business? In order that “historic” schools may continue to produce a slightly ameliorated type of didactically trained physician?
As a matter of fact, many of the schools mentioned in the course of this recital are probably without redeeming features of any kind. Their general squalor consorts well with their clinical poverty: the class-rooms are bare, save for chairs, a desk, and an occasional blackboard; the windows streaked with dust and soot. In wretched amphitheaters students wait in vain for "professors," tardy or absent, amusing the interval with ribald jest and song. The teaching is an uninstructive rehearsal of textbook or quiz-compend: one encounters surgery taught without patient, instrument, model, or drawing; recitations in obstetrics without a manikin in sight, —often without one in the building. Third and fourth year men are frequently huddled together in the same classes. At the Memphis Hospital Medical College the students of all four years attend the same classes in many of the subjects taught.
So much for the worst. It may be, however, that in the case of some schools with weak hospitals and no dispensaries, the didactic instruction is vigorous, clean cut, in its way effective. Such is the claim made at Dartmouth and at Bowdoin. Let us concede its justice: what of it? Logically, the position of these institutions would be stronger if they stuck to didactic instruction altogether. The moment that they offer a course in clinical microscopy, they are committed to an entirely different scale of values. For that they require patients whom they can observe closely and continuously in order that laboratory data and bedside data may be put together as the basis of a specific judgment. In other words, teaching must henceforth be concrete, not abstract; clinical, not didactic. Good didactic instruction may indeed to some extent accompany clinical teaching. We are not especially concerned to determine its actual extent.[1] Let it earn the school an extra credit, if you please. But its excellence is no substitute for missing, defective, or badly balanced clinical opportunities.
- ↑ The subjoined comparative schedule indicates the distribution between clinical and didactic work in schools of various grades. This table is not alone conclusive; for schools with weak clinical resources are not infrequently without illustrative material, so that a clinical lecture may perforce turn into a didactic lecture. Moreover, clinical instruction of the amphitheater type may, if the students are few and the conditions good, be as useful as a bedside demonstration; where, however, the students are many and the conditions poor, it may be no better than a didactic exposition.
