A retrospective survey of the progress made and of the reforms
instituted in medical education in the United States is instructive.
In many respects there is cause for much congratulation, while for
other reasons the situation gives rise to feelings of alarm. It is
pleasing to note and it augurs well for the future that a decided
advance has been made in the direction of a more thorough medical
training, yet at the same time it is discouraging to observe that,
despite these progressive steps, competition does not abate, but
rather daily becomes more acute. Dr. William T. Slayton has just
issued his small annual volume on "Medical Education and Registration
in the United States and Canada." From a study of this book, which
fairly bristles with facts, a sufficiently comprehensive opinion may
be formed in regard to the present state of medical education in this
country. According to this work, there is now a grand total of one
hundred and fifty-four medical schools. Of this number, one hundred
and seventeen require attendance on four annual courses of lectures,
and twenty-seven require attendance on sessions of eight months, and
ten on nine months each year. Twenty-nine States and the District of
Columbia require an examination for license to practice medicine;
eighteen of these require both a diploma from a recognized college and
an examination. Fifteen States require a diploma from a college
recognized by them or an examination. Five States, viz., Vermont,
Michigan, Kansas, Wyoming and Nevada, have practically no laws
governing the practice of medicine; Alaska the same. In order to gain
a clear comprehension of the existing state of affairs, a comparison
of the number of students at two periods, with a lapse of years
intervening sufficient to eliminate all minor variations, will be more
to the point than merely regarding the multiplication of schools. Many
of these mushroom institutions are not worthy of notice, containing
perhaps a dozen students, and brought into existence only for the
purpose of profit or from other motives of self-interest. The number
of students is as reliable an index as can be given. For instance,
taking the decade between 1883-84 and 1893-94, it will be found that
the students in regular schools in 1883-84 numbered 10,600; in 1893-94
they had increased to 17,601. Students in homoeopathic schools in
1883-84 were 1,267; in 1893-94, 1,666. The number of eclectic students
was stationary at the two periods. The increase during the period from
1893-94 to the present time has been at about the same ratio.
These figures reveal more plainly than words the existing condition of
affairs, which must, too, in the nature of things, continue until that
time when all the States fall into line and resolve to adopt a four
years' course of not less than eight months.
To make yet another comparison, the total number of medical schools in
Austria and Germany, with a population exceeding that of this country,
is twenty-nine. Great Britain, with more than half the population, has
seventeen; while Russia, with one hundred million inhabitants, has
nine. Of course we do not argue that America, with her immense
territory and scattered population, does not need greater facilities
for the study of medicine than do thickly inhabited countries, as
Germany and Great Britain; but we do contend that when a city of the
size of St. Louis has as many schools as Russia, the craze for
multiplying these schools is being carried to absurd and harmful
lengths. However, that the number of schools and their yearly supply
of graduates of medicine are far beyond the demand is perfectly well
known to all. The Medical Record and other medical journals have fully
discussed and insisted upon that point for a considerable time. The
real question at issue is by what means to remedy or at least to
lessen the bad effects of the system as quickly as possible. The first
and most important steps toward this desirable consummation have been
already taken, and when a four years' course comes into practice
throughout the country, the difficult problem of checking excessive
competition will at any rate be much nearer its solution. Why should
France, Germany, Great Britain and other European nations consider
that a course of from five to seven years is not too long to acquire a
good knowledge of medical work, while in many parts of America two or
three years' training is esteemed ample for the manufacture of a
full-fledged doctor? Such methods are unfair both to the public and to
the medical profession, and the result is that in numerous instances
the short-time graduate has either to learn most of the practical part
of his duties by hard experience, to starve, or to utilize his
abilities in some more lucrative path of life. Taking into
consideration the fact that the theory and practice of medicine have
become so extended within recent years, it must be readily conceded
that four years is barely sufficient time in which to gain a
satisfactory insight into their various departments. For a person,
however gifted, to hope to receive an adequate medical training in two
or three years is vain.
In those States in which the facilities for securing a medical
education are abundant, and where the time and money to be expended
are within the reach everyone, there is always the danger that an
undue proportion will forsake trade in order to join the profession.
This is especially the case when times are bad. Many persons seem to
be possessed of the idea that the practice of medicine as a means of
livelihood should be regarded as a something to fall back upon when
other resources fail. Accordingly, when trade is depressed and money
is scarce, there is a rush to enter its ranks. That this view of the
matter is altogether an erroneous one is too self-evident to need any
demonstrative proof. Again, although the question of a universal four
years' course is a most important one, it must not be forgotten that
examination takes almost as conspicuous a place. It is desirable that
every one entering on medical studies should possess a general
education. With the exception of a few unimportant schools, the
entrance examinations would appear to afford the necessary test. Then
comes the much more vital point of how to gage, in the fairest
possible manner, the extent of the medical knowledge of those who have
undergone their full term of study. For various reasons the conducting
of the final examinations by professors in the school in which the
student has been taught is open to many and grave objections, more
especially when these professors are themselves teachers in that
school. As has been pointed out in The Medical Record on more than one
occasion, the most obviously fair regulation is that of independent
examination by an unbiased State board. If this plan were carried into
execution, medical education in America generally would rest on a
firmer basis than in Great Britain, in which country the standard,
although nowhere so low as in parts of the United States, still varies
very considerably in the different schools. The General Medical
Council of England has arrived at the conclusion that competition must
be checked, and has lately brought into force two drastic measures
calculated to attain this object; one is the lengthening of the course
to five years, and, more recently, the abolishing of the unqualified
assistant. The medical profession of America is quite as conscious of
the disastrous results of competition as are its fellow practitioners
on the other side, and should use every legitimate means to sweep away
the evils of the present system.--Medical Record.
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