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SCIENCE 



[N. S. Vol. XL. No. 1035 



brandies of medicine all over the world our 

 clinical teacher has at best only a very super- 

 ficial knowledge and ought not to be the man 

 to teach them to the physician of the future. 

 The foregoing analysis shows, I believe, 

 conclusively, (1) that the teaching of medi- 

 cine to the future physicians is for nearly all 

 the heads of clinical departments only a sec- 

 ondary occupation and in some instances it is 

 not more than an ornament or a legitimate 

 business advertisement; and (2) that most of 

 the present heads of departments do not pos- 

 sess sufficient familiarity with the modern 

 medicine to be the instructors of present-day 

 medicine to the coming physician. 



The source of this anomalous situation is 

 to be found in the fact that heads of depart- 

 ments of medicine are chosen from the class 

 of physicians who are primarily busy practi- 

 tioners and consultants. They may be noted 

 men in their line and perhaps are indeed all 

 that the Council on Medical Education is 

 laying stress upon, namely, " great authori- 

 ties in their special fields both in the eyes of 

 the profession and in the eyes of the public." 

 But on account of that very virtue they are 

 in such demand in their private practise that 

 for years they could find no time to follow up 

 seriously the rapid advances in medicine. 

 For the same reason they are compelled to 

 treat their vocation as educators in the sci- 

 ence and practise of medicine only as a second- 

 ary occupation — ^which alone is bound to 

 bring unsatisfactory results, even if our pro- 

 fessors were well fitted to teach the medicine 

 of to-day. 



There is no doubt, then, that the present 

 mode of instruction of clinical subjects is very 

 unsatisfactory. Let us now examine the 

 methods by means of which the anomalous 

 situation could be mended best. I wish to 

 present at first my own suggestion very briefly. 

 I have pointed out before that the source of 

 the evil is to be found in the fact that at 

 present the heads of the departments are 

 chosen from a class of very busy practitioners, 

 for whom teaching is invariably only a second- 

 ary occupation. That fact points to the fol- 

 lowing plan as the most eificient remedy for 



our evil. Heads of departments should be 

 chosen from a class of physicians who from 

 the time of their medical graduation never 

 ceased to be close students of their science, 

 and for whom the study of and instruction in 

 a chosen clinical subject constitutes their 

 primary occupation. To the question, where 

 can we get this class of physicians? my an- 

 swer is: create it, or, more correctly expressed, 

 accelerate its development, since a fairly good 

 beginning has been made in the last few 

 years. I shall return later to this suggestion 

 and discuss it in detail. 



In considering plans for correction, we 

 ought to bear in mind that we are confronted 

 not with one evil alone, but with two, namely, 

 that (1) the present instructor in clinical sub- 

 jects can not and does not give his best time 

 to his calling as a teacher, and that (2) he 

 has been for many years out of close touch 

 with the advances in the medical sciences and 

 is therefore unfit to teach them efBciently. 

 Looking at our problem from this point of 

 view, it is evident that the creation of " full- 

 time " clinical professors will not cure the sec- 

 ond evil. Suppose a large number of noted 

 consultants, who are at present the professors 

 of medicine in the various schools, resolve 

 henceforth to make teaching their primary 

 or even their exclusive occupation — ^will this 

 resolution convert them at once into desirable 

 educators, fit to teach efiiciently modern medi- 

 cine? There may be many things which they 

 will have to learn from the beginning, just as 

 much as their students, and at an age when, 

 learning is no longer an easy task. 



The Johns Hopkins plan remedies both 

 evils. That school was fortunate to be able to 

 appoint as heads of the three chief depart- 

 ments of clinical medicine, men who always 

 were close students of their branches of medi- 

 cine, and who are willing to devote all their 

 time to the teaching and the study of their 

 subjects. As to the question, whether it is 

 best that such teachers should have no pri- 

 vate practise at all, opinions may differ, espe- 

 cially when this should be considered as a part 

 of a general plan applicable to all medical col- 

 leges. As far as I know such a requirement 



