to be effective in the reconstruction to which we look forward.
(1) However the educational prerequisite be defined, the board must be authorized to insist upon it as an educational, and not as a practice, preliminary. The sole reason for a preliminary requirement of any kind is as a method of restricting the study of medicine to those in whose favor an initial presumption of fitness exists. An ordinary secondary school education may be taken as indicating minimum competency only if it chronologically precede admission to the medical school. As a matter of fact, some state boards legally empowered to enforce the high school basis are often strangely careless as to the significance of dates; so that a requirement whose sole value resides in its priority to medical education is held to be satisfied if fulfilled just prior to graduation or to licensure.
The evaluation of preliminary credentials is a task requiring expert knowledge and experience. Certain boards have striven hard to discharge this function effectively; but they lack an organization competent to deal with it. It may be that as the feasibility of federated action is increased by an approach to uniformity in laws and ideals, a central authority can be constituted by voluntary coöperation of the state boards, maintained by contributions from their several funds, and charged with the business of procuring first-hand information respecting secondary schools and colleges. Such an agency could, by communication with the proper educational organizations engaged in the study and improvement of secondary schools, command reliable data for the evaluation of credentials prior to matriculation. In default thereof, the board of each state, instead of endeavoring to act on such knowledge as it can obtain, should get at once into effective relations with the state university, or with some endowed institution accustomed to pass upon questions of this kind; and the medical schools should be compelled to have a student's application "viséd" by the state board before matriculation is regarded as complete. If neither time nor subject credit could be given by the medical school for any work prior to completed matriculation, an actual four-year high school preliminary requirement would be in force.[1]
(2) The enforcement of even the four-year high school standard will so far clean up the medical field that the state boards will at once be relieved of the duty of dealing with actually disreputable schools. Until that has been accomplished, these boards should be empowered to refuse applications from the graduates of schools scandalously defective in teaching facilities. The power here in question, if extended too far, would involve serious dangers. For boards authorized to decide whether schools are satisfactory may be led to specify the details which determine their judgment. In some quarters they have already shown a tendency to prescribe minutely the contents of a proper medical education. Their motive has been excellent; they have tried to compel poor schools to give a good education. Unfortunately, that is quite impossible: teachers may sign a register showing due attendance upon their classes, just as students may scrupulously attend specified exercises in every essen-
- ↑ The same process can be employed in the south to enforce whatever standard is there decided on.
