368 



SCIENCE 



[N. S. Vol. XLIII. No. 1107 



The results of the joint product of edu- 

 cational plants, teachers and students, are 

 to be determined, on the one hand by the 

 scientific output of the institution and on 

 the other hand by the ability of the gradu- 

 ates to perform the services for which they 

 are trained. This ability does not become 

 fully manifest until the youths of to-day 

 become the mature men of to-morrow. "We 

 do not manufacture a product ready to 

 work perfectly the minute it is turned out 

 and for which there is an eager market to 

 stimulate us to devise methods of turning 

 out an ever greater quantity at less cost. 

 On the contrary we have to devise methods 

 which will train men to fill in a worthy way 

 the medical needs of the nation a generation 

 in the future, men for whom when first 

 turned out the public does not seem partic- 

 ularly eager. 



Our methods should be designed to fur- 

 nish the requisite training as directly, 

 simply and inexpensively as possible, com- 

 patible with adequate results. In studying 

 and trying out methods we should, how- 

 ever, focus our attention on the end results 

 desired, not on artificial standards such as 

 have at times been introduced by efficiency 

 engineers and other professional students 

 of other peoples' business who have been 

 active of late in the field of education and 

 who are apt, because of the difficulty of de- 

 termining the nature of the products of an 

 educational institution, to adopt some such 

 standard as the unit hour of instruction as 

 the product or to base estimates of efficiency 

 on the elaboration of machinery. On the 

 whole, however, I believe that we have been 

 fortunate in the breadth of view shown by 

 outside investigators of our own field of 

 education and that we ourselves are to be 

 blamed for too much emphasis on time re- 

 quirements, too great a readiness to stand- 

 ardize without sufficient study of the ulti- 

 mate result produced. This attitude has 



led to a condition where the requirement of 

 two years of premedical college work has 

 made much more rapid progress in the re- 

 quirements of licensure to practise in vari- 

 ous states than have practical examinations 

 in medicine. 



Under the cheaper methods of medical 

 instruction which prevailed in this coun- . 

 try until recent years the results on the 

 whole were not satisfactory. It has been 

 stated that as many as forty per cent, of 

 medical graduates quit the practise of 

 medicine within a few years after leaving 

 the medical school. Of the rest some by 

 natural ability and hard study subsequent 

 to graduation became of great value to so- 

 ciety and others, allowing themselves to 

 drift, became venders of prescriptions but 

 not men able to apply modern science to 

 relieve disease. 



The recent developments in medical edu- 

 cation have added greatly to the expense of 

 maintaining medical schools and to the cost 

 in time and money to those seeking a med- 

 ical education. Are the results satisfac- 

 tory? Can they be improved? Can the 

 expense be reduced without injuring the 

 product? These questions can not be 

 answered satisfactorily at the present time, 

 first, because of the relatively short period 

 that the newer methods of medical educa- 

 tion have been in force and, second, because 

 of the absence of satisfactory records of 

 the subsequent careers of our graduates. 

 They are, however, questions which every 

 institution should carefully study and 

 from time to time various institutions 

 should report the results of such studies 

 because of the help to other institutions 

 thus furnished. Only one institution, at 

 present, the Johns Hopkins Medical 

 School, I believe, furnishes an account of 

 the subsequent careers of each of its grad- 

 uates. Since this institution was the first 



