CHAPTER VIII. PROGRESS OF THE YEAR IN MEDICAL EDUCATION. By N. P. COLWELL, M. D., Secretary of the Council on Medical Education of the American Medical Association, Chicago, Ill. CONTENTS.-Progress in the last 12 months-Present status-Colleges having higher entrance requirements--State requirements of higher preliminary education-Financial aid to medical colleges-Closer relations with hospitals-Development by limitation-Helps in the general progress-Other improvements by licensing boards-Standards of medical practice-Relation of medicine to general educationEntrance to college by examination-Thorough and reliable examinations essential-Administration of entrance requirements-Choice of a medical school-Medical knowledge more extensive and complete State requirements more exacting-Nonrecognition of medical colleges-All-time clinical professors-Graduate courses in public health-Graduate medical instruction-In conclusion. The rapid and remarkable improvement which medical education has been undergoing during the past 10 years has not diminished during the past 12 months. There has been a further decrease in the vast oversupply of medical colleges possessed by this country in 1904. Of the colleges remaining a still larger number (85 per cent) have put into effect higher standards of preliminary education for admission (one or more years of collegiate work); more salaried expert teachers have been employed; endowments have been greatly increased; new buildings have been erected; new laboratories have been provided; closer relations have been established between the medical colleges and hospitals; and much better opportunities for medical students to study and observe the treatment of the sick have been provided. Medical education has indeed been greatly improved, while at the same time the opportunities for students to secure a thorough training in the latest and best methods of diagnosis and treatment, as well as in disease prevention, have been markedly increased. The diminution in the number of medical colleges, therefore, has resulted in the development of a better quality without in any way restricting the opportunities for those who are well qualified to study medicine. In addition to the improvements immediately within the medical colleges, medical education has been greatly improved by the establishing of better means for postgraduate medical instruction; better courses in preventive medicine, public health, etc., for the training of those who are to become health officers; and a larger provision financially and otherwise for medical research, by which many new facts will be added to the knowledge regarding the causation, diagnosis, treatment, and prevention of disease. Again, laws have been secured in a number of States providing for a better regulation of medical practice, for higher standards of preliminary education, and for better methods of examination. On the other hand, as this report will show, there still remain serious needs to be met before medical education in the United States will be on a par with that of other first-class nations, and before the people of this country will be safe from the menace of incompetent and unqualified practitioners of the healing art. PRESENT STATUS OF MEDICAL EDUCATION. The numbers of medical colleges, students, and graduates have still further decreased during the past year. This is a continuation of the expected reaction following the greatly inflated enrollments in the vast oversupply of medical colleges possessed by this country in 1904, when over half of the world's supply were in the United States. In fact, to those who are fully acquainted with the low educational standards held by a large majority of the medical colleges in 1904, the reduction in the number of medical students from 28,142 to 16,502, of medical graduates from 5,747 to 3,594, and of medical colleges from 162 to 101, gives evidence of marked improvement and in every sense reasons for congratulation rather than alarm. For example, among the thousands who graduated annually from medical colleges in and prior to 1904, very few had secured a good preliminary education, shown by the possession of degrees from colleges of liberal arts, while 817, or 22.7 per cent, of those graduating in 1914 were also graduates of standard colleges of arts and sciences.2 TABLE 1.-Reduction in number of medical colleges, students, and graduates. 1 See Jour. of Amer. Med. Assoc., educational number, Aug. 22, 1914, pp. 657-690; also statistics of professional schools, vol. 2 of this report. 2 See also vol. 2 of this report, chapter on professional schools, for slightly different figures reported to this bureau. Students. Graduates. Colleges. Students. Graduates. The clearness with which the public now understands the conditions and needs of medical education is shown by the following concise newspaper comment regarding the reductions in the numbers. of medical colleges, students, and graduates during the last 10 years. Says the Chicago Journal: Thirty years ago any ambitious youngster who had the price could find some "college" ready to fit him out with the magic letters "M. D."-ofttimes after a "course of study" so petty that a plumber's apprenticeship was a liberal education by comparison. To-day most of these diploma mills have been closed-though a few continue to do business at the old stand, and to send forth wretchedly unprepared men to undertake that most responsible task in the world, the care of the sick. The country needs not more doctors but better ones. It is getting them. The medical course of study in a first-class medical college of to-day is calculated to try the earnestness as well as the ability of a would-be physician. Six more medical colleges have been closed this year; these were all institutions that had been rated in the lowest classification (class C) by the Council on Medical Education of the American Medical Associciation. There have been 85 colleges closed by merger or otherwise since 1904, but during the same time 24 new colleges were organized, making a net reduction of 61 medical colleges. Of the colleges which closed, it is worthy of note (Table 3) that all but 3 of those rated in classes A and B were closed by merger. Of the 35 colleges which were closed outright, all but 3 were in class C, the lowest grade. A pamphlet containing the latest statement of classification will be sent on application to the Council on Medical Education. 73226°-ED 1914-VOL 1-13 1880 1890 1900 1904 1905 1906 1907 1908 1909 1910. 1911 1912 1913 1914 1915 CHART I.-FEWER BUT BETTER MEDICAL COLLEGES. Showing decrease in totals, but an increase of those having higher entrance standards since 1904. Total numbers of colleges are graphically indicated by the bands opposite the respective years. The black portions of the bands indicate the numbers of colleges requiring two years of collegiate work for admission, while the shaded portions indicate the numbers requiring one year of collegiate work. The unshaded portions of the bands indicate the numbers of colleges requiring for entrance a four-year high-school education or less. 1 Based on the classifications of medical colleges prepared by the Council on Medical Education. While the total number of colleges is growing smaller, however, and approaching more nearly the normal supply for this country, it is encouraging to note (see chart 1) that the number of high-grade, stronger medical colleges is constantly increasing. In 1904 only 4 medical colleges were requiring any preliminary education in advance of the usual high-school education, and the vast majority were requiring much less than that; now 84 are requiring one or more years of advance college work and several others will enforce the higher requirement next year. Of these 84 colleges, 34 require two years or more of collegiate work for admission. Many of the colleges have been remarkably improved also in regard to buildings, new laboratories, better equipment, larger hospital facilities and-most important-more and better full-time salaried instructors. COLLEGES HAVING HIGHER ENTRANCE REQUIREMENTS. The 34 medical schools now requiring as a minimum for entrance two or more years of work in a college of liberal arts in addition to a four-year high-school education are here given, together with the year when the requirement went into effect: California.-Leland Stanford Junior University, School of Medicine....... University of California, College of Medicine... Colorado.-University of Colorado, School of Medicine.. District of Columbia.-Georgetown University, School of Medicine. Howard University, School of Medicine.. Illinois. Northwestern University, Medical School.. Rush Medical College, University of Chicago. Indiana.-Indiana University, School of Medicine. State University of Iowa, College of Homeopathic Medicine Requirement in force. 1909 1905 1910 1909 1912 1914 1911 1904 1914 1910 1910 1910 |