SOME CONSIDERATIONS OF MEDICAL EDUCATION.

1459 and in State medicine was heavy and growing more attention also had perforce to be paid to the details of many branches of medical studies- he instanced mental diseases and ophthalmology-wherefore he considered 1 that, if it was granted that the curriculum must be lightened, III. it followed that it was in the preliminary scientific subjects The Requirements of the General Medical Cozcnaeil as to Prethat the change must come. He thought that the principle in liminary Scientific Education.-The Plczcc of Biology the Curriculum.-Instruction without Examination. -The of having subjects in the syllabus upon which it was possible English Conjoint Board and the Preliminary b’cientific that the students would not be examined might relieve Subjects. the overcharged curriculum and the principle suggested in THE General Medical Council has been for many years the first instance for biology might be extended in other aware that the curriculum of the medical student bade fair directions. to be overloaded, and some ten years ago official notice was The amendment was seconded by Sir John Batty Tuke taken of the fact by the institution of a Committee on Pre- on the ground that it brought to the notice of the Council a liminary Scientific Education, which committee, forming a principle " which would tend to reduce the amount of weary Joint Committee with the Committee on Examination, grind that went on and resulted in no intellectual activity and reported to the Council in 1904 in very important terms. The the acquisition of the minimum of knowledge," and as far as committee obtained information from a very large number of his remarks were levelled against the abuse of the examination licensing bodies and medical and scientific institutions, and system, he was undoubtedly expressing the opinion of most of as a result of summarising all the knowledge which it the medical profession and very many teachers and examiners. acquired it was able to state that no very great difference The Council, however, was divided as to the advisability, or of opinion existed among any of the bodies concerned. As even the possibility, of laying down that a subject should be so frequently happens, the position of the London medical a subject of teaching and not of examination, and it is schools was not quite on all fours with that of the other difficult not to anticipate that if a subject were explicitly institutions because the London schools, as forming parts of excluded from examination by the Council it would very the University of London, intimated that they would reply soon be excluded from study--at any rate, the classes in it through the University. The University, however, does not would come to be attended only on compulsion and in a perappear to have consulted all the schools, although there is no functory manner. Sir William Thomson made this point in reason to suppose that had this been done the result of the his contribution to the debate. While admitting that year by inquiry would have been less uniform. The eight recom- year the work of the medical student had piled up until mendations of the Joint Committee wereit was becoming more and more evident that five years 1. That an examination in chemistry in order to be sufficient should were quite insufficient to enable him to master the details comprise a written paper, a practical examination, and an oral of his training, he held that if biology was only to be an examination. 2. That in respect of chemistry a synopsis of subjects should be issued instructional course there would be difficulty in saving it by each licensing body and that the scope of the examination in a farce. The of the Council confrom whole becoming chemistry should not fall below that which has been indicated in the report of the visitors and has been generally approved by the licensing sidered that elementary biology in some form or another bodies. 3. That the examination in practical chemistry should not be limited must be retained in the curriculum, although there were to simple qualitative analysis but should include easy preparations and divergences of opinion as to the precise meaning of "elesimple experiments illustrating important principles. 4. That an examination in physics in order to be sufficient should mentary biology," a situation which induced some members comprise a written paper and an oral examination, the latter to to include practical questions on the use of physical instruments and urge that the Council should lay down a minimum apparatus. of biology, and which equally justified other 5. That in respect of physics a synopsis or syllabus of subjects should syllabus be issued by each licensing body and should include the elementary members of the Council in declining to attempt what they mechanics of solids and fluids and the rudiments of heat, light, and considered an impossible task. Eventually Clauses 6, 7, and electricity. 6. That elementary biology should be retained in the curriculum. 8 were approved of by the Council, while Dr. Mackay’s pro7. That an examination in elementary biology in order to be sufficient should comprise a written paper and an oral examination, the latter to posal reached this position that the Council instructed the include practical questions on specimens and dissections and on methods Education Committee to collect information and report on of microscopical investigation. 8. That, in respect of elementary biology, a synopsis of subjects should the subject of the feasibility of retaining certain subjects in be issued by each licensing body. the curriculum without requiring examination upon them. Until the sixth recommendation was reached the views of We shall see later what became of this instruction. the committee were adopted by the Council with unThe debate showed clearly that the Council, upon informaimportant verbal alterations, and indeed one or two of the tion derived from representative educational and examining recommendations were reaffirmations of resolutions which bodies, was not prepared to recommend any lightening of the Council had already decided by vote at previous debates. the curriculum as far as the preliminary scientific subjects But around the sixth recommendation "that elementary were concerned. There must be written and oral examinabiology should be retained in the curriculum’’ an interesting tions in physics, and every student must be prepared to be debate arose. This debate was started by a proposal of an examined in biology. While there was a tacit agreement absolutely novel character made by Dr. John Yule Mackay, that the curriculum was overloaded, the lightening of the who proposed for the consideration of the Council an amend- load by throwing biology overboard or by making the ment in the following words :instruction in chemistry and physics less important was not Thatthe Council is of opinion that while the subject of biology should found in keeping with modern or progressive ideas of medical be retained in the curriculum it will not regard it as necessary that a professional examination in the subject should be demanded, provided education. And at this juncture, at the same meeting of the the student has attended and duly performed the work of a satisfactory course of instruction in the subject as part of his curriculum at a Council, there occurred a second interesting debate, started university or duly recognised school of medicine. in a totally different manner but covering much of the Dr. Mackay, speaking in support of his amendment, placed same ground and dealing with many of the same questions, biology in a different position from that of chemistry or inasmuch as the adoption of the recommendations of the physics. He pointed out in an interesting speech that the Joint Committee by the Council may be regarded as an amount of work which the student was now compelled to do acknowledgment by the Council that the admittedly overcrowded condition of the medical curriculum could not be 1 Nos. I. and II. were published in THE LANCET of Oct. 23rd (p. 1232) and 30th (p. 1301), 1909, respectively, met by any modification of the preliminary scientific courses. in

SOME CONSIDERATIONS OF MEDICAL EDUCATION.

should not be

limited

biology

heavier, while

1460 other bodies which had followed the example of this Board in recognising school work as part of the medical curriculum. Following on the inspection of the examination the two subjoined resolutions were passed by the Council on

The ottier obvious alternative was to reconsider the length of the curriculum or the possibility of arranging the subjects within the curriculum in some more flexible manner. The practical action of certain institutions, notably the Conjoint Examination Board of the Royal College of Physicians of London and the Royal College of Surgeons of England, badI this possible reform in view. The situation which was revealed at this debate more than four years ago remains unchanged, and may be considered as the middle stage of a dispute which had its origin in 1890 when the medical curriculum was lengthened to five years ; and that the points at issue remain unsettled may be realised by a leading article which appeared in THE LANCET,2 having special reference to the views expressed by the science masters of public schools assembled in conclave to protest against the non-recognition by the General Medical Council of their

July 15th, 1903 :(1) That the examination in chemistry, physics, and biology of the Examining Board in England is in the opinion of the General Medical Council insufficient. (2) That the courses of study in chemistry, physics and biology in many of the teaching institutions which have been recognised by the Examining Board in 1
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greatly extended syllabus demanding from its students :-

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opinion

of the other bodies recognising work to school were found be insufficient. The Council then proceeded to define its requirements with respect to chemistry, physics, and biology, instructing each body to draw up a syllabus showing the course of study demanded and the subjects of the examination in each of the sciences. The English Conjoint Board drew up a new and

instituted in 1890 it was not contemplated that the preliminary sciences should be studied elsewhere than at recognised schools of medicine or science. But the Conjoint Examining Board in England from a very early period exercised its discretion under the charters of the Colleges and granted recognition of the science courses given at many schools, and the Board continues to do this despite the regulations of the General Medical Council which are held by the Colleges not to override their privileges. Whether if the wording of the regulations had been different, so that the authority of

years’

in the

Similarly the examinations

teaching. When the five

are

insufficient.

at the meeting of the Council on when Dr. Norman Moore moved that the communications between the General Medical Council and the Executive Committee from the English Royal Colleges in regard to the curriculum and examination in scientific sub-jects should be received and entered on the minutes. The course of instruction and details of the first professional examination which it was intended to incorporate in the regulations of the Cojoint Board for the future made it quite clear to the Council that, although the Royal Colleges. did not admit in any way that legitimate fault could be found with their curriculum, they were prepared to demand from their students a minimum course in chemistry, physics, and biology which ought to be sufficient for the acquisition of the elements of those sciences, that they were prepared to examine the students by paper and by viva vooe and to demand a fair standard of marks from the candidates. The Colleges, however, proposed that the courses need not run concurrently, need not be completed within one year, could be attended before the preliminary examination in general education was passed, and could be undertaken at any properly equipped school, while counting for not more than six months of the curriculum. That is to say, the Colleges, relying on (1) the prestige oftheir charters, (2) the admittedly admirable nature of their test examinations, and (3) the absence of any definite right, on the part of the Council to demand registration of every medical student as a proof of the commencement of medical education having taken place at an institution approved by the Council, intended to sanction the education of their students in the preliminary sciences at any place which seemed good to them. Regarded in one way, this was to resist the Council; regarded in another, it could be considered as a definite effort to lighten the burden of the student, for it enabled him to enter a medical school p actically ready to attack anatomy and physiology at once. (To be continued.)

This

was

the

position

May 28th, 1904,

4-ha. um

haveresisted resisted ititis noteasyto would atthe the time time have Collegeswould in the of the the

is not easy to at but language employed guess, vagueness earliest regulations affecting the five years’ course undoubtedly conduced to the awkward situation which has arisen. Probably the Council at the time had not even contemplated the possibility of the medical curriculum proper being commenced at any secondary school, or anywhere save at certain universities, medical schools, and scientific institutions. As soon as the flaw was seen an amending resolution was passed containing a new regulation, to come into e:Eect on Jan. 1st, 1900, to the effect that no medical student should be registered until he had commenced his studies at a school of medicine or at a scientific institution recognised by one of the licensing bodies and approved by the Council. The Conjoint Board in England refused to be bound by this regulation, and continued to recognise the instruction given in various schools in the preliminary scientific subjects as sufficient to admit students to the preliminary scientific examinations of the Board. That is to say, that schoolboys were able to count part of their schooltime, when they were presumably engaged upon their general education, as part of the statutory five years of the medical curriculum. The Conncil then asked for a return from all the teaching institutions recognised, with the object of finding out whether they were sufficiently equipped for teaching and whether the instruction given was adequate in amount. The return, which has been printed in the Council’s minutes, showed that the teaching given was, in the opinion of the Council, of an unsatisfactory nature. Biology was taught in very few schools. As to chemistry and physics, the report says :-

Colleges

MEDICAL MAYORS AND MUNICIPAL HONOURS.Up to the time of going to press we have been notified that the following members of the medical profession have bee, the statistics presented that in some of the cases it is actually possible elected mayors of their respective boroughs : Aldehurgh instrucfor six months of medical study to be constituted by a course of tion in chemistry and physics, limited, so far as these subjects are Mrs E Garrett Andcrson, M. D. Paris, L.S.A. (re-elected) ; concerned, to four or five hours a week, taken out at an ordinary Lymir’gr.on, Mr. Edward F. Chinery, F.RCS.Edin., grammar school during school hours, or at a technical institute, it may L. R. C. P. Edin.. M. R. C. S. Eng. ; Newark, Mr. F. H. be in its evening classes. Appleby, M.R.C.S. Eng., L.S.A. ; Oswestry, Mr. R. de la The Council then decided to inspect the first professional Poer Beresford, M.D.Glasg., L.RC.P., L. R. C. S. Edin., examination of the Conjoint Board in England and that of L.RC.P.Lond.; St. Albans, Mr. E. H. Lipscomb. M.B., The course of instruction followed in most of the schools is less than 15 hours a week ; in many it is very much less. And it is evident from

2

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THE

LANCET, Jan. 30th, 1909, p. 332.

B

0. Cantab., M.R.C.S. Eng.,

hampton,

Mr. J.

L. R C. P. Lnnd. ; WolverGrout, L. R. C. P. & S. Edin., L. F. P. S, Glasg.