, 648 houi-s; 

 obstetrics and gynecology, 216 hours; are arti- 

 ficial divisions proposed by the medical edu- 

 cational bodies as a means of insuring better 

 trained physicians and of eliminating bad 

 medical schools, but these regulations have re- 

 sulted in the state boards going one step fur- 

 ther with the same good intent. But what a 

 handicap has followed as a result of these 

 measiu'es. One state requires 170 hours of 

 general pathology, another 240, another 250, 

 and still another 270. Like varia,bility is 

 found in practically all the subjects in the 

 state board curriculums. Certain peculiar re- 

 quirements are exacted by some of the state 

 boards. For example, one says in substance, 

 either teach 60 hours of electro-therapeutics or 

 your graduates can not practice in our state. 



The day is not far distant when the schools 

 must either incorporate in their curriculums 

 the particular requirements of each state board 

 cuiTiculum or find that their graduates are not 

 qualified to practice in these states. To incor- 

 porate these requirements means an enormous 

 time expansion and this is impossible. The 

 schools are thus approaching an impasse of 

 their own creation and some remedy must be 

 found. The one obvious solution is the crea- 

 tion of an elastic cui-riculum. The students in 

 entering the medical school with a fixed curricu- 

 lum are beginning a four-year program that 

 requires all to do essentially the same kind 

 and the same amount of work at the same time 

 and in the same way. They are leashed to- 

 gether, made uniform in action and thought 

 like the rowers in a great galley; shackled 

 hand and foot, heart and soul, with chains of 

 our own forging. It follows that the more uni- 

 form the special senses and intellectual 

 processes, the more efficient becomes such a 

 eurriculmn. To reach its maximal efiiciency, 

 we must revamp and equalize the special 

 senses and intellectual processes, — but is this 

 education ? 



The fixed and congested curriculiun of to- 

 day must give way to an elastic curriculum 

 which is adjustable not only to these perplexi- 

 ties but also to instructional resources, clinical 

 resources, and to the growth of medical sci- 

 ence. It must provide for collective teaching; 

 cooperative study and individual study. 



Alexander Bain tells us that in the Scottish 

 universities prior to the eighteenth century the 

 quadrennial arts course was conducted by so- 

 called regents, each of whom carried the same 

 student through all the four years. In a 

 rectorial address to the students of Aberdeen 

 University, in 1882, he said: "You the students 

 of arts, at the present day who encounter in 

 your four years, seven faces, seven voices, 

 seven repositories of knowledge, need an effort 

 to understand how yoiir predecessors could be 

 cheerful and happy confined all through to 

 one personality; sometimes juvenile, some- 

 times senile, often feeble at his best." Con- 

 trast this with the condition to-day, when sev- 

 enty faces, seventy voices, and seventy person- 

 alities are encountered by the medical students 

 in the four vears of their course. To the 



