Page:Carnegie Flexner Report.djvu/187

Rh branch for a fixed number of hours; but the instruction will probably be no whit improved by such police regulation. Meanwhile every competent and earnest instructor is seriously hampered by the vain effort to aid those who are beyond human help. The fact is that an enforced entrance requirement at one end and a proper examination at the other will of themselves limit the survival of schools to those that are financially and educationally competent. Only so long as an entrance requirement cannot be enforced or a proper examination arranged, do the state boards need the power to close schools obviously and notoriously defective.

(3) The examination for licensure is indubitably the lever with which the entire field may be lifted; for the power to examine is the power to destroy. At present, these examinations are not only without stimulating effect; they are actually depressing. There is only one sort of licensing test that is significant, viz., a test that ascertains the practical ability of the student confronting a concrete case to collect all relevant data and to suggest the positive procedure applicable to the conditions disclosed. A written examination may have some incidental value; it does not touch the heart of the matter. It tends, indeed, to do just the reverse. Written examinations are notably apt to follow beaten paths. A collection of state board examinations covering even a brief period of years will contain most of the questions that will be asked hereafter. An effective, but purely mechanical and entirely useless drill may be employed to make examination-proof a student who in the presence of a sick person would be quite helpless. As a matter of fact, prominent publishers put forth "State Board Questions" and "Quiz-compends" with "answers." These manuals, well conned, guarantee the candidate's safety. Do not the several states appear to do almost everything in their power to resist the production of a well trained body of physicians? In the first place, they permit a half-dozen men to start a medical school as lightly as they permit them to open a printing-shop; and they then offer them every inducement to furnish poor training by permitting the graduates to undergo an examination for which they can satisfactorily prepare by an inexpensive drill that has no bearing on the practical ends for which doctors are needed. A proper examination would go far to correct all the defects that this report has sought to point out. For low entrance standards, deficient equipment, bad teaching, lack of clinical material, failure to correlate laboratory and clinic, would be detected and punished by a searching practical examination.

If the written examination were relegated to a subordinate position, the weight of the test would fall upon the applicant's ability to do things; schools incapable for whatever reason of training students in the necessary technique would be rapidly exposed through the annual publication of statistics proclaiming their failure. The state board results, now so frequently misleading, would be a trustworthy index which the more intelligent students would carefully scan; and those schools only would