6 FEBRUARY 1942, Page 9


revealing and accelerating hidden tendencies—has not lost its character. The medical pro- fession has seen some radical changes at its hands already ; and more must come in one field at least—that of the training of a doctor. The question of shortening that training has shown that it is already too short ; the new ideal of medicine as an ever- widening preventive organisation backed by an ever less needed system of cure, has its corollary in education ; financial difficulty is accentuated, and the cost of training to be a doctor is thrown into sharp relief against other professions ; the recognition that doctors are worth absolute exemption from military service must mike them ask whether (both as individuals and as practitioners) they are fit for the responsibility.

One can question, too, whether it is right that young men should have to give up their medical training for lack of funds ; examples are found all too frequently. Yet, unless it is true that the best doctors come from the richest families (which is more than doubtful), here is a flaw in the recruiting-system. Again, medical knowledge is changing, from the " empirical " such as is learnt only from experience at the bedside and by dint of a retentive memory) to the " rational " (which approaches the p'aysical sciences, and is learnt by grasping underlying prin- ciples'. The one will probably never lose its value ; but the other is becoming ever more important—and education must follow its lead. In short, the claims of an honours school in Natural Science at some stage make themselves felt. The history of medicine is strewn with examples of scientific medical men tackling the most difficult problems and solving them ; "scientific" thinking is as powerful a solvent in medicine as elsewhere. A medical education might be the finest a man could have. The strict discipline of anatomy and physiology, the broad out- look bred of biological studies, the humanity and sensitiveness learnt from constant contact with and work for the sick, the training in responsibility for other men's lives, the enormous scope (for a doctor must tread wisely and confidently over the vast field between a man's intimate bodily functions aid the most delicate mental disorder)—all this coalesces (or should do) into an impressive training. Small wonder that often the doctor seems to replace the priest of past times as a dispenser of unique knowledge and unquestioned advice.

But the student is faced from the first with the financial problem ; he must get qualified as soon as possible, as cheaply as possible ; outside interests (except sport) must be cut to a minimum ; he takes, as a rule, the easiest degree first ; he has no time for an honours degree or a little research ; as soon as qualified, he must go into practice to build up the income he needs to support his family. One holds no brief for the incompetent dilettante ; but there is no doubt that a man who, without jeopardising his pro- fessional skill, can keep up his languages, his reading, his music, or does some research, or travels, will be a better doctor for it. He has more reserves ; his contact with a patient can be broader ; his grasp of new ideas is quicker.

That medical training needs revision is widely felt, and the reforms proposed are multitudinous ; the introduction of new courses such as in sociology or anthropology ; a new orientation of preliminary biological training ; less or different anatomy ; less or different physiology ; more linking of early studies with medical practice ; a different examination-system ; a single national medi- cal qualification ; more " culture," more research ; more practical experience under supervision ; and so on. But the crux of the matter is still time. Of what a medical student learns in the five years after leaving his secondary school, very little is superfluous, and be has little time for more. • Time is short because his money is short. Money is short because living-expenses, fees and books for five years are costly. The problem is primarily financial ; and its solution must be in that sphere.

A reasonable possible solution is that after three years at a university the student should enter a sort of medical civil service by examination, living thereafter at the State's expense and con- tinuing in the service, of course, only on condition that his studies progress satisfactorily.. He thus ceases to lie a burden to his parents at the end of his university career ; he can take advantage of a new range of educational facilities ; he can absorb the proposed additions to his 'curriculum ; and he can keep his general education in step with his medical.

It may be said that this is going to lengthen a training already overlong. Certainly it is exasperating for a young man to go on learning year after year, while so many of his friends are independent. But extra time would make some research possible ; or permit an apprenticeship to a G.P. ; or allow the student to hold some partly responsible post at a hospital to do with a branch of medicine in which he was interested. There would be many ways of giving him work important enough for him to feel that he was doing something useful. It is the condensed training, with time for nothing but to absorb knowledge, which exasperates and palls.

No one can dogmatise as to the details of the final reform. But it certainly appears that the main point is that the State should take some of the burden off the young student. Is it asking too much? I think not. As Wilfred Trotter wrote in one of his essays: " At a time when it is no longer possible to conceal the wholly unique importance of medicine for the very existence of social life, that profession finds itself of all profes- sions the least in command of social prestige, the least privileged, the most exposed, and the hardest worked."

Doctors have been among the very few who may be truly said to extract good from the horrors of war. Let us hope that the plasticity which war enforces will be used to the best advan- tage, both by the public and by the medical profession, in fashioning the training-ground 'of the doctor of tomorrow.