Inquest on a Curriculum
197
the details of some nursing procedure. To the
patient he was a young chap not quite up to it; to
himself he was a young chap far beyond it: and
both were true—he could have dealt competently
with an obscure or alarming condition, he was only
at a loss with chronic and minor illness. But these
are to be his life's work; if he is ill-informed about
them at the outset he is at a disadvantage; and if
he is conditioned to find them boring he is handi-
capped indeed.
There is another way in which the medical stu-
dent's training fails him: he has worked where it
was always possible to give the patient something
like the best in the way of examination, investiga-
tion, treatment, feeding and environment. He
now finds that he is continually driven to make
shifts and compromises which seem, at first, to
stamp him as a hypocrite. He discovers not only
that he cannot do the best for his patients but that
he has not even been taught to do the best he can.
Of course he learns. He picks up a hint from a
colleague here, a trick from the district nurse there;
he supplements inadequate diets with costly
vitamins because he must not prescribe food; he
gives tonics where he would like to give blankets,
cod-liver oil where he should order a sojourn in the
country. He begins to realize that he can only
patch up where, given proper equipment he could
restore. Here the fault lies not wholly in his train-
ing; it is right that he should know the best in
treatment and learn to apply it. The defect is in
a medical service still unequipped in many direc-
tions to command the essentials of healthy living.
And it is not our duty, any more than it is the duty
of the crowner's quest, to give praise or blame, to
bring any of the agents to judgment, but rather to
find out by patient inquiry how the prewar curri-
culum came to be the poor frustrated thing it was,
and to share in the glorious task denied to the coro-
ner of infusing new life into the old framework.
INQUEST OF A CURRICULLUM
There are grave difficulties about training a man
to be a doctor, and it would be all too easy in the
present emergency to emphasize the utilitarian
side at the expense of his fundamental education.
Witness the reaction against experimental method,
contemptuously called Kaninchenmedizin in Cen-
tral Europe. This danger is naturally more vivid
to the minds of teachers than of students. Tea-
chers see clearly that if practice is not based on a
sound appreciation of scientific method and though
it will deteriorate rapidly when the student leaves
his medical school. They seek to provide a better
grounding; the suggestion reaching us from many
deans is that physiology should be an integral part
of the whole curriculum and that, in the teaching
of anatomy, structure should be continually related
to function. At Sheffield anatomy and physiology
are taught throughout the five years of training and
an examination in these subjects has been intro-
duced after the second M.B., a year before the
finals. Some feel that the time adjustment bet-
ween preclinical and clinical work and between the
start of clinical work and finals is wrong. From
St. Thomas's comes the view that time is wasted
by the student in cramming the minutiae of anato-
my ; and that the premedical subjects might well
be disposed of by the attainment of an acceptable
standard in matriculation or school certificate.
The student could then go to a central school of
anatomy—there might be two for the London
area—for 9 to 12 months. He would concentrate
on the essentials of anatomy and enough relevant
physiology, taught by the anatomists, to explain
function. At the end of the course he would take
an examination in which attainment of honours
standard could qualify for the primary fellowship.
He would then join his clinical medical school
which would be equipped with a department of
physiology. For a year he would study normal
physiology, physiological chemistry and clinical
methods, including the use of stethoscope, auros-
cope and ophthalmoscope, and would learn to
interpret radiograms he would also learn the
technique of urine testing, blood-examination and
other laboratory tricks. He would take another
examination at the end of a year before passing on
to clinical work and the study of morbid physio-
logy which is medicine. He would not be eligible
to sit for finals until he had completed 36 months
of clinical work, but to keep him mettled up there
might be sessional examinations at the medical
school. At present students are able to sit for part
of the finals within 30 months of the second M.B.,
and thus the average student is cramming for a
part of the final within 24 months of beginning
clinical work. This suggested curriculum, admir-
able as it is, lays emphasis chiefly, on groundwork
and is not directed towards the special needs of
general practice.
Students and general practitioners have different
suggestions to make. On the whole students see
more of general practice than do their teachers;
many of them are the children of general practi-
tioners and many hear the opinions of recently
qualified friends. Moreover that concern for social
conditions which springs from imaginative appre-
ciation of a neighbour's hardships—socialism in the
basic sense—flourishes among the young. If we
are not willing to put the world right in our early
twenties we are poor citizens. The British Medical
Students Association (p. 259) ask that the student
should receive better training in preventiv medi-
cine and gain more experience of chronic and meinor