June 2, 1922] 



SCIENCE 



581 



opments require for medical education a scien- 

 tific basis with a final polish added by a pre- 

 ceptor system correctly applied." 



There is such a thing as impractical idealism 

 being carried too far. Every one admits the 

 merits and advantages of full-time teachers, 

 in medicine, as in any other science. Certainly 

 no one could belittle the importance of re- 

 search; only a traitor to the ideals of the med- 

 ical profession would seek to hinder in any way 

 the closest practical correlation between clinical 

 teaching, research laboratories, and experi- 

 mental studies. The whole basis for medical 

 advance has been founded upon just this co- 

 operation between the clinical practitioner, 

 artisan if you will, and the research devotee, 

 each serving and advancing the same science, 

 but there never has been, and never can be, 

 created a science of medicine apart from the 

 practice of clinical medicine. If this be true, 

 any educational movement designed to segre- 

 gate one from the other will be disastrous to 

 each. It is not implied that the advocates of 

 full-time medicine actually have any such idea 

 in mind, yet many believe their academic ten- 

 dencies have made them lose sight of certain 

 fundamental and practical issues. The so- 

 called full-time movement probably is a step 

 in the right direction. It is an experiment the 

 results of which must be awaited with patience. 

 If it is to be the best system applied to medical 

 education, it is imperative that certain guiding 

 principles be borne in mind as the scheme is 

 worked out. To an active practitioner and 

 teacher some of the most important points 

 would seem to be these : 



1. The fundamental duty and moral obliga- 

 tion of any medical school is to supply a needy 

 public with an adequate number of alert, sane, 

 and trustworthy practitioners as eager to pre- 

 vent as to cure disease. This demands that 

 they be well grounded in those essentials upon 

 which the intelligent practice of medicine is 

 based. To meet this need contemporary medi- 

 cine must undertake a radical revision of both 

 the pre-medical and the medical curriculum 

 along lines that will better develop altruistic 

 and humanitarian motives as the controllers of 

 scientific ardor. The elective system should be 

 encouraged in certain ways but discouraged in 

 others; undergraduate specialism curtailed; 



and research, during student years, to the 

 neglect of acceptable proficiency in the funda- 

 mental sciences and their practical application 

 prohibited or at least critically limited. "Ap- 

 plying themselves early to research young men 

 get into back waters far from the main stream. 

 They quickly lose the sense of proportion, be- 

 come hypercritical, and the smaller the field, 

 the greater the tendency to megalocephaly" 

 (Osier). It is believed that if medical schools 

 would uniformly adopt such policies, the public 

 would be the gainer, specialties would not lack 

 for devotees, nor would scientific advancement 

 be hindered. Wise education seeks to simplify 

 and make clear — never to complicate and con- 

 fuse. 



2. The teachers employed in meeting this 

 moral obligation must be qualified both to 

 impart knowledge and to inspire enthusiasm. 

 These requirements can not be met except by 

 men who have demonstrated their ability to 

 advance clinical medicine. Clinical teachers of 

 this type can never be replaced, at least from 

 the students' viewpoint, by younger men of 

 great promise, but deficient in a most im- 

 portant attribute, namely, "responsible experi- 

 ence." It must be remembered that students 

 are best stimulated by contact with clinicians of 

 mature development and accredited success. 

 Such men can neither be created merely by 

 appointment nor developed by fiat. There is 

 food for serious reflection as to the correctness 

 of a contemporary system that fails to give to 

 medical students the best teachers available. 



3. A medical school does not completely 

 fulfill its moral obligation to the community 

 by the conferring of medical degrees. It is 

 obligated to keep behind its graduates — and 

 provide for them, as well as other practitioners, 

 ready means for post-graduate instruction, for 

 training in the various specialties, and for op- 

 portunities for higher research work. Facili- 

 ties, money and teachers alone will not meet 

 the demands. Of the greatest influence in a 

 medical school is a harmonious whole, and en- 

 thusiastic cooperation of faculty, students, and 

 alumni, in the performance of a common task, 

 and a total abstinence from the slightest trace 

 of intolerant cliquism. Regardless of the size 

 or source of the budget, medical education is 

 bound to fail in schools in which such an 



