Medical school

“ The main task of the medical schools will always be to train physicians. It does not fall within the scope of this address to define what this training should be, and I shall not attempt it, excepting in so far as it bears upon laboratory instruction. I believe that the medical school should make the future physician absorb as much as possible of the best medical science of the day and give him a certain initial skill and dexterity in carrying out the fundamental operations of the medical art. ”

“ Lastly comes the question as to how the university may co-operate in advancing medical education. A medical school is strictly a technical school--a school in which a practical profession is taught--while a university ought to be a place in which knowledge is obtained without direct reference to professional purposes. ”

“ For about 1871 anyone who wished might enter an American medical school practically anywhere in the country, without any preliminary education, and having taken two terms of ungraded lectures, that is, having listened to the same set of lectures two years in succession, might receive his degree of doctor of medicine. ”

“ Research in the medical school or the hospital, on the other hand, has developed slowly and has been in most institutions a matter of secondary importance. The reason for this is not difficult of demonstration when one remembers that even schools of university rank emerged only a short time ago from the proprietary state and that most physicians just past middle age can remember the two-and three-year course. ”

“ This was a great advance, for the medical schools were largely proprietary institutions whose standards were lower than in the university. But it is perhaps now true that the spirit of scholarship and research is more advanced in the medical school than in the college. When a medical school is sufficiently well endowed and its professors are men devoted to research, it is probable that it would be best for it to take charge of the education of students after they leave the high school, whether their period of instruction is to be four years or ten. ”

“ There is not the slightest difficulty in giving sound elementary instruction in physics, in chemistry, and in the elements of human physiology, in ordinary schools. In other words, there is no reason why the student should not come to the medical school, provided with as much knowledge of these several sciences as he ordinarily picks up, in the course of his first year of attendance, at the medical school. ”

“ After the year 1910 most of the large universities in this country will not admit further students to their medical departments unless they have a college degree or its equivalent, that is, unless they have devoted four years to college undergraduate work. It is generally understood, that in the last year of his undergraduate course the student who intends to take up medicine may elect such scientific studies in the college department as will obtain for him an allowance of a year's work in the medical school. ”

“ Those physicians who enroll themselves as students in the Washington Post-Graduate Medical School and faithfully follow the course of instruction which is open to them, can not fail to return to their professional work with broader and more exact information on many subjects relating to scientific medicine, with increased skill in the diagnosis and treatment of disease and with greater confidence in the resources of the noble profession to which they have devoted their lives. ”

“ In the evolution of general and medical education in this country it is becoming more and more evident that a well-rounded university needs a strong medical department, and it is now equally clear that a medical school cannot reach the highest stage of its development except as the medical department of a strong university. It is evident that within a few years the medical schools of this country will, with few exceptions, be the medical departments of universities. ”

“ College Physiology and Hygiene.—Some colleges offer courses in physiology which are dilute presentations of medical school work. Thus, in one course, the student may be taught something of human anatomy, physiology, hygiene and medical bacteriology, all of which may be useful for those who are not intending to study medicine. It is wholly undesirable for the medical student to take time from other college work for the sake of such courses. ”

“ Under an able faculty and with excellent facilities it is not surprising that the Medical School has been able to maintain a very high standard of efficiency and that it now meets fully the requirements of the Association of American Medical Colleges. ”

“ In view of the great scientific and social problems facing the medical profession it may be wise to plan a year of graduate work in mathematics and physics between graduation and entrance to medical school. Medical schools are not asking for such additional preparation, but the needs of medical wisdom are great beyond the power of liberal education alone to meet. ”

“ Its professors often came from a distance and had travelled extensively for purposes of study; they attracted patients of high rank from nearly every part of Europe, and these were generous in their patronage of the school. Students came from all over, from Africa and Asia, as well as Europe, and when abuses of medical practice began to creep in, a series of laws were made creating a standard of medical education and regulating the practice of medicine, that are interesting anticipations of modern movements of the same kind. ”

“ At Cambridge, Eng., the candidate for this degree must be a Bachelor of Physic of five years' standing, must have attended hospital practice for three years, and passed an examination satisfactory to the Medical Professors of the University,
At Oxford, an M.D. must be an M.B. of three years' standing. The exercises are three distinct lectures, to be read on three different days. In American colleges the degree is usually given to those who have pursued their studies in a medical school for three years; but the regulations differ in different institutions. ”

“ Medical inspection of school children is in its infancy. Before a satisfactory method will be worked out many experiments must be tried out and many careful inquiries made. The present fragmentary study was undertaken on behalf of the public health, hospital and budget committee of the New York Academy of Medicine to demonstrate a method of testing the value of certain elements entering into the effectiveness of our medical school work, in order to determine whether school clinics are a practical necessity. ”

“ It has done, and is doing, much to place the science of medicine on a firm basis. To the text-books of this school, every student who would qualify himself for medical practice must resort, to gain that knowledge upon which depends his future success. ”

“ A physician must practise according to the principles of his school. There are distinct and different schools of practice; allopathic or old school, homœopathic, Thompsonian, hydropathic or water cure; and if a physician of one of those schools is called in, his treatment is to be tested by the general doctrines of his school, not by those of other schools. It is presumed that patient and physician both understand this (108) .
A person professing to follow one system of medical treatment cannot be expected by his employer to practise another. ”

“ Only they must not be disappointed if they find many subjects treated in our courses as a medical class requires, rather than as a scientific class would expect, that is, with special limitations and constant reference to practical ends. Fortunately they are within easy reach of the highest scientific instruction. The business of a school like this is to make useful working physicians, and to succeed in this it is almost as important not to overcrowd the mind of the pupil with merely curious knowledge as it is to store it with useful information. ”

“ The entrance requirements were simple; a fair high school education, with Latin and Greek sufficient for the understanding of medical terms. For graduation, at least three years' study with a reputable physician was required; but this might include the two six-month courses of lectures which comprised the work of the Department. Even this very slender medical preparation was not required of college graduates, or of students who had already practised medicine four years, for whom one course was deemed sufficient. ”

“ At the close of the second winter session, the men are expected to be ready for the first professional examination at the College of Surgeons, in anatomy and physiology. It is the desire of both teachers and the hospital itself, that as large a proportion as possible of the students shall present themselves for examination at the regular time, as the credit of the school depends on the proportion of passes. ”

“ Flexner have obtained their medical education by a short course, they have had expert advice and their general point of view is sound. We need several university schools of medicine emphasizing research and demanding long preliminary preparation, the schools for the training of the great mass of practising physicians should require a training in science and the languages equal to two years of college, the schools in the south can not at present reach this standard, but should require a preparation equal to a four-year high school course. ”

“ An otherwise qualified medical student with a particular background — whether it be ethnic, geographic, culturally advantaged or disadvantaged — may bring to a professional school of medicine experiences, outlooks, and ideas that enrich the training of its student body and better equip its graduates to render with understanding their vital service to humanity. ”

“ Some laymen might wish to end the discussion of a person's medical education at the moment he receives his medical diploma, but those who are in the practice of medicine know that this is the end of only the initial phase of professional education and that there are many things not taught in the school that must be learned in practice. ”

“ The third great fact which is to be taken into consideration in dealing with medical education, is that the practical necessities of life do not, as a rule, allow aspirants to medical practice to give more than three, or it may be four years to their studies. Let us put it at four years, and then reflect that, in the course of this time, a young man fresh from school has to acquaint himself with medicine, surgery, obstetrics, therapeutics, pathology, hygiene, as well as with the anatomy and the physiology of the human body ”

“ In the school thus established by the energy of a college-bred youth and the wisdom of a backwoods practitioner, coupled with the assistance of a most able corps of teachers, he became at once a master spirit. Understanding the nature of the medical student with an insight given to but few, he had a hold upon the class peculiar to himself.
In 1851 he founded the Nashville Journal of Medicine and Surgery, and sustained it for a quarter of a century. ”

“ Let Us now consider in a brief manner the advantages we may hope for from the execution of our design. These are greater, and more in number, than strike our notice at once. We shall first consider the benefits which the Students of Medicine will derive from it.
In a place so remote as Philadelphia from every school of Physic, we cannot expect a very early inintelligence of all the medical discoveries and improvements which are made in Europe. In establishing medical colleges, the professors of each branch will find it incumbent on them to keep up a correspondence with the learned abroad. ”

“ It is a well-known law in the history of medicine that, whenever medical schools are attached to universities in such a way that students who come to the medical department have been thoroughly trained by preliminary studies and have such standards of scholarship as obtain in genuine university work, then great progress in medicine and in medical education is accomplished. ”

“ As far as I can learn, every body approves of my plan for instituting medical schools, and I have the honour of being appointed a public professor for teaching physic in the college here. Can any man, the least acquainted with the nature of that arduous task, once imagine it possible for me to acquit myself in that station, in an honourable or useful manner, and yet be engaged in one continued round of practice in surgery and pharmacy, as well as physic?
To prepare for a course of lectures every year requires some leisure, and a mind undisturbed with too great a variety of pursuits ”

“ At no time in the history of the school, it is important to state, do the church authorities appear to have been in control of its affairs. At most, one or two of the monks seem to have taken part in the teaching for limited periods of time; but in its main characteristics the school may truthfully be described as an institution created and managed by physicians for the advancement of medical science and the best interests of the profession as a whole. ”

“ It was realized that this would make the teaching of medicine more serious and keep the practical side of medicine from obscuring too much the scientific and cultural aspects of the medical training. In modern times in America we made the mistake of having our medical schools independent of universities, but with the advance in education and culture we have come to imitate the custom of the thirteenth and the fourteenth century in this regard. ”

“ So strong, however, has been the growth of American public opinion that a four-years course of medical training has become the standard in medical schools, and in the majority this is in addition to one or two years' training in the natural sciences. ”