Postgraduate medical education and the specialties : with special reference to the problem in London.

  • Great Britain. University Grants Committee.
Date:
1962
Catalogue details

Licence: Public Domain Mark

Credit: Postgraduate medical education and the specialties : with special reference to the problem in London. Source: Wellcome Collection.

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    When the functions of specialist hospitals were limited to the practical handling of special diseases, their isolation from one another and from the rest of medicine may have been an asset rather than a liability. The consultant and his trainee assistants became extremely skilled in a narrow range of skills. If a man wanted to learn the technique and results of cystoscopy, where better than St. Peter’s and St. Paul’s ? As has been noted, the consultant had an additional appointment at a general hospital and the assistant’s stay was only a brief interlude in a series of more general appointments. The increasingly rapid development of medical knowledge in the last quarter century has made this isolation less comfortable, for medicine advances not on a narrow but on a broad front. For example, an uncommon nervous disease (Wilson’s Disease) described from Queen Square is now known to be a mani- festation of a specific biochemical fault involving copper-containing protein inthe blood. The problem now is not, one merely of diagnosis, but of exploring the nature of the biochemical fault and its treatment. The growing point of knowledge has moved from the neurological physician to the biochemist and geneticist, and the paediatrician rather than the neurologist is now most in- volved in trying to prevent the manifestations of this kind of disease. The real dangers of isolation are revealed by the Institutes. These have the additional function of advancing knowledge and of training men to advance knowledge. Nowadays, leadership in medicine is increasingly linked to pro- gressive thought and thus to a habit of mind which is most easily got by ex- ploringthefringesofknowledge. Theinstitutesthemselves tend to be increasingly staffed by men who spend the whole of their lives within their walls; Ph.D. students spend upwards of two years there. Some of the penalties of isolation which these men experience are as follows :— (a) Intellectual isolation : This, the greatest penalty, is what Universities from their foundation have sought to avoid. Dangerous to science in general, it is even more dangerous to medicine which, benefiting from the remarkable advances in the basic sciences, has undergone drastic revision in the last quarter century. Being out of contact with these developments not only makes a man outmoded in his knowledge and outlook ; it also makes him rigid and intolerant and out of sympathy with his more progressive colleagues. In this connection it is interesting to note that the major advances in the specialties in the last quarter century have not, in the main, come from these special hospitals. Thus, the surgical approach to diseases of the central nervous system and of the cardiovascular system developed chiefly elsewhere. Intellectual isolation is felt most keenly in the separation of the specialties from general science on the one hand and general medicine and surgery on the other.