Cornell University Medical College - Samaritan Yearbook (New York, NY)

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. . .rurprififzgly little change in cw'rirzzlzzm. D clinical implications of the fundamental pninciples we are learning. The effect is to focus our attention away from the fundamentals and on their implications, for after all, is this not what we have come to medical school for? We become not men of science, but physicians, with our feet based on the 'loam of science and our heads stretched up into the ether that is still clinical medicine. We are told, often, that the best physician is the one who knows the most basic science. But our training does not bear this out. Rather the best physician is the one who knows enough basic scientific theory to temper the art of medicine. Much has been written about this in the literature. It is widely claimed that too much time has been allotted to the preclinical subjects. Anatomy should be shortened. Physi- ology and chemistry should be combined. Perhaps. But there is an increasingly insistent cry that on the other hand bemoans the dwindling number of men delivered into re- s h b ' earc y the medical schools of the country. The holders of this view point out that most of our important discov- eries are being made by men who are not physiciansg that the work in -the areas in which medical progress must be made is being done by men who have had no medical training. Thisview demands more theory, more technique, more stimulus to do original investigative work. There canno Certainly men trained in 'both approaches are needed g that they cannot be trained in both at once has become more and more apparent. Each school must choose, must decide which type of training .it will stress and then give that tra. .A . . . ining without introducing more of the other than is necessary to give the student a solid foundation For after ll a , medical school is still only 'four years lon and th g, ere is a limit to how much one can assimilate in that period of time Already this time factor h b t be a right and a wrong to this problem. r. Mor1'ill. Q . . . anzpbilbefzten wizb fezciliti Delivery Room. er for demofzslmlizzg paziiefztff' groups meez in each ozlzerhf work azrenzff' Dr. Model! and Dr. Gold . . . Me five bzzildizzgf fronlifzg on York Avenue. A. ta , as een attacked by the lengthening house staff training. Much more time cannot y be added at any point without making the trainingf practice p M pi A ty, fafio atbSufd1Y lafge- This is the approach to the group problem. In it we are likely to lose sight of the individual problem. The mass S Mm ff ttsi of information that must be presented to the student in P p 1 .fs2 i f his four years is great and fairly well standardized throughf' fp yppfi out the country, with the emphasis varying according to 7 p the orientation to the problems outlined above. This makes .H i it dangerously easy for the teach-ing methods to rely heavily ,tvzv ' 09a --

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all provide better than adequate care for the sick. It must carry out far-reaching research plans in medicine to en- rich our cultural base and eventually make even better medi- call care possible. And it must teach-must train its students to carry on -both the other parts of its program with com- petence and assurance. Let us now examine how that is 'being done at the present time at the Cornell-New York Hospital Medical Center. When the medical school first moved uptown to its present quarters and assumed its impressive hybrid title, a most important change was made in the nature of the faculty that requires some discussion. At that time the men responsi'b'le for the shaping of the new unit felt that the job of running its various subdlivisions required the undivided attention of the men in charge. Accordingly, the professorships of the major clinical departments were made for the first time full time positions. It was required that the men who filled these positions should hold no others and should have no private practice outside the hospital. Many of the men who already had large and lucrative practices naturally felt unwilling to give them up so that the personnel shifted sharply with the move. This was the logical culmination. of the trend to hospital medicine-to the picture of the physician as a specialist. The new men were themselves products of the new training and their efforts were oriented to it. With the rapid ad- vances in laboratory techniques and the overwhelmingly massive addition of source information to each facet of medicine the institution of full time clinical professors foredestined the Cornell student to be slanted for spe- cialization. Surprisingly the curriculum and the methods of teaching have had to be changed very little to point the way to the new medicine. The student spends the first two years of his course in the classrooms and laboratories of the five buildings fronting on York Avenue. He takes anatomy and biochemistry, physiology and bacteriology, pathology and pharmacology. He is then briefly introduced to physical di- agnosis. The third year he spends on the wards of the various clinical specialties. The fourth year he spends mainly in the out-patient departments. The variable factor is not, obviously, the subjects taught, but the orientation of the men who do the teaching. The increasing segmentation of labor at all levels is the phenomenon of our age. The expanding complexities of Kipx Bay-Yorkville Health Center. Stadentf get first Ivana' experience u in pnblir health work. civilization have brought us to a point where no one can hope to follow it all-few can hope to fo-llow more than one or two threads. This is especially true in medicine where the geometrically multiplying data are inexorably eradicating the general practitioner. In his place is spring- ing up a veritable horde of specialists. The specialties are formed and then sub-divided. As the divisions overlap one with the other, they split again. The orderly procession of it all must delight the Aristotelian lover of the syllogism, but it cannot help but confound us who hope to find somewhere in the maze a niche of our own. Faced with this situation the school can do nothing else but try to fit us for the specialist future, and this it is doing. In so doing it is forced to choose carefully the weightqof each course, each fragment of course, in the curriculum. For that reason it must weed out not just that which is completely valueless but also that which is of relatively little use in train- ing us for the future that has been chosen for us. The preclinical courses are taught, with minor excep- tions, with an eye to the clinical problems and procedures that arise from them. Especially in the dynamic sciences of physiology and biochemistry we are early madeto see the . . . laboratory advice and arrirtancef' D80 --,tt Q-L 'al W Q. clinia learn the 1 is thi beconi based into often, most Rathe basic Mu widely the pf ology there bemoa search of thi eries 2 llle W4 made trainin ITIOIE 1 Thei Certain Q and rn Which trainini flecessa all, me is a lil of lengths bfi add, ratio al This HFC of infc his foul Out th, Orin the if dang

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. . . the pre-clifzicfzl courses. Bacteriology labemtory. on didactic lectures and parrotted procedures. This will give the student the factual material he must have and it will promote physical dexterity-but it will not promote mental dexterity and this is certainly the physician's most valuable asset. It is an undeniable fact that, although the classes in medical schools are small, and the facultyfstudent ratio high, the students have less time for individual exploration and expression than in any other graduate training. Efforts are made to alleviate this by the smalll group arrangement of laboratory time, the requirement of special theses in several departments, the ward case study and the small tutor groups of the clinical years. But even much of this time is unfortunately dedicated to senseless repetition of the didactic material. Actual elective time is at a minimum. The 'benefit the student will derive from the work he does in small units is often directly related to the interest and capability of the tutor at hand. This type of -teaching requires more skill than the giving of lectures, and it is perhaps the greatest fault of our medical education that our teachers give more thought to their medicine than to their teaching-more thought to their content than to their method. By this we do not imply that they do not do enough spoon feediingf' Quite the opposite-in most cases they do not do enough to stimulate the student to think through and beyond the problems with which he is confronted. It is not enough to tell the student that he must work things out for himself. The approach to medical problems is largely unfamiliar to the student until late in his career and its aspects are confusing. A certain amount of further effort must be expended to point out to the student in which areas, and by which methods, he may most fruitfully work on his own. This is especially important in the third year where the student must do a good deal of unpleasant, routine work in which he is very likely to bog down unless his interests are steered into more inspiring channels. lf the clinical work is not intelligently supervised, the student .10. . . . the mm!! group mwzfzgement of labomlory time. Pbyriology experiment. may fail to make the necessary extrapolations from his individual case work. Studies in education during the recent war brought to light precepts which may be of use to us in concluding our survey of medical teaching. Over and over again it was proven that by using the newly developed visual and other aids it was possible to teach a large amount of material to a large number of students in a relatively short period of time. The material thus presented was generally well assimilated so that it was long remembered and easily available for implementation. It is possible that some of these methods may take their place in the teaching of college level courses and the preclinical work in medical school. If so, they may significantly shorten the amount of time needed to train students in these subjects. But this must be the only way in which such shortening can come about-through the introduction of new and more efficient teaching methods. For the other important lesson the war taught us was that students were ill equipped to cope with graduate study when their undergraduate training was actually curtailed under the existing methods. This was just as true in medical school as in any other, and we must guard carefully against letting a similar situa- tion develop because of -our own efforts to shorten the preparatory time in medicine. The clinical subjects may also benefit to some extent from these new systems, but clinical teaching is already well suited to its subject matter and requires only the more careful training in teaching of those who do it. In the first fifty years of its history Cornell has developed from its uncertain, strife-riddeni inception to one of the foremost medical schools in the world, This growth was possible because of the progressive spirit prevailing among the men who directed its destiny. We certainly trust that in the future a similar spirit of enlightenment will carry Cornell to even greater heights. Richard Horace Granger.