CHAPTER VII
THE COURSE OF STUDY
THE HOSPITAL AND THE MEDICAL SCHOOL
The Third and Fourth Year (continued)
In the end the final test of a medical school is its outcome in the matter of clinicians. The battle may indeed be lost before a shot is fired: a low average of student intelligence and inferior laboratory training will fatally prejudice even excellent clinical opportunities, for they rule out certain essential features of clinical training on a modern basis. A serviceable type of doctor was doubtless once produced under conditions that we now pronounce highly unsatisfactory; again, students defectively trained sometimes meet with success in examination or other tests designed to ascertain the quality of their instruction. It is not necessary to investigate closely the merits of the test in order to refute the argument that it endeavors to sustain. The institutions that seek to establish the non-importance of facilities that they do not possess emphasize strongly the importance of those they do. And with good reason. Before undertaking the responsibility of instruction in chemistry or physics or biology, a competent teacher stipulates that he be provided. with this, that, or the other. He is not to be put off with the assurance that some men have successfully mastered the subject without laboratory or tools. Very properly he takes the ground that whatever may be true of individuals, in general boys will be much better trained in a laboratory with the essentials than in a bare room practically without them. It is equally true of clinicians. Doctors have after a fashion been made by experience—i.e., their patients paid the price; further, some graduates of every feeble clinical school in the country have passed state board examinations or obtained hospital appointments, at times after competitive examinations in which they defeated students from schools more highly favored; it still remains true that to do full duty by the young student of clinical medicine, his teachers need access to acute cases of disease in respectable number and variety; that the school which lacks such medical facilities is in no position to teach modern medicine.
In the matter of laboratories we discovered no slight cause for satisfaction. Within two decades the laboratory movement has gained such momentum that its future, even its immediate future, is in no doubt. A race of laboratory men has been trained and quite widely distributed. They know their place and function; they have educated the college administrator to accept them at their own valuation. Where deficient resources still force a compromise, the apologetic attitude is a sufficient promise of more liberal provision by and by. On the clinical side the outlook is less reassuring. The profession itself has in large measure still to be educated; the clinical faculty often stands between the university administrator and a sound conception of clinical training. It happens, therefore, not infrequently that a university president will hear
