EDUCATION
129
Grover F. Powers, M.D., Contributing Editor
Dr. Thebander attended “The World Conference on Medical Education” and contributes the
following report of her observations. Dr. Thelander’s suggestion regarding the use of the terms human or childhood ecology should interest semanticists.
G. F. P.
THE
WORLD
CONFERENCE
ON
MEDICAL
EDUCATION
By Hulda E. Thelcinder, M.D.
I
r IS a year and a half since the World Conference on Medical Education was held in London. Soon after the sessions anumber of journals carried short reports of
the meetings or abstracts of some of the speeches. This conference was too
signifi-cant to be quickly forgotten. Fortunately the entire proceedings are now available in
book form under the title First World
Con-ference on Medical Education published by
the Oxford University Press. It should be in
every medical school library.
There probably will be other
interna-tional conferences on medical education in
the future. I would like to urge that medical schools make it possible for their younger teachers to attend such a conference.
The London Conference was beautifully
structured and expertly executed. The
sub-ject matter discussed by the educators from
all over the world are the current problems facing medical education. The meetings
were divided into 4 main sections : (A)
Re-quirements for Entry into Medical Schools;
(B) Aims and Contents of the Medical
Cur-riculum; (C) Techniques and Methods of
Medical Education, and (D) Social and
Pre-ventive Medicine.
Section A, Requirements for Entry into
Medical Schools
At these meetings it soon became
appar-ent that at the international level it was
hard to find a common denominator. In
the United States we are accustomed to en-roibment of a limited number of medical
students and the selection of these after prescribed premedical training. Selection is
therefore made at the age of 20 or older. In many countries this is not the practice. En-roblment may be unlimited and elimination takes place during the course of training by
failure in the studies or by examinations. Selection in some countries takes place as early as 17 or 18 years or even at 16 years of age. In Dakar it was reported there were
not enough applications and actual
recruit-ing took place. In many areas of the world because of the state of health there is a great need for more doctors. The cost of
training, inadequate faculties and facilities deter adequate training of doctors for the work required. There was a great deal of
discussion on preparatory training. In some countries it was indicated that too much
Latin and Greek was required and not
enough physics and chemistry. In others the opposite seemed to be true, that so much time was devoted to science that the
hu-manities were entirely neglected. In this connection the paper of S. M. K. Mallick
Medicine--A Technology or a Profession?,
page 29, should be read. And also How
Much Chemistry? by Sir Charles Dodds,
page 140.
With the present frequent exchange of students and the enrollment of our young people in foreign medical schools the
ques-tion of selection and training of doctors in
any country becomes of paramount impor-tance to us even here at home.
Section B, The Aims and Contents of a
Medical Curriculum
In the section on the curriculum there
130 THELANDER - WORLD CONFERENCE ON MEDICAL EDUCATION
The audience was taken right down the line
of sui)jects, anatomy, physiology, pathology,
pharmacology, psychology, and the clinical specialties. It was very interesting to hear
established methods challenged. In the
United States we are accustomed to think of England as having the ideal course in
anatomy and yet some of the severest
criti-cisms came from the British doctors. It was even stated that students attend classes in
physiotherapy to prepare for their anatomy examinations. It was especially stressed that training in anatomy should not be limited to dissection but it should be taught from the surface of the body, by x-ray, at
sun-gery, in the post-mortem room, from
mod-cbs, and at the bedside. Dissection served only a limited purpose. Structure and func-tion should not be separated.
It was emphasized that pathology is a
dynamic and not a static state as it is
usually taught. It is a continuous deviation from the normal and involves physiological as well as structural changes.
These sessions were filled with so many admirable papers that it is hard to choose among them. The Description of
I.ntegrat-ing Anatomy and Physiology by S.
Zucker-man and H. P. Gilding of Burmingham, page 243, has many suggestions for our teachers in U.S.A. who are seeking new
methods of integrating subjects. Oliver Cope’s presentation on Teaching Medicine
and Surgery as One Discipline, page 313, is also excellent. The Balanced Curriculum by Sir Henry Cohen, page 384, no teacher in a medical school can afford to miss. In
it Sir Cohen sifts and sorts the problems
until the answers seem evident.
A great deal of the discussion on every
subject concerned itself with training the
basic doctor. Teaching should be based on the person and not the disease. There has
been too great a tendency to disintegrate
without ever considering the whole man as a patient. Another author compared our medical education to a patchwork quilt when it should have a continuous design
woven into the fabric.
There was also a great deal of emphasis on the necessity to inspire students to wish to continue the acquisition of new knowledge. There is too great a tendency
to feel that bits of information are the sole
aim. The medical years should bay a sound foundation upon which the doctor can then build a lifetime medical career.
Section C, Techniques and Methods of
Medical Education
Section C was devoted to teaching
meth-ods and in this section too it was relatively easy to find a common meeting ground. All the techniques were discussed. There were
papers on bedside teaching, teaching in the
clinic, in the home, in the laboratory. The lecture, the seminar, the clinical pathobogi-cab conference all had a round. Visual aids, observation screens, library and museum came up for scrutiny. The discussion per-mitted both sides to have a hearing. The
speaker who might be overenthusiastic about a certain method frequently had its limitations dramatically presented in the
discussion period. There was considerable
feeling expressed regarding visual aids and
films noting that many were poorly
de-signed, quickly became obsolete, and were expensive to produce. One discussant stated that multicolored slides and graphs kept him so preoccupied with color and line that he missed the significance of the
illus-tration. This was “vividly” shown at one of the exhibits at the last AMA meeting in San Francisco. A portion of the heart exhibit
had so much illuminated paint in it that it
was impossible to see beyond the glare.
EDUCATION 131
one institute in which the entire week-end was devoted to the subject of teaching teachers. Many favorable comments came
from the people who had attended this
conference.
Section D, Social and Preventive Medicine
The last bike the first section covered sub-ject matter that had such varied
implica-tions in different countries that it will take a long time to find a common meeting
ground. Maybe this is not necessary. The
economic and public health situations pose very different problems in different coun-tries. The subject matter of papers rebated
to epidemiology, nutrition, housing,
ge-netics, psychology and statistics. The
great-est problem posed was the integration of these subjects into the already crowded
curriculum. Many schools now have chairs in social medicine (not socialized). London
has established a chair in human ecology. In the U.S.A. many if not most schools are experimenting with teaching methods
that will orient students to the effect of
psychiatric, social and economic problems on the well being of the family and the individual. These appear in the
curricu-bum under many titles. It would seem to me
that if we all adopted the term human ecob-ogy, or in pediatrics if we wish to limit it to childhood ecology, it would simplify our semantics. Webster defines ecology as the
biology dealing with the mutual relations
between organisms and their environment.
In refreshing my memory on the very de-bightful and inspiring visit to the London Conference 3 positive suggestions, already
mentioned or implied above, emerge:
1. That at the next World Conference on Medical Education, which I believe is
ab-ready being planned, we have a good
rep-resentation from among our young
teach-ers-I mean teachers-not research workers
primarily.
2. That we simplify and clarify our
gropings concerning teaching man in his environment by adopting the phrase human or childhood ecology to cover the subject
matter in rebating man to his environment. Human ecology should be one of the ma-jor subject matters on the medical
curnic-ubum.
3. That at least some of the regional meetings on medical education try the
real-istic experiment of adding practice to
preaching at the meetings. Why not bring
some tape recordings of lectures, some
medical films, some exhibits, or even a
speech teacher or critical students to the meeting and have a real self evaluation of teaching techniques?
There were many excellent articles by
members of the profession from the U.S.A. but their ideas are familiar to us. We can learn more from outside influence. It is quite
