Friday, February 14, 2014

Study Like It’s 1864

John Wood, 1825-1891 Giving a Lecture
Recently, I stumbled across an 1864 article from the British Medical Journal by Dr. P. M. Latham called “A Word or Two on Medical Education: And a Hint or Two for those who Think it Needs Reforming.”  I was curious to see how much medical education had changed in 150 years. The answer: not as much as you would think. We no longer try to cure pneumonia by bleeding or brandy (Latham, 1864, p. 143)—thank goodness for antibiotics!—but many educational methods are still startlingly similar.

What has changed:

An increased emphasis on clinical education. Dr. Latham recounts how two graduating, award-winning medical students approached him and asked how they could learn their profession. “During three whole years they had been hard at work upon all that lectures and museums could teach them. […] But they had utterly neglected the wards of the hospital. This was their own honest confession and regret” (1864, p. 141). Fortunately, clinical competence is now a key part of the curriculum.

No prizes for going to class. It seems there used to be a broader range of class choices and incentives. Dr. Latham lists a wide range of scientific topics and notes, “On most of these subjects, it is not thought enough to specify the number of lectures to be attended: prizes are given annually to stimulate competition, and are given to the most proficient in all of them” (1864, p. 142). For better or worse, the curriculum is now more structured, and awards are fewer and farther between.

What hasn’t changed:

Lecture format. Today’s students may laugh at old medical universities, with “the ruinous amount of taxation they levied upon the time and thought of medical students, with their hundreds and hundreds of lectures sentenced and inflicted upon them without mercy” (Latham, 1864, p. 141). But it is a bitter laugh.

Overwhelming amount of information. No one ever said medical school would be easy, with “lectures on Anatomy, not by few, but by hundreds; lectures on the Principles and Practice of Medicine … Principles and Practice of Surgery … Forensic Medicine, including Toxicology and Toxicological Analysis … Materia Medica … Chemistry … Botany … Physiology …” (Latham, 1864, 142). To say nothing, of course, of interprofessional education.

Theory before practice. Latham argues that, just as people do not learn to read by learning the philosophy and history of reading, medical students should learn the practical aspects of their calling before hearing lectures, so they can “exercise some judgment upon the subject matter” (1864, 143). Even now, this notion sounds radical. What would happen if this suggestion were taken? Students would almost certainly make more mistakes… and maybe learn from them.

What aspects of medical education do you think should change? Put in your “word or two” in the comment box.

~Kelli Hines, MLIS
  Scholarly Communication Librarian

Picture -  John Wood FCRS 1825-1891 Giving a lecture, Oil Painting by Henry J. Brooks 1888 - Wellcome Library, London

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