- Email: [email protected]
Selected Seed
SELECTED SEED
333
of
general education and intelligence should be required ; and these have usually been gauged by examinations taken at school, Besides offering a to intellectual accomplishment the results rough guide indicate whether the student is likely to get over the
THE LANCET LONDON: SATURDAY, AUGUST 28, 1948
similar hurdles he will meet in his medical career. On the other hand, by themselves examinations can be an unsteady guide. In a debate in the House of Lords last May, Lord ELTON2 declared :
Selected Seed To
get
good crop of doctors one needs not only and good cultivation but also good seed.
a
soil In the past few years much has been written on the cultivation of the medical student, and some comprehensive horticultural directions have lately come from the British Medical Association.! Relatively little, however, has been said about the selection of the seed that is to be cultivated, and we have therefore chosen this as the main subject of our educational number for 1948. The information and papers we have collected show that in fact a good deal of thought is at last being given to the fundamental question of how to select the right students for medicine. Formerly there was less need, for the students mostly selected themselves : the number of applicants was little more than the medical schools could hold, and the authorities had no more to do than reject the obviously unsuitable. Now, on the other hand, the applicants are so manythat the selectors have increasingly a positive rather than a negative task ; instead of excluding losers they have to pick winners, which is far harder. Must they still rely on academic
good
tests, school records, and personal impressions, are
there any useful
new
methods of
assessing
or
young
people’s capabilities ? .
thinking about methods of discovering ought surely to know what kind of qualities, What are the ones that make a we seek. qualities doctor ? good High intelligence perhaps ? But some valuable doctors have had only just enough intelligence to pass their qualifying examinations. Acuity of Before
we
’* So far as the traditional examination goes... the successful candidate need possess neither common sense nor common honesty, neither courage nor adequate physique, nor even an original mind. It is the kind of examination in which Shakespeare and Cromwell, and almost certainly Mr. Winston Churchill, would have ignominiously failed. For in early years the possession of a strong character or original mind only too often serves as a sort of nonconductor for the ideas of other people ..."
Recognising the deficiencies of the school examination measuring ability, some universities are beginning to turn to intelligence tests for supplementary information. With such tests random marking is eliminated and a quick answer is obtained ; and though it may not always be the right answer the work of EYSENCK3 and others indicates that a higher correlation of assessment with performance is achieved by considering the results of examinations and intelligence tests together than by relying on either singly. Investigations now proceeding, some of which are described in this issue, may bring to light a group of tests more consistently reliable than any at present employed. A great deal more than intelligence goes to the making of a good doctorand the student who by average standards is insufficiently intelligent may, if stable and determined, not only succeed in qualifying but become a better doctor than his brighter unstable’ friend. In the final analysis, therefore, examination results and intelligence tests do not fully prove a candidate’s suitability or unsuitability, which can be judged only with knowledge of his character, temperament, and personality. On a later page we
in
observation ? But observation varies with interest, such which cannot be judged before training is begun. review some of the methods now used for tells while in Dr. MiLLAR another article Specific aptitude for medicine ? But psychologists judgment, of a proposal at Aberdeen to obtain a fuller picture assure us that aptitude can be confidently identified of character and capabilities through adaptation of only in respect of basically different functions such the War Office Selection Board procedure. Though as mathematics and manual dexterity. Sense of their methods not may prove to be applicable, both vocation ? But in the applicant of, say, 17, whose W.O.S.B. and the National Institute of Industrial interests and personality are not fully moulded, this Psychology, which has pioneered selection for industry, is often. fleeting. (We are told that at this age can offer useful experience to the medical selector. intend to become surgeons, about half the For example, comparison of the initial w.o.s.8. assesswhile the other half want to be psychiatrists ’) The ment with subsequent performance during training truth is that, since a doctor may pursue any of a shows that, while the procedure can be valid, validity score of different careers within medicine, no single varies between the different boards. Though based answer to our question can be found : for which we on scientific principles, it cannot be entirely indepenshould perhaps be thankful, since it would certainly be disastrous if the profession were all of a type. dent of the people operating it-a fact evident also at Medicine in fact defies the job-analysis which in other medical schools. It benefits from the help of the fields is deemed essential to rational selection ; and few who have a flair for their task, but the possession of this flair can be proved only by cold statistics ; it follows that in the choice of medical students and there is merit in the w.o.s.B. of checking progress can come only from empirical studies. But individual selectors’ assessment practice candidates’ the against this empiricism is no excuse for mere adherence to later performance. the status quo, particularly as the efficiency of existing At every stage the need is for more facts ; and methods, apart from impressions, is unknown. until validation is obtained the advocate of one Everyone agrees that certain minimum standards system is in no position to decry another. The more
applicants
1.
of a Doctor : Report of the Medical Curriculum Committee of the British Medical Association. London, 1948. See Lancet, 1948, i, 833, 839.
Training
2. House of Lords: Official Report, May 26, col. 1054. 3. Eysenck, H. J. Brit. J. educ. Psychol. 1947, 17, 20.
334
OUT OF PRINT
the job, the longer validation takes; and universities may perhaps decide that the best hope of speedy progress lies in continuing with their present time adopting an alternative techniques, at the same either as a shadow " method or for the selection of, perhaps, half their students. One valuable function of the Medical Research Council’s committee on selection would be the integration of reports from each centre. In this study special attention will nodoubt be given to the student who fails to qualify ; plainly, his failure is less commonly a reproach to himself than to the system which allowed him to start training, and it is the concern of every selector to
complex
"
OUT OF PRINT
UNDERGRADUATES need no reminder of the book shortage ; to them this is a recurring obstacle that has somehow to be overcome each time they enter a fresh field of study. The extent of their difficulties is reflected in a report from the Association of Scientific .W’orkers.1 Last spring the association’s Cambridge branch made a survey to find out what proportion of books recommended by university science teachers could be had from booksellers, and to what extent the shortage was affecting the demand for American books. Sometimes any of several books are recommended ; so the investigators first grouped recommended books under topics, counting the topic as covered if any one of the recommended books was obtainable. They found that no recommended book (whether British or American) was to be had in almost half-44% to be exact-of the 128 topics about which inquiry was made ; and, commenting on the present-day student’s tendency to cling to books once he has them, they deny that the second-hand market provides any major relief. There is nothing new about this impoverishment. Originating in the war, it has been accentuated by a number of post-war influences, which we enumerated last year.2 Commonly the deficiency is attributed to insufficient supplies of paper ; actually, it is due rather to over-all incapacity of the printing and associated trades to deal with the demand, which could be met only by reorganisation, with further trained workers and enhanced supplies, including more glue and binding materials. The U.S.A., less embarrassed -by these impediments, is naturally bent on filling the gap ; and the measure of her success is the growth in the proportion of American books among those recommended at Cambridge from about 10% in 1939 to about 33% at the present time. As with British books, not all the American ones are to be had, for the import of learned, scientific, and technical books in English " is restricted to 200% of pre-war value ; as the actual number of American books ordered has doubled since 1939 and theirr price has risen by half, the current demand is about 300% by value of pre-war, and thus about two-thirds of the American books required are obtainable. This is still a higher proportion than that for British works, which in the Cambridge study was only just over half (56%). The report acknowledges that the U.S.A., with her large industrial and scientific activity generally, has a greater number and variety of specially qualified authors ; and there is no suitable British alternative for many of her scientific and technological works of reference. There are, however, other reasons for the paucity of new British advanced works. In this country authors are placed at a, disadvantage by delays in "
1. A Survey of the Shortage of Scientific Textbooks in Cambridge. Issued by the Association of Scientific Workers, 15, Half Moon Street, Piccadilly, London, W.1.
2.
Leading article, Lancet, 1947, ii, 471.
find out how the failure might have been predicted. Similarly, it may prove possible to follow up applicants who have been rejected, and particularly those who are afterwards accepted by another medical school; for all they know, the schools may now be rejecting With many questions some of their best candidates. still unanswered, one thing is clear : in the future, as in the past, each university must be free to choose its students according to its lights ; but protection of this right should not prevent them from helping themselves, and each other, to find out whether they Is their are really getting the students they want. seed the best on the market?,
publication, whereby a new American book may satisfy the demand while its British counterpart is still with the publisher ; and additional deterrents are lack of time and of financial inducement. At the universities increased teaching pressure leaves little time for writing new books and makes it difficult for those who during the war fell behind with their reading to catch up. As to financial inducement, publishers try to divide their inadequate resources equally among authors ; and small impressions for all mean small royalties for all. With the aim of minimising these handicaps, the report proposes that the Government and universities should-like some industrial undertakings-make special provision for reading and writing, perhaps in the form of sabbatical years; and with important books Government subsidies, it is suggested, might make up for the smallness of royalties. Home requirements are not the only reason for fostering new works. By her books Britain has earned abroad a great reputation, which on economic and other grounds must be maintained and expanded. Nowadays, to get an average-size page of a textbook set in type costs about El ; and this high cost is reflected in the eventual price of the book. If more books were distributed overseas, the expense of type-setting would be more widely distributed and thus the price of the book could be reduced. There is also the further point that; for the cost of manufacture, books yield a higher profit abroad than almost any other article. Moreover, overseas book sales promote trade in other directions; a country which buys its medical books from Britain will also tend to look to this country for pharmaceutical supplies. Less tangibly, books take an important part in linking the country of their origin with the place where they are read. On each of these scores we shoilld applaud the association’s restraint in refusing to recommend that the allocation of books for foreign markets should be impaired for the sake of better supplies at home. At the same time we should recognise the extent to which the shortage irt this country derives from determination to sell overseas. The report quotes figures showing that of all books produced here in 1947, valued at over E30 million, 24-5% was exported.3 No separate figures -for scientific works are given ; but the case of a well-known work on bacteriology is cited : 6000 copies of this have lately been printed3 and of these 4500 were exported ; after a two-year wait a Cambridge bookseller, who had ordered 150, received only 5. As to a remedy, the report is unequivocal: in the absence of a general increase in book production there should be discrimination in favour of learned, scientific, and technical books." This claim has often been advanced,2 and has equally often met with the retort, notably from some branches of the trade, that accession to it would amount to censorship. But, as the report points out, discrimination is already exercised in the preference accorded to imported books of learning ; "
3. Bookseller, March
20, 1948.
°
333
of
general education and intelligence should be required ; and these have usually been gauged by examinations taken at school, Besides offering a to intellectual accomplishment the results rough guide indicate whether the student is likely to get over the
THE LANCET LONDON: SATURDAY, AUGUST 28, 1948
similar hurdles he will meet in his medical career. On the other hand, by themselves examinations can be an unsteady guide. In a debate in the House of Lords last May, Lord ELTON2 declared :
Selected Seed To
get
good crop of doctors one needs not only and good cultivation but also good seed.
a
soil In the past few years much has been written on the cultivation of the medical student, and some comprehensive horticultural directions have lately come from the British Medical Association.! Relatively little, however, has been said about the selection of the seed that is to be cultivated, and we have therefore chosen this as the main subject of our educational number for 1948. The information and papers we have collected show that in fact a good deal of thought is at last being given to the fundamental question of how to select the right students for medicine. Formerly there was less need, for the students mostly selected themselves : the number of applicants was little more than the medical schools could hold, and the authorities had no more to do than reject the obviously unsuitable. Now, on the other hand, the applicants are so manythat the selectors have increasingly a positive rather than a negative task ; instead of excluding losers they have to pick winners, which is far harder. Must they still rely on academic
good
tests, school records, and personal impressions, are
there any useful
new
methods of
assessing
or
young
people’s capabilities ? .
thinking about methods of discovering ought surely to know what kind of qualities, What are the ones that make a we seek. qualities doctor ? good High intelligence perhaps ? But some valuable doctors have had only just enough intelligence to pass their qualifying examinations. Acuity of Before
we
’* So far as the traditional examination goes... the successful candidate need possess neither common sense nor common honesty, neither courage nor adequate physique, nor even an original mind. It is the kind of examination in which Shakespeare and Cromwell, and almost certainly Mr. Winston Churchill, would have ignominiously failed. For in early years the possession of a strong character or original mind only too often serves as a sort of nonconductor for the ideas of other people ..."
Recognising the deficiencies of the school examination measuring ability, some universities are beginning to turn to intelligence tests for supplementary information. With such tests random marking is eliminated and a quick answer is obtained ; and though it may not always be the right answer the work of EYSENCK3 and others indicates that a higher correlation of assessment with performance is achieved by considering the results of examinations and intelligence tests together than by relying on either singly. Investigations now proceeding, some of which are described in this issue, may bring to light a group of tests more consistently reliable than any at present employed. A great deal more than intelligence goes to the making of a good doctorand the student who by average standards is insufficiently intelligent may, if stable and determined, not only succeed in qualifying but become a better doctor than his brighter unstable’ friend. In the final analysis, therefore, examination results and intelligence tests do not fully prove a candidate’s suitability or unsuitability, which can be judged only with knowledge of his character, temperament, and personality. On a later page we
in
observation ? But observation varies with interest, such which cannot be judged before training is begun. review some of the methods now used for tells while in Dr. MiLLAR another article Specific aptitude for medicine ? But psychologists judgment, of a proposal at Aberdeen to obtain a fuller picture assure us that aptitude can be confidently identified of character and capabilities through adaptation of only in respect of basically different functions such the War Office Selection Board procedure. Though as mathematics and manual dexterity. Sense of their methods not may prove to be applicable, both vocation ? But in the applicant of, say, 17, whose W.O.S.B. and the National Institute of Industrial interests and personality are not fully moulded, this Psychology, which has pioneered selection for industry, is often. fleeting. (We are told that at this age can offer useful experience to the medical selector. intend to become surgeons, about half the For example, comparison of the initial w.o.s.8. assesswhile the other half want to be psychiatrists ’) The ment with subsequent performance during training truth is that, since a doctor may pursue any of a shows that, while the procedure can be valid, validity score of different careers within medicine, no single varies between the different boards. Though based answer to our question can be found : for which we on scientific principles, it cannot be entirely indepenshould perhaps be thankful, since it would certainly be disastrous if the profession were all of a type. dent of the people operating it-a fact evident also at Medicine in fact defies the job-analysis which in other medical schools. It benefits from the help of the fields is deemed essential to rational selection ; and few who have a flair for their task, but the possession of this flair can be proved only by cold statistics ; it follows that in the choice of medical students and there is merit in the w.o.s.B. of checking progress can come only from empirical studies. But individual selectors’ assessment practice candidates’ the against this empiricism is no excuse for mere adherence to later performance. the status quo, particularly as the efficiency of existing At every stage the need is for more facts ; and methods, apart from impressions, is unknown. until validation is obtained the advocate of one Everyone agrees that certain minimum standards system is in no position to decry another. The more
applicants
1.
of a Doctor : Report of the Medical Curriculum Committee of the British Medical Association. London, 1948. See Lancet, 1948, i, 833, 839.
Training
2. House of Lords: Official Report, May 26, col. 1054. 3. Eysenck, H. J. Brit. J. educ. Psychol. 1947, 17, 20.
334
OUT OF PRINT
the job, the longer validation takes; and universities may perhaps decide that the best hope of speedy progress lies in continuing with their present time adopting an alternative techniques, at the same either as a shadow " method or for the selection of, perhaps, half their students. One valuable function of the Medical Research Council’s committee on selection would be the integration of reports from each centre. In this study special attention will nodoubt be given to the student who fails to qualify ; plainly, his failure is less commonly a reproach to himself than to the system which allowed him to start training, and it is the concern of every selector to
complex
"
OUT OF PRINT
UNDERGRADUATES need no reminder of the book shortage ; to them this is a recurring obstacle that has somehow to be overcome each time they enter a fresh field of study. The extent of their difficulties is reflected in a report from the Association of Scientific .W’orkers.1 Last spring the association’s Cambridge branch made a survey to find out what proportion of books recommended by university science teachers could be had from booksellers, and to what extent the shortage was affecting the demand for American books. Sometimes any of several books are recommended ; so the investigators first grouped recommended books under topics, counting the topic as covered if any one of the recommended books was obtainable. They found that no recommended book (whether British or American) was to be had in almost half-44% to be exact-of the 128 topics about which inquiry was made ; and, commenting on the present-day student’s tendency to cling to books once he has them, they deny that the second-hand market provides any major relief. There is nothing new about this impoverishment. Originating in the war, it has been accentuated by a number of post-war influences, which we enumerated last year.2 Commonly the deficiency is attributed to insufficient supplies of paper ; actually, it is due rather to over-all incapacity of the printing and associated trades to deal with the demand, which could be met only by reorganisation, with further trained workers and enhanced supplies, including more glue and binding materials. The U.S.A., less embarrassed -by these impediments, is naturally bent on filling the gap ; and the measure of her success is the growth in the proportion of American books among those recommended at Cambridge from about 10% in 1939 to about 33% at the present time. As with British books, not all the American ones are to be had, for the import of learned, scientific, and technical books in English " is restricted to 200% of pre-war value ; as the actual number of American books ordered has doubled since 1939 and theirr price has risen by half, the current demand is about 300% by value of pre-war, and thus about two-thirds of the American books required are obtainable. This is still a higher proportion than that for British works, which in the Cambridge study was only just over half (56%). The report acknowledges that the U.S.A., with her large industrial and scientific activity generally, has a greater number and variety of specially qualified authors ; and there is no suitable British alternative for many of her scientific and technological works of reference. There are, however, other reasons for the paucity of new British advanced works. In this country authors are placed at a, disadvantage by delays in "
1. A Survey of the Shortage of Scientific Textbooks in Cambridge. Issued by the Association of Scientific Workers, 15, Half Moon Street, Piccadilly, London, W.1.
2.
Leading article, Lancet, 1947, ii, 471.
find out how the failure might have been predicted. Similarly, it may prove possible to follow up applicants who have been rejected, and particularly those who are afterwards accepted by another medical school; for all they know, the schools may now be rejecting With many questions some of their best candidates. still unanswered, one thing is clear : in the future, as in the past, each university must be free to choose its students according to its lights ; but protection of this right should not prevent them from helping themselves, and each other, to find out whether they Is their are really getting the students they want. seed the best on the market?,
publication, whereby a new American book may satisfy the demand while its British counterpart is still with the publisher ; and additional deterrents are lack of time and of financial inducement. At the universities increased teaching pressure leaves little time for writing new books and makes it difficult for those who during the war fell behind with their reading to catch up. As to financial inducement, publishers try to divide their inadequate resources equally among authors ; and small impressions for all mean small royalties for all. With the aim of minimising these handicaps, the report proposes that the Government and universities should-like some industrial undertakings-make special provision for reading and writing, perhaps in the form of sabbatical years; and with important books Government subsidies, it is suggested, might make up for the smallness of royalties. Home requirements are not the only reason for fostering new works. By her books Britain has earned abroad a great reputation, which on economic and other grounds must be maintained and expanded. Nowadays, to get an average-size page of a textbook set in type costs about El ; and this high cost is reflected in the eventual price of the book. If more books were distributed overseas, the expense of type-setting would be more widely distributed and thus the price of the book could be reduced. There is also the further point that; for the cost of manufacture, books yield a higher profit abroad than almost any other article. Moreover, overseas book sales promote trade in other directions; a country which buys its medical books from Britain will also tend to look to this country for pharmaceutical supplies. Less tangibly, books take an important part in linking the country of their origin with the place where they are read. On each of these scores we shoilld applaud the association’s restraint in refusing to recommend that the allocation of books for foreign markets should be impaired for the sake of better supplies at home. At the same time we should recognise the extent to which the shortage irt this country derives from determination to sell overseas. The report quotes figures showing that of all books produced here in 1947, valued at over E30 million, 24-5% was exported.3 No separate figures -for scientific works are given ; but the case of a well-known work on bacteriology is cited : 6000 copies of this have lately been printed3 and of these 4500 were exported ; after a two-year wait a Cambridge bookseller, who had ordered 150, received only 5. As to a remedy, the report is unequivocal: in the absence of a general increase in book production there should be discrimination in favour of learned, scientific, and technical books." This claim has often been advanced,2 and has equally often met with the retort, notably from some branches of the trade, that accession to it would amount to censorship. But, as the report points out, discrimination is already exercised in the preference accorded to imported books of learning ; "
3. Bookseller, March
20, 1948.
°