University of Michigan Medical and Nursing School - Aequanimitas Yearbook (Ann Arbor, MI)

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Dean William N. Hubbard, jr., M.D.

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THE EVOLUTION OF A MEDICAL SCHOOL Medicine exists only as a component of complex societies and the profession takes its definition from the responsibility it has to serve the health of man. As these health needs and goals change, the profession's working definition is thereby changed. A medical school must prepare its graduates for the actual professional re- sponsibility they will carry and in this context the fundamental force for change is the evolution of the health needs and goals of society. But substantial improvement in the effectiveness of the phy- sician's efforts and in the efhciency of his practice depends on improved scientific knowledge transmitted into the understand- ing, skills and technology that identify modern medicine. This knowledge is produced most commonly in a setting where its mode of application is secondary in importance to its improve- ment of the explanation and understanding of events. The tension between those who produce and those who utilize can be a natu- ral and reciprocal stimulating force when the medical school appreciates and supports the essential values of each. lf one dom- inates then professional obligations are threatened, while if the other dominates any significant professional progress will halt. The curriculum design and teaching content will change in re- sponse to the dynamic tensions between knowledge and its trans- lation into service. A third major evolutionary force is the increasing variety of fields of knowledge and disciplines of practice relevant to opti- mum health care. A basic dilemma in designing the teaching program of a medical school is that the physician is only a com- ponent-albeit an essential and most central one-in the total sys- tem of efforts necessary to secure health. The growing number and importance of the other specialized elements of this loose system and the necessity to formalize their relationship within institutional organizations require a corresponding reaction in the education of the physician. Actually, it is only within a University that there exists in a single institution the range of research, education and practical skills that are required to meet the health related demands of our society. Because of this, the medical school must tend away from its past practice of operating as a self-contained unit. lts future will depend on its success in giving a decisive place to these many elements of the Universityg thus becoming a University center for health. Such a center will necessarily be concerned with the research and educational base as well as the means of enhancing the availability of health services in the community. The scientific techniques suitable to understanding the cellular and molecular levels of organization of living systems are not applicable to an organization at the level of a health care system: but the basic objective logic of scientific explanation and analysis is applicable. We do not discard our antecedents, however, asgwe acquire new characteristics, either in the genetic, the cultural or the pro- fessional realms. The physician emerged in a priestly role, giving his own personal comfort and support to man in his struggle to survive in a hostile world. All that has followed in the history of medicine has not amended or diminished the expectation of the patient that his physician will fulhll this dedication. Without this dedication the very idea ofthe physician is forfeit. Historically, a sharing of common experience led to the codification of empirical knowledge. Until about a century ago the experimental approach to science had not affected medicine and even today much of medical practice is based on empiricism. But the major limitations on health today are characteristically of complex etiology and defy a simple approach to diagnosis and therapy. Accidents, alcholism, behavioral disorders and diseases related to age are still awaiting precise scientific analysis. The experimental and reductionist thrust of biological science has had its impact on medicine principally in thepast thirty years. lt now holds our great hope for the future since it promises the potential of controlling biological events. ln a curious way it also returns us to the beginning of medicine where the nature and purpose of human life was a central concern. How shall the teaching ofthe medical school respond to this? Science itself is abstract and does not contribute to such value judgments. Political values can degenerate into nationalism where the idea of competitive survival extends to annihilation of the human race. The societal values of civilization can become so dominant that individual human worth loses its validity within faceless groups that pursue selfish ends. Economic values that can free man from the slavery of devoting all his labor to assuring survival can also become a commercial ethic which has accumu- lation of wealth and its accompanying power as a single over- whelming goal. Medicine shares all of these unhappy alternatives and can he destroyed by exclusive trust of either science, nationalism, pro- fessional group values or a commercial ethic as the foundation of its future. The elements of greatness in the tradition of med- icine present it with an opportunity to provide both the example and the precept that will reaffirm the literal brotherhood of man and the ultimate essentiality of individual human worth. Each physician must take this opportunity by himself and in his own fashion. lf he does so, he may provide a model for mankind's survival. lt is the preparation ofthe physician for this role that is the ultimate aim ofthe evolution ofthe medical school. W. N. Hubbardhlr., M.D.