380 



SCIENCE 



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



to the hospital. Students are encouraged 

 to believe that they can get adequate clin- 

 ical training only in large cities and that 

 the most valuable interneships are in the 

 larger hospitals in these cities. Clinical 

 teaching thus becomes to a large extent 

 mass instruction. Intimate relations be- 

 tween individual students and individual 

 teachers become difSeult even during the 

 interne year. 



The old apprenticeship system in med- 

 ical education had some marked advan- 

 tages which present system of mass instruc- 

 tion lacks. Is it not possible to restore 

 some of the advantages of the old appren- 

 ticeship system without loss of modern 

 scientific training? Can we not utilize a 

 large number of clinical centers for clinical 

 teaching and a large number of progres- 

 sive men as teachers instead of restricting 

 clinical teaching to a few men connected 

 with large hospitals adjacent to medical 

 schools in large cities? 



I believe this can be brought about by 

 encouraging a greater number of practis- 

 ing physicians to qualify for the term doc- 

 tor in its original sense of teacher. Why 

 should not our medical students after two 

 years of premedieal college work and two 

 or three years in the medical school be 

 qualified to reside in hospitals, for the most 

 part small hospitals, where they could earn 

 board and room by helpful work about the 

 place and at the same time study under the 

 immediate supervision of members of the 

 hospital staff. Such hospitals should pro- 

 vide diagnostic centers along the lines out- 

 lined above. If a few students thus acted 

 as clinical clerks in a series of hospitals 

 during the course of two or three years fol- 

 lowing the present second or third year in 

 the medical school they could get a broad 

 experience in direct contact with medicine 

 as it is best practised at the present time. 

 Variations in the types of hospitals would 



secure training in the varied lines of medi- 

 cine. Each student would come in intimate 

 contact with a considerable number of ac- 

 tive progressive men whom he would stim- 

 ulate and some of whom would in turn in- 

 spire. Only hospitals of a certain grade 

 would be recognized for this service and 

 this in turn would serve to stimulate hos- 

 pital development. The immediate clin- 

 ical facilities of the medical school could 

 be utilized for supplementing and strength- 

 ening the extra-mural hospital service and 

 the clinical staff would have supervision of 

 the clinical teaching in the hospitals and 

 give the final examinations. The expenses 

 of the medical course would be reduced and 

 the public would profit from a more direct 

 training of its practitioners. Further- 

 more, this system would help to overcome 

 one of the greatest dangers of our present 

 system of education, the destruction of 

 originality through too many years of sub- 

 ordination of personality to mass domina- 

 tion by teachers. It would tend to produce 

 independence in the students. 



Such a plan may not, of course, be best 

 for all schools but it may for some. As an 

 association let us maintain the scientific 

 ideal in medicine but let us not carry 

 standardization too far. Let us encourage 

 different methods of reaching the results at 

 which we all should aim, the establishment 

 in our students of habits of independent 

 accurate observation, of judgment based on 

 knowledge of fundamentals and of skilled 

 execution based on practical experience, 

 and then let us study the results as scien- 

 tifically as possible and base our changes In 

 methods so far as we can on observed facts. 

 C. R. Bardeen 



XJNIVEESITY OF "WISCONSIN 



THE FOREST SERVICE 

 The annual report of the forester of the 

 Department of Agriculture made public on 



