Page:Carnegie Flexner Report.djvu/92

74 institutional expediency; but it may prove of actual pedagogical importance. When Columbia and Michigan arranged that the four years of the A.B. course might contain two years of the M.D. course, institutions lacking medical departments were impelled to offer just enough of the medical curriculum to meet the competition. The half-school thus avoids loss of time to the student and loss of students to the university. The arrangement took advantage of the break in the middle between the laboratory and the clinical years; but a deeper reason made the experiment feasible.

The bachelor's course has under modern conditions a double aim: it is simultaneously cultural and vocational The sciences fundamental to medicine have obviously both characters: they are vocational to the extent that they are instrumentally indispensable; they are cultural, as is all enlarging and releasing experience, whether of men, books, or travel. Culture is indeed in this aspect an incidental value of all novel experience. So far, then, the combined course may be fairly said to be feasible, because it enriches the college curriculum; and the college may do well to offer the opportunity.

Is the scheme equally sound from the standpoint of medical education? The professional and cultural standpoints, though obviously overlapping, are not identical. The professional purpose involves greater concentration, is on the lookout for definite correlations, and steers towards an evident practical goal. The medical curriculum possesses a certain organic unity in virtue of the fact that each of its parts does this same thing. The college as college is indifferent to the ultimate practical bearing; the medical school cannot afford to forget it. As to certain subjects, indeed, there is perhaps little to choose. The college has already taken chemistry wholly out of the medical curriculum; it may be allowed to take bio-chemistry, too. In reference, however, to other subjects, pathology, physiology, etc., it is important—once more from the standpoint of medical education—to distinguish between two forms which the combined course assumes. To take advantage of it at Columbia or Michigan—complete four-year schools—the student goes over into the medical department, which is compactly organized with laboratories and clinics interwoven. He spends the entire period of four years there. The college has nothing to do with it beyond registering his credits for the first two years towards his A.B. degree. That fact makes absolutely no difference to the medical teachers. The student is trained for four years just as he would be trained if he had his A.B. degree to start with. The combined course in this form exacts no sacrifice from the medical school.

In the case of the half-school or the divided school the situation is different: the medical subjects are apt to be parceled out among the general scientific laboratories, and there are no clinics or clinicians at all. The professors themselves may lack medical training. There is no observable goal to steady or beckon the teacher. Counting