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PART-TIME MEDICAL EDUCATION
1086
Letters to the Editor
Vice-Chancellor’s action and to raise a legal fund. A teach-in was being arranged for Tuesday. The subject may be guessed. Apparently no-one from Porton was among the invited
speakers. United States Though the rioting students were ejected from the buildings they had occupied at Columbia,’ things were by no means back to normal last week. In most of the constituent schools, formal classes have been suspended, and students were to be graded on the work done before April 23. Informal classes were being held in odd spots around campus-often on such radical sub" jects as Columbia and the Warfare State " or the writings of Herbert Marcuse. Songs, dances, and plays were performed, while 100 policemen patrolled the campus and kept outsiders out. The trustees and the faculty have each appointed committees to propose changes in the university structure: they are expected to award disciplinary powers to faculty and students, and an effective part in decision-making to faculty, with student advice. The Student Strike Committee called for a strike, to continue if necessary through and beyond the summer session, but dropped its original demands for the resignation of the president and vice-president.
Why is there so much unrest among America’s six million students ? The leaders of demonstrations are usually among the brightest, in the top 10% of their classes-though they are often joined by antisocial rowdies, many of whom are not students. Most commentators believe that a basic cause of the turmoil is failure of communication between administration and students. Someone has to have authority: as the president of Tufts University puts it, " Power is unequally distributed in the university community because responsibility is unequally distributed." Jaroslav Pelikan, a Yale scholar, points out that a university president is a member of both the trustees and the but easily becomes too much an executive and develops faculty, " a managerial mentality ". Thus instead of a simple announcement that the controversial gymnasium at Columbia would not be built, " concessions dribbled out in legalistic terms ", to quote the New York Times. At certain universities, including Yale, Minnesota, and University College of Los Angeles, the administration has made serious efforts to keep contact with the students, and unrest has been minimal. On the other hand, David Truman, the vice-president of Columbia, claims that he has worked to improve communication with the students for five years, and that, when he tried to confer with the militants, " They really didn’t want to talk ". This may be because" they believe talk is futile: as one Columbia student said: The onus of the guilt should rest with the administration, since all faculty and student protests through legitimate channels have been ignored." Many, not only students, criticise university administrations in general, and faculty members too, for being remote not only from the students but from society; Mark Rudd, leader of the Columbia militants, told the president: "You might want to know what is wrong with this society, since after all you live in a very tight self-created dream world." John Summerskill, outgoing president of San Francisco State College, believes that the only way to avoid student protest is " to start trying to solve the underlying problems of the society "-perhaps true, but a tall order. During and since the Columbia episode there have been demonstrations at many colleges, including Colgate, Denver, Georgia, Michigan, Northwestern, Princeton, Trinity, and Wellesley: many of these have been aimed at increasing enrolment of black students and improving conditions for them. Amid so much bitterness it is pleasant to record that, at Duke, students peacefully and successfully demonstrated to persuade the trustees to increase the wages of non-academic employees, aided by the divinity-school faculty, who voted unanimously to divert their annual salary-increases to campus maids and policemen. 1. See
Lancet, May 11, 1968, p. 1031.
PART-TIME MEDICAL EDUCATION SiR,-The Royal Commission on Medical Education reports that this country faces a serious shortage of doctors and that an immediate increase in output of medical graduates is required. The Royal Commission put forward recommendations to increase the number of medical-school places over the next thirty years, but made no reference to a valuable source of future doctors-namely, the dedicated and talented workers at present employed in Health Service hospital posts which do not take full advantage of their potentialities. There are many nurses and technicians who embarked upon their present careers because of wrong advice, domestic pressure, undue diffidence, or misfortune in their G.C.E. examinations. They are, nevertheless, devoted to the care of the sick or to medical science and their value to ward or laboratory would be greatly enhanced if they were medically qualified. By the same token their past experience would increase their value to the Health Service as doctors. There is today a strong movement towards improved parttime educational opportunities for laboratory technicians who wish to obtain a science degree. This is certainly progress but some frustration will inevitably remain and will not be overcome without the attainment of the full independence which only a medical degree can confer upon the hospital worker. Consideration should therefore be given to making it possible for nurses and laboratory workers in the Health Service to study for a medical degree whilst still in employment. No lowering of academic standards should be contemplated but concessions could be made by management committees to part-time medical students as they have been to employees studying for National Certificates and other qualifications. Thus up to two days weekly release from duties, a six-hour day, and the provision of evening lectures, demonstrations, and laboratory sessions by the medical schools would enable the Health Service as a whole to gain far more from these workers than their present departments would lose. Traditionalists claiming that medical education must be fulltime will surely accept that the " spare time " vocational employment of nurses and technicians is no less appropriate than the spare-time activity of the average full-time medical student. That medical schools should continue activity into the night may seem revolutionary but the colleges of advanced technology have provided " after hours " education for scientists for many years with great benefit. The possibility of the class-toclass transfer envisaged would do much to bring closer together medical and non-medical hospital workers to their mutual benefit and that of the Service. May I therefore suggest the Ministry of Health carry out a survey to determine the number of hospital workers willing and qualified to embark on medical training provided they could continue to discharge their domestic responsibilities by retention of their present posts and salaries, albeit with the concessions mentioned above. Smethwick, A. L. WOOLF. Worcestershire.
CARDIAC TRANSPLANTATION at certain ethical aspects of heart replacement operations. The president of the Royal College of Surgeons made a dignified defence on television some weeks ago of the fact that no such operation had then been conducted in Britain. The fatuous spectacle the weekend before last of eminent members of a cardiac team displaying flags and buttons I back Britain " at a TV interview suggests that the TV camera was photographing the last night at the Proms, or a football ground, rather than recording a moment in the lives of two families, of whom one member has died tragically and another may die at
SIR,-Much criticism has been directed
"
any moment.
Letters to the Editor
Vice-Chancellor’s action and to raise a legal fund. A teach-in was being arranged for Tuesday. The subject may be guessed. Apparently no-one from Porton was among the invited
speakers. United States Though the rioting students were ejected from the buildings they had occupied at Columbia,’ things were by no means back to normal last week. In most of the constituent schools, formal classes have been suspended, and students were to be graded on the work done before April 23. Informal classes were being held in odd spots around campus-often on such radical sub" jects as Columbia and the Warfare State " or the writings of Herbert Marcuse. Songs, dances, and plays were performed, while 100 policemen patrolled the campus and kept outsiders out. The trustees and the faculty have each appointed committees to propose changes in the university structure: they are expected to award disciplinary powers to faculty and students, and an effective part in decision-making to faculty, with student advice. The Student Strike Committee called for a strike, to continue if necessary through and beyond the summer session, but dropped its original demands for the resignation of the president and vice-president.
Why is there so much unrest among America’s six million students ? The leaders of demonstrations are usually among the brightest, in the top 10% of their classes-though they are often joined by antisocial rowdies, many of whom are not students. Most commentators believe that a basic cause of the turmoil is failure of communication between administration and students. Someone has to have authority: as the president of Tufts University puts it, " Power is unequally distributed in the university community because responsibility is unequally distributed." Jaroslav Pelikan, a Yale scholar, points out that a university president is a member of both the trustees and the but easily becomes too much an executive and develops faculty, " a managerial mentality ". Thus instead of a simple announcement that the controversial gymnasium at Columbia would not be built, " concessions dribbled out in legalistic terms ", to quote the New York Times. At certain universities, including Yale, Minnesota, and University College of Los Angeles, the administration has made serious efforts to keep contact with the students, and unrest has been minimal. On the other hand, David Truman, the vice-president of Columbia, claims that he has worked to improve communication with the students for five years, and that, when he tried to confer with the militants, " They really didn’t want to talk ". This may be because" they believe talk is futile: as one Columbia student said: The onus of the guilt should rest with the administration, since all faculty and student protests through legitimate channels have been ignored." Many, not only students, criticise university administrations in general, and faculty members too, for being remote not only from the students but from society; Mark Rudd, leader of the Columbia militants, told the president: "You might want to know what is wrong with this society, since after all you live in a very tight self-created dream world." John Summerskill, outgoing president of San Francisco State College, believes that the only way to avoid student protest is " to start trying to solve the underlying problems of the society "-perhaps true, but a tall order. During and since the Columbia episode there have been demonstrations at many colleges, including Colgate, Denver, Georgia, Michigan, Northwestern, Princeton, Trinity, and Wellesley: many of these have been aimed at increasing enrolment of black students and improving conditions for them. Amid so much bitterness it is pleasant to record that, at Duke, students peacefully and successfully demonstrated to persuade the trustees to increase the wages of non-academic employees, aided by the divinity-school faculty, who voted unanimously to divert their annual salary-increases to campus maids and policemen. 1. See
Lancet, May 11, 1968, p. 1031.
PART-TIME MEDICAL EDUCATION SiR,-The Royal Commission on Medical Education reports that this country faces a serious shortage of doctors and that an immediate increase in output of medical graduates is required. The Royal Commission put forward recommendations to increase the number of medical-school places over the next thirty years, but made no reference to a valuable source of future doctors-namely, the dedicated and talented workers at present employed in Health Service hospital posts which do not take full advantage of their potentialities. There are many nurses and technicians who embarked upon their present careers because of wrong advice, domestic pressure, undue diffidence, or misfortune in their G.C.E. examinations. They are, nevertheless, devoted to the care of the sick or to medical science and their value to ward or laboratory would be greatly enhanced if they were medically qualified. By the same token their past experience would increase their value to the Health Service as doctors. There is today a strong movement towards improved parttime educational opportunities for laboratory technicians who wish to obtain a science degree. This is certainly progress but some frustration will inevitably remain and will not be overcome without the attainment of the full independence which only a medical degree can confer upon the hospital worker. Consideration should therefore be given to making it possible for nurses and laboratory workers in the Health Service to study for a medical degree whilst still in employment. No lowering of academic standards should be contemplated but concessions could be made by management committees to part-time medical students as they have been to employees studying for National Certificates and other qualifications. Thus up to two days weekly release from duties, a six-hour day, and the provision of evening lectures, demonstrations, and laboratory sessions by the medical schools would enable the Health Service as a whole to gain far more from these workers than their present departments would lose. Traditionalists claiming that medical education must be fulltime will surely accept that the " spare time " vocational employment of nurses and technicians is no less appropriate than the spare-time activity of the average full-time medical student. That medical schools should continue activity into the night may seem revolutionary but the colleges of advanced technology have provided " after hours " education for scientists for many years with great benefit. The possibility of the class-toclass transfer envisaged would do much to bring closer together medical and non-medical hospital workers to their mutual benefit and that of the Service. May I therefore suggest the Ministry of Health carry out a survey to determine the number of hospital workers willing and qualified to embark on medical training provided they could continue to discharge their domestic responsibilities by retention of their present posts and salaries, albeit with the concessions mentioned above. Smethwick, A. L. WOOLF. Worcestershire.
CARDIAC TRANSPLANTATION at certain ethical aspects of heart replacement operations. The president of the Royal College of Surgeons made a dignified defence on television some weeks ago of the fact that no such operation had then been conducted in Britain. The fatuous spectacle the weekend before last of eminent members of a cardiac team displaying flags and buttons I back Britain " at a TV interview suggests that the TV camera was photographing the last night at the Proms, or a football ground, rather than recording a moment in the lives of two families, of whom one member has died tragically and another may die at
SIR,-Much criticism has been directed
"
any moment.