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JAMA 100 Years Ago
September 6, 2000


Author Affiliations

JAMA 100 Years Ago Section Editor: Jennifer Reiling, Editorial Assistant.

JAMA. 2000;284(9):1069. doi:10.1001/jama.284.9.1069

Medical education in the United States has made wonderful progress during the last decade. The day of the two-year school is past and gone; that of the three-year school is rapidly drawing to a close; and already we hear talk of establishing courses of medical study extending over five years of eight to nine months each. Simultaneously, scientific medicine has also reached a higher plane than ever before. Original research, new discoveries, and finished clinical and other studies are making their appearances in a manner that betokens a sound foundation, through training, and fully equipped hospitals and laboratories. That this progress of medicine in general is gratifying to all who have its true interests at heart, naturally goes without saying. But there is much to be done. The great majority of our medical schools fail to adequately meet the responsibilities they shoulder in offering young men and women "full opportunities" to secure a thorough medical education. The crying need at this time is greater facilities for proper clinical instruction. In this respect, perhaps, all our schools fall short, although there is a heaven-wide difference between the two extremes reached.

One of the necessities of a properly equipped medical school is a large hospital. It does not suffice that this hospital is adjacent to the college; it must be under the full and unrestricted management of the college, as far as the medical work is concerned. It should form one essential part of the machinery for giving instruction, as it is the mainstay of the college. Indeed, to a large extent the hospital, with its wards, its outpatient department, its operating rooms, its dead-house, and its laboratories, is the medical school. All other instruction is naturally preliminary to observation and study in the hospital. The eager, intense competition on part of recent graduates for all kinds of interneships is sufficient evidence of the need of students themselves feel of further clinical training. Give a student but fair opportunities to work in the hospital and he is more than willing to spend a year or more after graduation. He asks no pay, simply a chance. Indeed, in some medical centers, the best students spend the last year or more of their medical course in the most arduous special training for the hospital examinations—a system fostered by the antiquated method of examining applicants for interneships and by the absence in the college of the necessary facilities for proper clinical instruction. The day of exclusively hearsay learning in medical schools is past.

Like the student of other biologic sciences, the student of medicine demands the chance to see and to feel with his own senses. And he should have it. But how? In the first place no medical school should be considered fully organized without a well-established general hospital under the unquestioned and permanent control of its faculty, as the first and fundamental requisite. It is high time that the state take cognizance of the opportunities for, and the character of, the practical, clinical instruction offered by the various corporations that send up graduates as applicants for state license to practice medicine. At present the state pays little or no attention to this part of the medical schools.

Secondly, the existing hospitals, city, county, and endowed, should be organized and utilized to the fullest extent. Educate the governors of hospitals and the public so that they may see that the use of the hospitals for clinical study by medical students, when rightly conducted, means improvement in the treatment of the patients and of the scientific work of the hospitals. There are neglected opportunities of clinical instruction in all our large cities. The number of interneships may be increased quite generally without detriment to the service.

In the third place, the clinical teacher should be in such a position that he would feel more his responsibilities. The clinical departments should be reorganized, and men should be placed at their head who are properly paid and of whom more may be demanded than of those who regard their clinical services merely as a means of rapidly acquiring a large private clientèle. Commercialism and clinical teaching do not harmonize. There are able young men springing up who are willing to devote their energies to scientific clinical teaching and work for a financial return commensurate with that received by scientists in other departments. This means money, and we are fully aware of the status of our medical schools in this respect. Progress, however, lies in this direction. Finally, it may be emphasized again that in order to realize for our medical students the best opportunities for correct clinical teaching, the hospital must be an integral part of the school, and as completely under its control as the chemical or other laboratory—all other arrangements are in the end unsatisfactory, temporary, and often irksome and unsafe.

JAMA . 1900;35:501