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MEDICAL EDUCATION
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MEDICAL See also:EDUCATION . Up to 1858 each University, Royal See also:College of Physicians or of Surgeons, and Apothecaries' See also:Great See also: On presentation of a certificate to the registrars of the Council, and on See also:evidence being produced that the See also:candidate is sixteen years of See also:age, his name is inscribed on the " Students' Register." The subjects of examinations are: (a) See also:English See also:language, including See also:grammar and See also:composition(marks not exceeding 5% of the See also:total obtainable in this See also:section may be assigned to candidates who show a competent knowledge of shorthand); (b) Latin, including grammar, See also:translation from specified authors, and translation of easy passages not taken from such authors; (c) See also:mathematics, comprising See also:arithmetic; See also:algebra, as far as See also:simple equations inclusive; See also:geometry, the subject-See also:matter of See also:Euclid, Books I., II. and III., with easy deductions; (d) one of the following optional subjects—See also:Greek, See also:French, See also:German, See also:Italian or any other See also:modern language. Certificates are accepted from all the universities of Great Britain and Ireland, from the leading See also:Indian and colonial universities, from See also:government examination boards, and from certain chartered bodies. The German Abiturienten Examen of the gymnasia and real-gymnasia, the French diplomas of Bachelier es Lettres and Bachelier es Sciences, and corresponding entrance examinations to other See also:continental universities are also accepted. As regards professional education, the Council divided its resolutions into " requirements " and " recommendations "; the former consisting of demands on the licensing bodies, non-compliance with which renders them liable to be reported to the Privy Council; the latter are regarded merely as suggestions for the general conduct of education and examination. The requirements may be summarized as follows: (a) Registration as a medical student. (b) Five years of See also:bona-fide study between the date of registration and the date of the final examination for any diploma entitling the holder to be registered under the Medical Acts. (c) In every course of professional study and examination the following subjects must be contained, the Council offering no See also:opinion as to the manner in which they should be distributed or combined for the purposes of teaching or examination, this being See also:left to the discretion of the bodies or of the student—(i.) physics, including the elementary See also:mechanics of solids and fluids, and the rudiments of See also:heat, See also:light and See also:electricity; (ii.) See also:chemistry, including the principles of the See also:science, and the details which See also:bear on the study of medicine; (iii.) elementary See also:biology; (iv.) See also:anatomy; (v.) See also:physiology; (vi.) materia medica and See also:pharmacy; (vii.) See also:pathology; (viii.) See also:therapeutics; (ix.) medicine, including medical anatomy and clinical medicine; (x.) surgery, including surgical anatomy and clinical surgery; (xi.) midwifery, including diseases See also:peculiar to See also:women and to new-See also:born See also:children; (xii.) theory and practice of See also:vaccination; (xiii.) forensic medicine; (xiv.) See also:hygiene; (xv.) See also:mental disease. (d) The first of the four years must be passed at a school or See also:schools of medicine recognized by any of the licensing bodies; provided that the first year may be passed at a university or teaching institution where the subjects of physics, chemistry and biology are taught; and that graduates in arts or science of any university recognized by the Council, who shall have spent a year in the study of these subjects, and have passed in them, shall be held to have completed the first of the five years of medical study. (e) The study of midwifery practice must consist of three months' attendance on the indoor practice of a lying-in See also:hospital, or the student must have been See also:present at not less than twenty labours, five of which shall have been conducted throughout under the direct supervision of a registered practitioner. The fifth year of study is intended to be devoted to clinical See also:work and may be passed at any one or more public hospitals or dispensaries, See also:British or See also:foreign, recognized by the licensing authorities; six months of this year may be passed as a See also:pupil to a practitioner possessing such opportunities of imparting See also:practical knowledge as shall be satisfactory to the medical authorities. This latter method is rarely employed. The " recommendations " of the Council contain suggestions which may or may not be acted on by the bodies. For the most See also:part they are complied with in connexion with the system of practical and clinical teaching. The Council satisfies itself that its requirements are acted on, and that the examinations are " sufficient," by cycles of inspection about every five years. The examination of each licensing body is visited by an inspector, who forwards his report to the Council, which sends each report to the body for its information ,and remarks. As yet it has never been the See also:duty of the Council to report to the Privy Council that any examination has not been found sufficient:-,,,, Most universities exact attendance at more classes than the colleges and halls; for instance, See also:botany and natural See also:history are taught to their students, who are also examined in them. But with these exceptions the system of professional education is fairly uniform. Since 1875 attendance on " practical " classes has been called for in all subjects. Under this system the larger classes in which the subjects are taught systematically are broken up, and the students are taught the use of apparatus and the employment of methods of investigation and observation. Tutorial instruction is super-imposed on teaching by lecture. Much the same See also:plan is adopted in respect of clinical instruction: not only is the student taught at the bedside by the lecturer, but he receives, either from the See also:house-surgeon or house-physician or from a specially appointed clinical See also:tutor, an insight into methods of examination of diseases, and learns practically the use of the See also:stethoscope and other See also:aids to diagnosis, and of surgical and obstetrical See also:instruments. In fact, it may be said that each subject of instruction is duplicated. If this is taken into See also:account, it must be evident that the time of the student is fully occupied, and the belief is rapidly growing that five years is too See also:short a See also:period of study. As a matter of fact, the See also:average time taken to obtain a British licence to practise is upwards of six years. The See also:probability is that the See also:solution of the difficulty will be found in the inclusion of such subjects as physics, biology and chemistry in a " preliminary scientific " examination, which may have to be under-taken before registration as a medical student, thus leaving the whole five years to be devoted to purely professional study. The German regulations in regard to professional study are few. They are those for the Stoats Examen, for which the See also:Germany university degree is no longer necessary. The regu- lations for the See also:admission of candidates to the Staats Examen are contained in the royal proclamations of the 22nd of See also:June 1883. They comprise: (a) Certificate of a course of study at a classical gymnasium of the German See also:Empire. In exceptional cases, the same from a classical gymnasium outside the German empire may be considered sufficient. (For details of the course of study and examinations, see Minutes of the General Medical Council, vol. See also:xxvii. appendix 3.) (b) Certificate from a university, certifying a course of medical study of at least nine See also:half-years at a university of the German empire. (c) Certificate that the candidate has passed, entirely at a German university, the medical Vorpriifung, and thereafter has attended for at least four half-years the medical studies of a university. (d) The See also:special testimony of the clinical See also:directors bearing See also:witness that the candidate has taken part as Praktikant (clerk or See also:dresser) during two half-years at the medical, surgical, and gynaecological clinics; has himself delivered two cases of labour in the presence of his teachers or assistant physicians; and has attended for a half-year as Praktikant the clinic for diseases of the See also:eye. The medical Vorprufung referred to is necessary alike for the Stoats Examen and the degree of See also:Doctor of Medicine. It takes See also:place at the end of the second year (See also:fourth semestre), and includes the subjects of experimental physics, chemistry, botany, See also:zoology, anatomy and physiology. It is conducted by a See also:board appointed yearly by the See also:Minister of Education. No one can practise medicine in See also:France who does not possess the diploma of Doctor of Medicine of a French university. The
Prance.
qualification of Officier de sante is no longer granted.
Before he can inscribe as a student of medicine the
applicant must have obtained the diplomas of Bachelier es lettres
and Bachelier es sciences. Although the course of professional
study may be completed in four years, a longer time is generally
taken before the student proceeds to the final examination for
the doctor's degree. Each year is divided into four trimestres;
at each trimestre the student must make a new inscription. The
trimestres are (1) See also:November and See also:December, 56 days; (2) See also:January,
See also:February, See also: In contrast to the freedom in regard to atten-
See also:dance on systematic lectures, there are strict direction and See also:control
in regard to hospital attendance and practical courses. The
student is required to sign a register ad hoc each time he goes
in and out. From the beginning of the third year, e.g. from the
ninth quarterly inscription, hospital attendance is enforced till
the end of the fourth year. No one can renew his trimestral
inscription without producing a See also:schedule of his last trimestral
See also:stage, showing that during it he had not absented himself more than five times without explanation. Practical work is, obligatory during each of the four years.
Besides systematic courses of lectures, Conferences are held by the assistant-professors (agreges) in natural history, physiology, general pathology, See also:internal pathology, See also:external pathology. At the end of the first year the student is examined in See also:osteology, myology and the elements of physiology; at the end of the second year, in anatomy and physiology in all their branches; at the end of the third year, in medicine and surgery; at the end of the fourth year, an examination is held over the whole See also: As See also:late as 188o medical education in the United States was in a deplorable condition. In the See also:early history of the See also:country, before and shortly after the beginning of the 19th uattaa See also:century, the few medical colleges had shown a dis- states. position to require a liberal education on the part of those who entered upon their courses, and some effort was made, through the agency of state boards, to control the licence to practise. But as the country increased in See also:population and See also:wealth preliminary requirements were practically abolished, the length of the courses given each year was shortened to four or five months or less, and in the second and final year there was simply a repetition of the courses given during the first year. This is to be attributed mainly to the fact that there was no general See also:national or state supervision of medical training. Medical colleges Could obtain See also:incorporation under state See also:laws without difficulty, and brought considerable advantages in the way of See also:prestige and increased practice to those concerned. That the existence of a college depended solely upon the fees of the students encouraged the tendency to make both entrance and See also:graduation requirements as easy as possible, especially as there was no state supervision, and the See also:mere See also:possession of a diploma entitled the holder to practise. Fortunately, during this period the practical See also:character of the clinical instruction given in the better colleges fitted the graduates in some measure for the actual necessities of practice, while the See also:good traditions of medicine as a learned profession stimulated those who adopted it as a career, so that in the See also:main the body of practitioners deserved and held the confidence and respect of the community. From the See also:middle of the 19th century there has been See also:constant agitation on the part of the physicians themselves for an improvement in medical education. The first notable result was an increase in the time of instruction from two to three years (See also:Chicago Medical College, 1859; Harvard Medical School, 1871), the lengthening of each session to six months or more, and the introduction of graded courses instead of a repetition of the same lectures every year. The improvement thus begun became marked during the See also:decade 1890-1900, amounting almost to a revolution in the rapidity with which the course of instruction was amplified. Many factors co-operated to produce this result: the general development of scientific instruction in the colleges and secondary schools, the See also:influence of the large number of medical graduates who completed their training by study in See also:European schools, the See also:adoption by many states of stringent regulations regarding the licence to practise within their See also:borders, the good examples set by many leading schools in voluntarily raising their requirements for entrance and graduation, and, perhaps above all in its general effect, the agitation continually maintained by several national or state associations which in a measure have exerted the general regulating control that in other countries has been enforced by national legislation. Among the most influential of these associations are the See also:American Medical Association, the American See also:Academy of Medicine, the Association of American Medical Colleges, the See also:Illinois State Board of See also:Health, and the University of the State of New See also:York. The different states make their own general regulations as to the practice of medicine within their borders. Certain states recognize the medical diplomas granted by other states having equivalent See also:standards of examination. Such certificates are generally required to be (a) of graduation from a " reputable medical school," (b) certificates of moral character, (c) the applicant must be at least twenty-one years of age. These enable the candidate to present himself before the state board for the state examination. In many states the applicant must satisfy the board not only as to his professional, but as to his general education. The See also:standing of the various medical schools is usually left to the state boards, each one determining the matter for its own state, consequently a school may confer a degree recognized as reputable in several states but not in others. Only three or four states regulate the chartering of institutions. In other states any body of men may secure articles of incorporation of a college or school by paying the necessary state See also:fee, without question as to the ability of the incorporator to furnish an education. 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 See also:majority this is in addition to one or two years' training in the natural sciences. There are some sixty-five state boards, and many have adopted strong medical practice acts. The standard of preliminary requirements for entrance to the medical schools is being gradually raised, and a large number of the states demand a certificate of a high school education, while the colleges comprising the Association of Medical Colleges, which See also:numbers more than half the American medical schools, accept as an entrance standard a certificate of at least one year's study at a high school. In the report for 1908 of the United States See also:bureau of education of 71 schools, which report the number of their students having an arts degree, it is stated that a degree was held by only 15% of the candidates in medicine. These students were mostly distributed between the Johns See also:Hopkins Medical School (which from the date of its See also:foundation in 1893 has only admitted college graduates, and has in addition stipulated that candidates shall have a knowledge of French and German and have already completed a year's training in the natural sciences), Harvard Medical School and See also:Columbia University, and the medical departments of the universities of See also:California, See also:Michigan and Chicago (See also:Rush Medical College) require on entrance the equivalent of a two-years' college course, which must include French and German, together with physics, chemistry and biology. This tendency is in accordance with the recommended standard of medical education suggested by the Council of Medical Education and adopted by the House of Delegates of the American Medical Association, of which the following is a See also:summary : r. (a) The preliminary of a four-years' high school education or an examination such as would admit to a recognized university. (b) In addition a year of not less than nine months devoted to chemistry, physics and biology and one language (preferably French or German) to be taken at a college of the liberal arts. 2. Previous to entering a medical college every student should receive from the state board a " medical student's entrance certificate " to be given on the production of See also:credentials of training as above. 3. Four years of study in a medical college having a minimum of a 3o-See also:weeks' course each year, with not less than 3o See also:hours' work per See also:week. 4. Graduation from college to entitle a candidate to present himself for examination before a state board. 5. A satisfactory examination to be passed before the state board. Practically all medical schools admit women, but there are three See also:separate schools of medicine for women: The Women's Medical College of See also:Philadelphia, See also:Pennsylvania; Women's Medical College, See also:Baltimore, See also:Maryland; New York Medical College and Hospital for Women—the last being one of the eighteen homoeopathic colleges of the United States.
AuTnoiuTxEs.—J. M. See also:Tower, Contributions to the See also:Annals of Medical Progress and Medical Education in the United States, before and during the See also:War of See also:Independence (See also:Washington Government See also:Printing See also:Office, 1874) ; N. S. See also:Davis, History of Medical Education and Institutions in the United States (Chicago, 1851) ; Contributions to the History of Medical Education and Medical Institutions in the United States (Washington, Government Printing Office, 1877) ; J. B. See also:Beck, An See also:Historical See also:Sketch of the State of Medicine in the American Colonies (See also:Albany, 185o) ; Bulletins of the American Academy of Medicine (The Chemical See also:Publishing See also:Company, See also:Easton, Pa.); H. L. See also: 14, 1909) ; A. Flexner, Medical Education in the U.S. and See also:Canada (1910). (W. H. H. ; H. L. Additional information and CommentsThere are no comments yet for this article.
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