Page:Carnegie Flexner Report.djvu/94

76 A uniform or fixed apportionment between various subjects is in schools of the highest grade neither feasible nor desirable. The endeavor to improve medical education through iron-clad prescription of curriculum or hours is a wholly mistaken effort; while mechanical regulation cannot essentially improve the poorer schools, it may very seriously hamper competent institutions. There is no one way to study medicine, still less one way to advance it. If the teaching is in inferior hands, printed directions will not save it. The prescribed curriculum is a staff upon which those lean who have not strength to walk alone.

Fortunately, current practice varies widely. The Johns Hopkins, for example, offers 700 hours' instruction in anatomy, of which about 400 are required, Harvard 427; Rush gives 108 hours to histology, Cornell 265; Columbia requires 490 hours in anatomy, embryology, and histology; Harvard gives 513 hours to pathology, Western Reserve 304. These discrepancies are of slight importance, for the medical curriculum is throughout constituted of overlapping parts: apparent deficiencies in one subject are supplied in another. Physiology revises and mends anatomy, and the clinical years may be safely relied on to build out here and there the details of pathology. A certain carefully selected, irreducible minimum in each subject must of course be common throughout these institutions; the rest may be left open, to vary from school to school, and within each school to vary to some extent with different individuals. The medical school is above collegiate grade; it is a professional school on a college basis. Its students are presumably mature and will doubtless prove increasingly well trained. They are fit to be trusted with a certain degree of discretion, in a field within which selection between alternatives of equal importance must in any event take place. The fourth year at Harvard is left open to choice; at Johns Hopkins one-fourth of each year is subject to election; intensive study at certain points is encouraged without endangering the fundamentals common to all. The problem of medical education and orientation is not otherwise manageable. In the effort to force every important subject as it has developed into the common curriculum-be it ever so inadequately - the average curriculum now calls for something like 4000 hours of prescribed work. The demand is an impossible one. It originates partly in the effort to make the medical school repair the omissions of preliminary education; higher standards will relegate something at least to the high school and college, and so far relieve congestion. As for the rest, we require a modified conception of what any sort of school can and ought to attempt. The mature student, competently guided, needs not to be policed like the “breeching scholar in the schools." His every moment must not be preëmpted by an assigned task. Von Strümpell rebukes the same tendency in Germany: "Somewhat more rarely in the first, very often, however, in the later semesters, many students hear lectures for eight to ten hours a day. From morning to night their time is taken up with classes; they rush out of one lecture hall into another, hearing a huge mass of facts and theories put forward. One can readily imagine the condition inside their