Teaching Chest Disease: The Student as an Individual

Abstract

In 1910 the report of Dr. Abraham Flexner called attention to the chaotic situation which then existed in the field of medical education in the United States. Diploma mills and proprietary institutions were only slightly worse than some departments of even the best medical schools. Few medi cal diplomas carried with them the assurance that the recipient had met acceptable requirements in the various branches of medicine. In the intervening 45 years a great deal of effort has been directed toward raising the standards of medical education in this country. This has been accomplished to the extent that a diploma from an American medical school now indicates that a student has attained a reasonable acquaintance with a rather specific body of knowledge and some pro ficiency in a common set of technics. A large number of medicah students are now taking, and for the most part passing, examinations given by a national board. Much of this standardization has been beneficial in rais ing the level of medical practice. But has it also had some deleterious effects? Have we standardized down as well as standardizing up? Do the present standards prevent bold and original thinking on the pant of medi cal students and medical faculties? To each of these questions I believe the answer is yes. One false premise of some advocates of standardization is the considera tion of medical students as standard colhege graduates taking a standard program designed to make them standard doctors. Since no such thing as the standard college graduate, medical student on doctor exists, the medi cal schools run the risk of directing their activities toward hypothetical persons. This is not an idle sophistry. It is possible and perhaps preferable although more difficult to direct medical education toward the needs of the individual student. The simplest method of doing this, and one which has worked well in schools where it has been given some trial, is to allow the student greater choice in the selection of his course of study. This plan does not imply the offer of a completely cafeteria-style course of study. Rather it suggests that the required courses be cut so drastically that they can be presented in about one-half the time of four academic years. To the critic who protests that the minimum essentials “cannotbe covered in such time,― I reply that they cannot be covered in the currently alloted time if one means by “covering― attaining an intelligent and useful understanding of the principles of the basic sciences and the clinical disciplines. The fields are too large. If one means by “covering― the transcription by students