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EXAMINATIONS.
459
THE
LANCET.
LO1DOI1TSATURDAY, AUGUST 28, 1926.
EXAMINATIONS. IT will be seen, if reference is made to the explanatory note with which the Students’ Number starts, that the first part of the Number deals with the various patterns by which qualification can be obtained for the legal practice of medicine. The choice of career, which depends upon such qualification, should be guided by consultation of the articles which follow, dealing with the conditions of appointments in the State and Public Services, and with the provisions for the qualified man to attend special courses and to pass special tests, where success will give him the right or, at any rate, a winning opportunity to obtain employment in accordance with his chosen bent. Examinations as standardised by the G.M.C.—how, when, and where they must be sat for, and what are the tests to be surmounted-form the general text of the main part of the Students’ Number, and we are reminded by various articles and letters in the press that physical and mental disorders may be associated with the struggles of a certain percentage of examinees. And it is a truth that, in the attempt to become doctors, some aspirants become patients. We do not want to exaggerate the fact, or to support the amiable family theory that when the name of one of its members is absent from a pass-list the condition of his or her health accounts satisfactorily for the catastrophe. But, on the other hand, these breakdowns among students, and especially among medical students, do occur under the nervous stress of impending examinations ; the thing happens and should not be minimised. Those in charge of the strenuous courses which precede our professional examinations will do well to keep the matter in mind. We know that many examiners are influenced by a wise appreciation of the strain put upon a jumpy class of candidates, but kindness cannot condone inability to respond to tests. It is the inability which needs the preventive treatment of previous counsel. Five years ago the registration of medical students rose to the abnormal height of 3420, and there became reason for an apprehension that a point was being reached where the bulk of men and women requiring medical education could not be dealt with by the machinery in existence, to say nothing of the implied threat to professional careers from the mere number of the entrants who would later have to live by the practice of their science and art. Until that time those who conceived perpetually that the profession was overcrowded had few facts to support their theory; they were being misled by the circumstance that there were certain centres where many doctors had congregated for various reasons, and they conceived the local congestion and its resulting acute competition to be a general malady, whereas it was only sporadic. But the great recruiting of 1919, the reasons for which we can all surmise, could not be viewed with equanimity, even by those who knew the old assertion of overcrowding to be largely incorrect ; for an unmistakable testimony to the public esteem in which medicine was held was becoming a practical embarrassment, and justifying A graph illustrating fear for the economic position.
the figures (see p. 480) indicates that the various factors which led to the multiplication of students have lost their force, and there is no reason to think that the medical profession will be overcrowded in the immediate future. Further, we do not know that the unusual addition to the roll of qualified men, corresponding with the swelling of the students’ ranks, has brought any undue consequences with it; even with the increased number of doctors that we now have the medical profession is not to-day redundant, for the amount of work that has to be done steadily swells, as does the number of varying avenues which have to be traversed bv the folloivers This is the fact which should be of medicine. remembered when we are told dogmatically that examinations must be stiffened to keep out the weaker candidates. Things are not as simple at the threshhold of a learned profession as they are at the doors of a test match. On these occasions unusual barriers can be erected and stringent measures taken to regulate ingress when too many persons are expected. And Access to the precautions havea logical eftect. entertainments is strictly guarded in defence of those who have paid their money-translated into terms of examinations, for those who havelearned their work. But examinations, especially in such a far-ranging collection of subjects as medicine, do not play the same practical role. A serious proportion of those who have paid with their industry and intelligence for the opportunity to enter the qualified ranks do not succeed assuredly or promptly, and it is this high element of uncertainty which conduces to the failure of nervous students. No general relaxation of standard is desired from the authorities, while, from the economic aspect, a stiffening can be justified on public grounds by the satisfactory number of candidates : but the ideal part which the examinations should play in the curriculum has not yet been found, despite repeated and real research. And the uncertainty of the results of these tests does affect some examinees seriously. Wecan welcome our recruits with the assurance that there is plenty of work for them to do, and we can congratulate them because that work has to be done in every section of professional endeavour in fairer and more generous circumstances than used to prevail in times not far away. With regard to contract practice, hope lies in that betterment of organisation which experience is bringing, and which has been in the minds of many since the passage of the National Insurance Acts ; the position does not promise to improve pecuniarily, and consolation must be sought in the reflection that, as such practice stands at present, it is hugely better in its material results than it was 20 years ago, when it was admittedly scandalous. The Services, only in the last few weeks, have made drastic revision of their regulations in favour of their medical staffs, and the authorities at medical schools will certainly have noted the opportunities now offered to their pupils. Elsewhere salaries have risen, and medical officers, though poorly other paid in comparison with those who public duties, receive better terms ; and their terms have not been wholly dictated by the general rise in prices, but havefollowed on a tvider appreciation by the public of the meaning and value of preventive treatment and organised therapeutics. These are reasons for congratulating our students upon If entrance to the arena their choice of a career. is fenced around with difficulties, there is zest in the surmounting of these. And the return for success is not the pleasure of looking on, but the privilege of
discharge
solid
playing.
THE
LANCET.
LO1DOI1TSATURDAY, AUGUST 28, 1926.
EXAMINATIONS. IT will be seen, if reference is made to the explanatory note with which the Students’ Number starts, that the first part of the Number deals with the various patterns by which qualification can be obtained for the legal practice of medicine. The choice of career, which depends upon such qualification, should be guided by consultation of the articles which follow, dealing with the conditions of appointments in the State and Public Services, and with the provisions for the qualified man to attend special courses and to pass special tests, where success will give him the right or, at any rate, a winning opportunity to obtain employment in accordance with his chosen bent. Examinations as standardised by the G.M.C.—how, when, and where they must be sat for, and what are the tests to be surmounted-form the general text of the main part of the Students’ Number, and we are reminded by various articles and letters in the press that physical and mental disorders may be associated with the struggles of a certain percentage of examinees. And it is a truth that, in the attempt to become doctors, some aspirants become patients. We do not want to exaggerate the fact, or to support the amiable family theory that when the name of one of its members is absent from a pass-list the condition of his or her health accounts satisfactorily for the catastrophe. But, on the other hand, these breakdowns among students, and especially among medical students, do occur under the nervous stress of impending examinations ; the thing happens and should not be minimised. Those in charge of the strenuous courses which precede our professional examinations will do well to keep the matter in mind. We know that many examiners are influenced by a wise appreciation of the strain put upon a jumpy class of candidates, but kindness cannot condone inability to respond to tests. It is the inability which needs the preventive treatment of previous counsel. Five years ago the registration of medical students rose to the abnormal height of 3420, and there became reason for an apprehension that a point was being reached where the bulk of men and women requiring medical education could not be dealt with by the machinery in existence, to say nothing of the implied threat to professional careers from the mere number of the entrants who would later have to live by the practice of their science and art. Until that time those who conceived perpetually that the profession was overcrowded had few facts to support their theory; they were being misled by the circumstance that there were certain centres where many doctors had congregated for various reasons, and they conceived the local congestion and its resulting acute competition to be a general malady, whereas it was only sporadic. But the great recruiting of 1919, the reasons for which we can all surmise, could not be viewed with equanimity, even by those who knew the old assertion of overcrowding to be largely incorrect ; for an unmistakable testimony to the public esteem in which medicine was held was becoming a practical embarrassment, and justifying A graph illustrating fear for the economic position.
the figures (see p. 480) indicates that the various factors which led to the multiplication of students have lost their force, and there is no reason to think that the medical profession will be overcrowded in the immediate future. Further, we do not know that the unusual addition to the roll of qualified men, corresponding with the swelling of the students’ ranks, has brought any undue consequences with it; even with the increased number of doctors that we now have the medical profession is not to-day redundant, for the amount of work that has to be done steadily swells, as does the number of varying avenues which have to be traversed bv the folloivers This is the fact which should be of medicine. remembered when we are told dogmatically that examinations must be stiffened to keep out the weaker candidates. Things are not as simple at the threshhold of a learned profession as they are at the doors of a test match. On these occasions unusual barriers can be erected and stringent measures taken to regulate ingress when too many persons are expected. And Access to the precautions havea logical eftect. entertainments is strictly guarded in defence of those who have paid their money-translated into terms of examinations, for those who havelearned their work. But examinations, especially in such a far-ranging collection of subjects as medicine, do not play the same practical role. A serious proportion of those who have paid with their industry and intelligence for the opportunity to enter the qualified ranks do not succeed assuredly or promptly, and it is this high element of uncertainty which conduces to the failure of nervous students. No general relaxation of standard is desired from the authorities, while, from the economic aspect, a stiffening can be justified on public grounds by the satisfactory number of candidates : but the ideal part which the examinations should play in the curriculum has not yet been found, despite repeated and real research. And the uncertainty of the results of these tests does affect some examinees seriously. Wecan welcome our recruits with the assurance that there is plenty of work for them to do, and we can congratulate them because that work has to be done in every section of professional endeavour in fairer and more generous circumstances than used to prevail in times not far away. With regard to contract practice, hope lies in that betterment of organisation which experience is bringing, and which has been in the minds of many since the passage of the National Insurance Acts ; the position does not promise to improve pecuniarily, and consolation must be sought in the reflection that, as such practice stands at present, it is hugely better in its material results than it was 20 years ago, when it was admittedly scandalous. The Services, only in the last few weeks, have made drastic revision of their regulations in favour of their medical staffs, and the authorities at medical schools will certainly have noted the opportunities now offered to their pupils. Elsewhere salaries have risen, and medical officers, though poorly other paid in comparison with those who public duties, receive better terms ; and their terms have not been wholly dictated by the general rise in prices, but havefollowed on a tvider appreciation by the public of the meaning and value of preventive treatment and organised therapeutics. These are reasons for congratulating our students upon If entrance to the arena their choice of a career. is fenced around with difficulties, there is zest in the surmounting of these. And the return for success is not the pleasure of looking on, but the privilege of
discharge
solid
playing.