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3. I have now received from Dr. Pearce the letter submitted herewith, in which he indicates the kind of conditions upon which the Foundation would probably be prepared to grant us the sum of $250,000 Mex. in respect of each Chair, but adds that they would desire a statement of our conception of the problem before final action, in order to prevent the possibility of mis- understanding. As, su far as I am aware, the general problem: of modern medical education has not been the subject of dis- cussion in Council, it has appeared to me that a brief analysis of the situation may be useful in explanation of the scheme out. lined by Dr. France in his letter and, if approved by the Council may serve as a convenient basis for our official application to the Foundation.
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Modern Tendencies in Medical Teaching.
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6. If I may attempt very briefly to summarize some of the principal tendencies of modern medical education, they appear to take as their starting point the fact that, in view of the rapid extension and progress both of medicine and of medical science, the medical curriculum has become so seriously overloaded as to render it necessary to change the emphasis from the facts of medicine to its method. The old formal lecture on facts is falling into discredit and is increasingly giving place to clinical exposi tion, illustrated by the practical study of cases on the lines along which medical progress has been largely achieved. higher standard of teaching is thereby rendered necessary, and the tendency is even for clinical teaching to be entrusted
time to the work giving their whole men selected for their proved ability as teachers instead of to eminent practitioners, whose teaching powers are largely a matter of chance and whose lucrative private practice tends always to have
to
the first clain on their time.
A
and
4. The natural assumption on the part of the layman perhaps, that full-time clinical Chairs are no less, but no desirable than (say) a full-time Chair in Mathematics. The
7. Such, then, is the origin of the system known as the part-time mathematical lecturer is probably somewhat more difficult to find than his part-time colleague in medicine, and for that reason priority would properly be given to the mathematical "medical-urit," a group composed of a full-time specialist as Chair, but in either case the question would be largely one of Chief, with such number as may be necessary of full-or part- Fortunately, then, for present time assistants, to which is entrusted the care of a certain number Of this medical-unit the simplest expression is that finding the necessary money. purposes, The Rockefeller Foundation are interested in medical of beds. education and we can therefore hope for assistance in connection proposed in paragraph 1(a) of Dr. Pearce's letter a pro- with medical chairs, when assistance for wider University pur fessor, with one full-time assistant and a resident house officer. I have spoken of "beds," but the importance is being increasingly realized of bringing the student into contact with the beginnings poses would be impossible.
5. So to state the situation would be seriously to misunder of disease as well as with its grosser manifestations, in view both stand the attitude. of the Foundation. It would, I think, L of the growing place of preventive public health and of the correct to say that then interest is the improvement, rather that nature of the normal relations of the practitioner with private in the assistance, of medical education. If we are prepared, will patients, and this aspect of the case is dealt with by placing the their help, to adopt as our aim the creation of a medical scho out-patient work as well as the wards under the medical-unit fully up to the modern standard of University medical education staff. To his point allusion is made in Dr. Pearce's paragraph It means the adoption of 2(4), and it may be noted that suitable premises for the out- that help wil be forthcoming.
The same paragraph refers also to laboratory standard which our limited resources render, for the present, in patient department at the Government Civil Hospital are now possible for our Faculties as a whole, and one result will inevit being built. ably be the creation of certain anomalies as between the differen facilities at the hospital. Laboratory methods are assuming a that adequate though relatively simple-facilities for the pur- Faculties, which one can only ask the other Faculties loyally very important place in routine diagnosis, and it is to be hoped accept until we are in a position to bring them up to a correspond
Proposed Clinical Staff. ing standard. My study of the detailed figures leads me to believ pose may be provided in the Hospital itself. indeed, that the principal difficulty in the way of the acceptan
8. Breaking off, for a moment, to discuss the practical ap- of the suggested grant is not that of meeting the conditions out lined by Dr. Pearce so much as that of setting up a standard plication of the above principles to Dr. Pearce's detailed which, sooner or later, we must aim in other directions. But a desiderata, I assume that the suggested endowment of each Chair in all directions, the standard is the only right one, I trust the will be available for the purposes of the unit as a whole. this will not be regarded as a reason for hesitating to accept the advised and am satisfied that it is useless to attempt to obtain men of the desired calibre at any salary less than one of $8,000- suggested grant.
I am
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