Doctors: Training for Tomorrow's Needs

The manifesto rang with a tone of bitter disappointment. "We are growing intellectually passive," it said. "Much of our time is squandered in academic exercises from which we learn little."

Rigid curriculum, formal teaching methods, an overlong lecture schedule —little about their studies seemed to please the 25 students who presented their complaints to Dr. Robert H. Ebert, dean of Harvard's prestigious medical school.

The dean was neither annoyed nor surprised. A relative newcomer to the job (TIME, July 9), he was just back from a White House conference where he had, like his students, questioned most of the basic assumptions of U.S. medical education. Dr. Ebert told the future doctors that they were on the right track. He encouraged them to work out their own choice of lab demonstrations and lectures—in effect, to acquire knowledge as they think best.

Learning to Think. All over the U.S., medical education is suffering from growing pains. The U.S. needs to produce 11,000 new doctors a year by 1975* to maintain the present, barely adequate ratio of one practicing physician to every 1,000 people. Existing schools turned out only 7,400 graduates last year; enlargement of classes, and at least two dozen new schools, should reach the desired goal by the late 1970s. But the problem of quality will remain. Rising living standards and a growing sophistication in health matters are creating a clamorous demand for the best .in health care. And it is this demand that confronts medical educators with their greatest challenge.

Man has learned so much about medicine, says U.C.L.A.'s dean of curriculum, Dr. David Solomon, that "the schools now cannot cover more than a small fraction of the total medical information available." Yet, paradoxically, several leading medical schools have come to the conclusion that the way to meet the problem is not to prolong medical education but to shorten it. Today, for virtually all physicians, education takes a minimum of nine years after high school: four in college, four in medical school, one in an internship. Specialists spend two to seven years more in an ill-paid residency.

One of the first requirements of a renovated curriculum, says Dr. Hans Popper of Manhattan's burgeoning Mount Sinai Medical School, is to "replace the process of fact cramming with instruction in the principles of thinking. What the medical student needs most is to learn basic principles." After that, said the A.M.A.'s Council on Medical Education at a Chicago meeting early this month, the young doctor must put his training to practice as soon as possible.

Four into Three. No matter how well taught, medicine remains an inexact science. "You will find it difficult," University of Rochester Physiologist Dr. William D. Lotspeich tells his students, "to exist in a state of not knowing—but you must get used to it. You will, unhappily, often have to make decisions on the basis of incomplete information."