596 



SCIENCE 



[N. S. Vol. XLI. No. 1060 



the practical as well as the investigative work 

 of his department, just exactly as the dean 

 of a school is an adjunct in developing school 

 spirit and school policy. The advocates of 

 the full-time instructor should never, not 

 even implicitly, subordinate the teaching 

 value of the properly qualified private prac- 

 titioner. 



Even broader in scope is the fallacy that 

 there is an important and essential variance 

 of principle in teaching the clinical phenom- 

 ena of disease, and in teaching function and 

 structure or aberrations of both, in the labo- 

 ratory. It is diiScult to analyze this fallacy 

 and at the same time avoid an undesirable 

 discussion of the primary pedagogic principles 

 involved in teaching medical students. It may 

 be pardonable, however, to dip into abstrac- 

 tions just deeply enough to say that whether 

 our efforts at teaching be confined to the funda- 

 mental or to the clinical branches, our aim is 

 toward equipping our pupils to form proper 

 judgments. If, as a result of their training, 

 our students can affirm or deny conclusions, 

 either by proper process of reasoning or by 

 the direct comparison of objects to ideas, we 

 may rest easy in the thought that the discipline 

 of their medical education has been fruitful. 

 And the process by which they should be taught 

 to form proper judgments is exactly the same 

 in the hospital ward as it is in the laboratory. 

 In both places the student is taught to know 

 certain fundamental truths, and from these 

 he is taught to reason certain definite con- 

 clusions. The fact that in so many hospital 

 wards and clinic rooms the student is taught 

 to Tcnow, to the exclusion of being taught to 

 think, is responsible, in large measure, for the 

 fallacy that clinical teaching is, part and 

 parcel, separate and distinct from fundamental 

 teaching. If one doubts that clinical teachers 

 err with hopeless frequency in this direction, 

 let him pick up at random a number of clin- 

 ical text-books and examine them critically. 

 The conclusion will be unavoidable that pre- 

 ponderant stress and effort is laid on crowding 

 the student with facts — on teaching him to 

 know. One of the most recent clinical text- 

 books states in its preface that the very best a 



teacher can hope to do is to teach his student 

 to know. 



This particular fallacy regarding the specific 

 difference between fundamental and clinical 

 teaching should not be dismissed by merely 

 stating it. It is essential to expose the danger 

 to which it leads. And this can be done no 

 better than by quoting a sentence from last 

 year's report of the Conference on Medical 

 Education. This report states that 



Clinical teachers know that in the very nature 

 of things the teaching of anatomy and pathology 

 is in no way parallel to the teaching of medicine 

 and surgery, because the teaching of medicine and 

 surgery is inseparably associated with the prac- 

 tise of medicine and surgery. 



This allows us absolutely no other alterna- 

 tive than the conclusion that anatomy and 

 pathology are not inseparably associated with 

 the practise of medicine and surgery. Surely 

 the council can not hope that this conclusion 

 will go unchallenged. 



On the part of the clinicians there has al- 

 ways been a tendency to introduce this notion 

 of the subtle, specific teaching value of private 

 practise as a sort of abracadabra, charm, amu- 

 let, something to conjure with in the realm of 

 medical education. They have studiously 

 avoided the fact that the plan for full-time 

 clinical instruction contemplates developing 

 the principles of practise in their most util- 

 izable form, namely from a variety of clinical 

 material, intensively correlated and studied, 

 and housed under one roof. Is there more to 

 be learned of the basic traits of human nature 

 on Fifth Avenue, or on Michigan Avenue, 

 than there is in the wards of Bellevue or of 

 Cook County Hospital? Or does the wealthy 

 patient have a more legitimate demand on a 

 larger share of the sympathy, interest, pity, or 

 sweetness and light of his doctor's pervasive 

 personality than does the helpless sufferer in 

 the charity ward ? The plan for full-time clin- 

 ical instruction does contemplate the full 

 realization of the intimate relationship between 

 teaching medicine and practising medicine; 

 what it does not contemplate is the injudicious 

 mixture of private practise and teaching. And 

 in this particular, the plan is strong against all 



