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COACHING, TRAINING, AND TEACHING
629
dents ofproprietary drugs and may not have heard of " Somebody’s" test or syndrome, they have lived a
communal life and have had much greater opportunities for informal discussions and arguments than are possible in civilian life. They have learned how men live when well-and have seen the varied reactions of the human being to pain and fear, excitement and boredom, ’discipline and responsibility. Surely no better training for a doctor could have been " laid on." All that we, the seniors, have to do is to restore their confidence in themselves and to counter-propagate propaganda. WM. ANDERSON. Aberdeen.
COACHING, TRAINING, AND TEACHING SiR,--At a time when the resources of medical education are being replanned and expanded, it would I think be useful to define these three complementary activities. ’
- Coaching is the assembling of knowledge in preparation for a test of mental assimilation-i.e., the examination. Coaching may follow teaching, but should never precede or coincide with it. Training is the acquisition of techniques by practical experience: It may coincide with teaching, but should never precede it. Teaching provides a ,fundamental introduction, a critical survey, and a challenge to original thought; it promotes judgment and insight, enthusiasm, and inquiry. It should precede and accompany training, but never degenerate into coaching. Clever young graduates, with a fund of systematic make good coaches ; able technicians may make good trainers. But teaching calls for a balanced view of the part and the whole ; it demands a broad outlook and a deep insight, with scepticism for the established and an open mind for the new. When coaching is allowed to predominate in education, the body medical presents itself as a cleanly dissected corpse. When training is given more than its due, the result is a robot. Only when teaching is given its proper scope and precedence does this body medical emerge
knowledge,
as
a
growing living organism.
London, W.I.
L. S. MICHAËLIS.
MASS RADIOGRAPHY I have followed with keenness 1941 SIR,—Since Dr. Brailsford’s writings on this subject, but his letter of March 30 suggests that he cannot be familiar with the actual working of mass-radiography units. It is the practice in nearly all such units for the clerks to take a short but stereotyped history from all the volunteers before their X-ray. Surely Dr. Brailsford will admit the value of such a history. Would he waste valuable medical man-power in the taking of histories from the 93% of those examined who will be found to have radiologically normal chests ? I can assure him that abnormal cases get due attention at every stage and that their history is taken by a competent and experienced medical officer. The fundamental issue is not whether the large film is superior to the miniature film-for each method is serving a different purpose-but whether the miniature film has been failing in its purpose. It should act as a sieve mechanism to weed out the abnormal from the normal chest films ; no attempt should be made to use it for diagnosis, or for the assessment of activity, or for serial observations of a lesion, for which a, large film is needed. Has he any evidence that the miniature film has failed in-its purpose to " spot " lesions, especially small lesions ? At the moment about 20 units are operating under the national scheme, and experience has been sufficient for this question to be answered. Personally, I have been surprised by the constant ability of the miniature film to detect small lesions. Tuberculosis officers and chest physicians have commented on the surprising clarity with which the very small lesions stand out, owing to the high contrasting qualities of the film. I should be interested to hear from Dr. Brailsford of abetter alternative, which incorporates speed in dealing with large numbers, low cost of operation, and an equal standard of efficiency. Dr. Brailsford has missed the point of -my statement that I could see no reason why 2880 volunteers a day
should not be dealt with by each mass-radiography unit. How can efficiency suffer when three separate teams are each working an eight-hour shift throughout the twentyfour hours ? Surely, munition and aircraft components did not suffer by production in an identical mariner .. during the war ? Dr. Brailsford uses the phrase, " ...a few more roads ... to clear a lake of fish." Why should one deride such a, positive attempt ? At least some progressive effort is being made, which is better than sitting at the lakeside and calling for the help of some mystic power. The small beginning is not to be despised ; I feel sure that the dispensary system at its inception had its critics, but time and progress have shown its value.. My own experience leads me to think that mass miniature radiography, if correctly handled, can give valuable assistance in the field of chest diseases, both in diagnosis and in research. A. E. BEYNON. Nottingham. SUPPLIES OF STREPTOMYCIN SIR,-Your correspondent, Dr. Grenvi]Lle-Mathers-I who referred to the lack of supplies of streptomycin (April 13, p. 557) may be interested to know-that a short article appeared on page 226 of the Pharmaceutical Journal of April 6, 1946, stating that persons who require streptomycin should send their requests to Dr. Chester S. Keefer, chairman of the Committee on Chemotherapeutic and Other Agents, National Research Council, 65, East Newton Street, Boston 18, Massachusetts. The note says also that, since the drug is in the experimental stage, details of the nature of the illness and of the organisms causing it must be furnished, " preferably by the doctor in charge of the case." Each request will be considered and if approved shipment will be made by the manufacturing laboratories. F. WRIGLEY. Welwyn Garden City, Herts. PARALYSIS AGITANS: A DISCLAIMER Sm,-During 1945 a group of private persons interested in ascertaining the cause of, and in finding a cure for, paralysis agitans, approached the National Hospital, Queen Square, and, voluntarily forming themselves into a " Parkinson’s Research Society," decided to raise funds to support research into diseases of the nervous system with special reference to paralysis a,gitans. At a meeting held at the hospital in July, 1945, the members elected a chairman and committee, and, by donations and covenants, provided a sum of money which was handed to the hospital for the prosecution of the research in question. To this lay committee was added a member of the honorary medical staff of the hospital, -while I became the honorary secretarv of the society. Steps had been taken to start this enterprise, when, early in this year, it came to my knowledge, and to that of members of the honorary medical staff, that the chairman of the society, without previous consultation with the hospital authorities and on his own initiative, was notifying members of the society and some sufferers from paralysis agitans, by letter, that in fact the cause of the disease had already been found to be bacterial and that a cure for it had been discovered. The name and address of a medical practitioner not connected with the National Hospital, in respect of whom these claims were made, were given in these letters, and patients were advised to put themselves under his treatment. The board of management of the National Hospital is advised by its medical committee that these claims cannot be endorsed, and that it is not in the public interest that the hospital should collaborate with an organisation that sponsors and gives publicity to them. I am therefore authorised to ask the courtesy of your columns for an announcement that the National Hospital dissociates itself wholly from the Parkinson’s Research Society and from all claims made by it. The chairman of the society has been so informed and the two members of its committee who are connected with the hospital have resigned from the society. The members ofthe society have been offered the return of their donations and subscriptions -which were given to the hospital for the purposes of the proposed research. H. EWART MITCHELL, The National Hospital, Secretary. Queen Square, W.C.1. .
-
’.
-
-
dents ofproprietary drugs and may not have heard of " Somebody’s" test or syndrome, they have lived a
communal life and have had much greater opportunities for informal discussions and arguments than are possible in civilian life. They have learned how men live when well-and have seen the varied reactions of the human being to pain and fear, excitement and boredom, ’discipline and responsibility. Surely no better training for a doctor could have been " laid on." All that we, the seniors, have to do is to restore their confidence in themselves and to counter-propagate propaganda. WM. ANDERSON. Aberdeen.
COACHING, TRAINING, AND TEACHING SiR,--At a time when the resources of medical education are being replanned and expanded, it would I think be useful to define these three complementary activities. ’
- Coaching is the assembling of knowledge in preparation for a test of mental assimilation-i.e., the examination. Coaching may follow teaching, but should never precede or coincide with it. Training is the acquisition of techniques by practical experience: It may coincide with teaching, but should never precede it. Teaching provides a ,fundamental introduction, a critical survey, and a challenge to original thought; it promotes judgment and insight, enthusiasm, and inquiry. It should precede and accompany training, but never degenerate into coaching. Clever young graduates, with a fund of systematic make good coaches ; able technicians may make good trainers. But teaching calls for a balanced view of the part and the whole ; it demands a broad outlook and a deep insight, with scepticism for the established and an open mind for the new. When coaching is allowed to predominate in education, the body medical presents itself as a cleanly dissected corpse. When training is given more than its due, the result is a robot. Only when teaching is given its proper scope and precedence does this body medical emerge
knowledge,
as
a
growing living organism.
London, W.I.
L. S. MICHAËLIS.
MASS RADIOGRAPHY I have followed with keenness 1941 SIR,—Since Dr. Brailsford’s writings on this subject, but his letter of March 30 suggests that he cannot be familiar with the actual working of mass-radiography units. It is the practice in nearly all such units for the clerks to take a short but stereotyped history from all the volunteers before their X-ray. Surely Dr. Brailsford will admit the value of such a history. Would he waste valuable medical man-power in the taking of histories from the 93% of those examined who will be found to have radiologically normal chests ? I can assure him that abnormal cases get due attention at every stage and that their history is taken by a competent and experienced medical officer. The fundamental issue is not whether the large film is superior to the miniature film-for each method is serving a different purpose-but whether the miniature film has been failing in its purpose. It should act as a sieve mechanism to weed out the abnormal from the normal chest films ; no attempt should be made to use it for diagnosis, or for the assessment of activity, or for serial observations of a lesion, for which a, large film is needed. Has he any evidence that the miniature film has failed in-its purpose to " spot " lesions, especially small lesions ? At the moment about 20 units are operating under the national scheme, and experience has been sufficient for this question to be answered. Personally, I have been surprised by the constant ability of the miniature film to detect small lesions. Tuberculosis officers and chest physicians have commented on the surprising clarity with which the very small lesions stand out, owing to the high contrasting qualities of the film. I should be interested to hear from Dr. Brailsford of abetter alternative, which incorporates speed in dealing with large numbers, low cost of operation, and an equal standard of efficiency. Dr. Brailsford has missed the point of -my statement that I could see no reason why 2880 volunteers a day
should not be dealt with by each mass-radiography unit. How can efficiency suffer when three separate teams are each working an eight-hour shift throughout the twentyfour hours ? Surely, munition and aircraft components did not suffer by production in an identical mariner .. during the war ? Dr. Brailsford uses the phrase, " ...a few more roads ... to clear a lake of fish." Why should one deride such a, positive attempt ? At least some progressive effort is being made, which is better than sitting at the lakeside and calling for the help of some mystic power. The small beginning is not to be despised ; I feel sure that the dispensary system at its inception had its critics, but time and progress have shown its value.. My own experience leads me to think that mass miniature radiography, if correctly handled, can give valuable assistance in the field of chest diseases, both in diagnosis and in research. A. E. BEYNON. Nottingham. SUPPLIES OF STREPTOMYCIN SIR,-Your correspondent, Dr. Grenvi]Lle-Mathers-I who referred to the lack of supplies of streptomycin (April 13, p. 557) may be interested to know-that a short article appeared on page 226 of the Pharmaceutical Journal of April 6, 1946, stating that persons who require streptomycin should send their requests to Dr. Chester S. Keefer, chairman of the Committee on Chemotherapeutic and Other Agents, National Research Council, 65, East Newton Street, Boston 18, Massachusetts. The note says also that, since the drug is in the experimental stage, details of the nature of the illness and of the organisms causing it must be furnished, " preferably by the doctor in charge of the case." Each request will be considered and if approved shipment will be made by the manufacturing laboratories. F. WRIGLEY. Welwyn Garden City, Herts. PARALYSIS AGITANS: A DISCLAIMER Sm,-During 1945 a group of private persons interested in ascertaining the cause of, and in finding a cure for, paralysis agitans, approached the National Hospital, Queen Square, and, voluntarily forming themselves into a " Parkinson’s Research Society," decided to raise funds to support research into diseases of the nervous system with special reference to paralysis a,gitans. At a meeting held at the hospital in July, 1945, the members elected a chairman and committee, and, by donations and covenants, provided a sum of money which was handed to the hospital for the prosecution of the research in question. To this lay committee was added a member of the honorary medical staff of the hospital, -while I became the honorary secretarv of the society. Steps had been taken to start this enterprise, when, early in this year, it came to my knowledge, and to that of members of the honorary medical staff, that the chairman of the society, without previous consultation with the hospital authorities and on his own initiative, was notifying members of the society and some sufferers from paralysis agitans, by letter, that in fact the cause of the disease had already been found to be bacterial and that a cure for it had been discovered. The name and address of a medical practitioner not connected with the National Hospital, in respect of whom these claims were made, were given in these letters, and patients were advised to put themselves under his treatment. The board of management of the National Hospital is advised by its medical committee that these claims cannot be endorsed, and that it is not in the public interest that the hospital should collaborate with an organisation that sponsors and gives publicity to them. I am therefore authorised to ask the courtesy of your columns for an announcement that the National Hospital dissociates itself wholly from the Parkinson’s Research Society and from all claims made by it. The chairman of the society has been so informed and the two members of its committee who are connected with the hospital have resigned from the society. The members ofthe society have been offered the return of their donations and subscriptions -which were given to the hospital for the purposes of the proposed research. H. EWART MITCHELL, The National Hospital, Secretary. Queen Square, W.C.1. .
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’.
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