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Northwestern University in cooperation with the Mutual Broadcasting System presents the reviewing stand program in its twenty second year on the air today the reviewing stand will discuss problems in training doctors now are moderator James H. McBurney dean of the School of Speech Northwestern University will introduce participants in today's transcribed discussion Mr McBirney Welcome to the reviewing stand I'm happy to present our guests tonight Dr Granville a Bennett dean of the College of Medicine at the University of Illinois. Dr George De Rossi associate dean of the School of Medicine this University of Chicago and Dr Richard H. young Dean of the medical school at Northwestern University. And we are working I had to present this discussion of problems in training doctors as a part of a National Medical Education Week. Dean Young what is this Medical Education Week What's it all about Medical Education Week begins tomorrow it was established to create a better and greater understanding of the problems of medical education and to get a better appreciation of the contributions to National Health and Welfare made by our school. Seems to have been a growing name on the part of the citizens of the country for. Some type of form and form and which medical education could be surveyed I think that there has been a failing or a growing feeling of personal interest in personal and committed the welfare which says. Then a force which has caused the development of a medical education we are entering the US This is probably a fairly logical consequence of the considerable success of such campaigns is the national policy of campaigning the development of the fact is back Sainz for infant power paralysis the large campaigns and the progress that's being made by the cancer groups and the other groups and it is a fact that the backbone of these groups is the medical profession and the medical schools with their responsibility of training doctors and providing centers for medical research I have a real interest in this whole program and it isn't surprising that the same concern that our people are showing for health and disease is now being shown for the medical schools Well I would hope that this Northwestern University to go east and could make some contribution to its medical week Dr Bennett what are they more pressing problems faced by medical school. But of course there are many pros pressing problems but I would submit that one of a more pressing problems that we deal with the medical schools is the attraction of a fine faculty and ability to hold a of an affective teaching faculty and of course. To many other areas of medical education many other component parts of a medical school but one of the factors involved is the financial problems confronting medical education across the country. Courses I say if they are the problems that we have are coming from the fact that medicine is. Much broader a subject than I was fifty years ago there are many more things that we have to teach. We still want to teach a savings within a four year span which is the usual period of a medical education this means that we must continually develop better instructional techniques that we must select a better type of student and that we must have better facilities for teaching and all of these things add up to a continuous need to re-equip and remodel our schools and all of these things of course cost money which is our greatest problem or course directly or in the good directly finances presented termit tremendous problem and that is true of all the medical schools in the country there are eighty one medical schools in this country forty two of which are privately and Dowd the others are supported by the city or the state agency and the problem is presented we have about twenty eight thousand medical school students in this country at this time however the problem education is not merely the four years of undergraduate education we are presented with teaching the postgraduate student the graduate student and in turn some of the auxiliary medical services such as laboratory technicians physical therapists nurses and I think in your case Dr Bennett and the school only of them additionally construction of a large class of pharmacists each year we have a College of Dentistry and what's of Faculty of Medicine for to space very actively in the construction of these professional groups well are the medical schools the country over turning out enough doctors Dr I would say very definitely yes that is a difficult problem to answer there are some two hundred twenty five thousand positions in this country of course the utilization of physicians in. Is Present day and age different for example there are some fifteen thousand or eighteen thousand of those two hundred twenty five thousand physicians that are engaged in post-graduate education such as internship and residency they're engaged in our armed forces about two to three doctors per thousand of our armed ma'am. But even though we have. As you say enough doctors now which I think might be debated by some people the fact remains that our population is increasing at a fairly rapid rate and we may not have enough doctors in the years to come there's no evidence that that the country is going to require fewer doctors per thousand people in ten years and then the whole problem as we go let's more complex ration care as it's true of the. Number of physicians has increased over this last period of forty forty years by approximately one hundred twenty percent or as a population increases been in the neighborhood of eighty percent. But the problem of little care is taken a very very different form than that than many years ago that it had many years ago. It has become a highly complex structure with large centers a large areas of specialization which require in many instances require a large number of trained personnel to take care of a particular case situation would you men like to have more students applying for admission to the medical schools very definitely yes of course they have very highly highly qualified type of student I'd like to point out for example that. In nineteen forty nine fifty S there were about twenty four thousand applicants for medical school whereas in one thousand and fifty four fifty five the number of episodes for medical education medical school admissions go up to approximately fourteen thousand well that's I think there is a point here and it ought to be straightened out. As far as the term applicants and applications. Frequently you would hear that the words confused with each applicant as a rule will make three to five applications therefore when there are fifteen thousand applicants there'll often be about forty five thousand to fifty thousand applications so that there are a lot of duplications Now as far as the number of students admitting on how the forty five thousand that Dr Bennett retired two hundred twenty four thousand and four thousand about seven thousand murder now this last year about fifteen thousand applied and there are about seventy six hundred admissions in other words the ratio is that. Or than two to one more time I'm a astonished at these application figures that you give Dr Bennett that is that the number of Africans have reduced it was actually read a lot of alert as I've explained that letter is one of the reasons that when US would we'd like to have more qualified applicants we certainly would I don't know all of the reasons I suspect that there are many reasons in which the number of applicants falling off in the last few years. Perhaps more important value among these family the attraction of certain other types of scientific work attraction the electronic field and in the field of chemistry. It's entirely possible to know that the high cost of medical education labor and deterrent along the period of training required in medicine lay a benefactor that is a. Cause. For potential applicants not to apply for medicine but I think there are many factors in the Dodge's I think as there is a general plan for as the population increases if a college going age and we will have more and more students entering higher education in ten years and we have now that we're going to get more applicants for musical schools of course they the impression is that it is a broad I think it's you man are I highly selective in need and they have students that you met and that is that many people who apply are denied admission Dr Well I think it is true that medical schools are highly selective and I think they should be because their responsibility is to pick out of all the applicants the men who are going to be the best doctors for the years to come and I want to ask Dr Bennett a question he said that he would be glad to have more. Students applying to the university don't know my medical school we couldn't handle very many more in our school we'd be glad to see a few more schools but we're worried about increasing our enroll in those well I would like to say that lower and mark our lives as. I would like to say and many more highly qualified applicants for medicine throughout the country not in that particular institution but I would point out that the ratio of those admitted. Compared with those of sunny levels school lives changed in nineteen forty nine and fifty for example there was a ratio of one student unlettered to three students apply this ratio as dry up though it is so the blessed year being fifty four fifty. One. Out of every one point nine. One student was admitted so that one out of two playing in the school phoned the place and some was the country cursed the limiting factor so anything and factually I think that the answer to any increased number of medical students is through the establishment of a new school and although I said that there eighty one medical schools at the present time in the office and there are eight schools this year the University of Miami becomes a four year school I believe next year the University of Mississippi and following that the University of Missouri University of West Virginia Seton Hall in Jersey City and the issue even school in the New York during school they Einstein schools but what are some of the these factors determining Dr Young the number of students who can admit let's say in our medical school is primarily on the basis of facilities. We can accommodate about one hundred twenty eight in a freshman and sophomore class and in devising units you have to make your class down into units of the top twenty five as a single teaching unit the reason for medical education costing so much is that in the overall education of the students you have between the teacher and the student the patient. And you have the individual ratio of a teacher to a student far higher than you would you know liberal arts school or another type of education and that is the most. Costly factory might have one on if you men are saying we're going to expand medical facilities is going to be in the direction of a savaging new. Medical schools rather than. Bringing more students into the established school but what effect would that have on the quality of medical education. Do not believe a third up would. Effect the verse and then a wave of the quality of medical education I think that we followed their medical education might be adversely affected if our existing medical schools word to increase beyond an optimal point in the student body but. Other medical schools can and are being established for news the status of the established no and then schools and can be a specialist and will be examined their teaching programs will be examined their students and faculty ratios will be examined the availability of teaching material of those patients and their teaching office for those will be examined by a good any damage well or this was done in part by through questionnaire or material that the school must furnish to the accrediting agency but there is a live on committee. Of the American Association of American Medical Colleges and of the Council on medical education and hospitals of the American Medical Association and this lives on committee and makes visits to the school in question and spends a great deal of time and a great deal of care in going over the entire program interviewing faculty members interviewing students looking at the programs looking at the facilities examining the budgets and make their recommendations upon this type of the examination very often the medical educator will be invited to go along with such a team of exams some my son years ago I think they used to have a lot of these proprietary schools and some of them fly by night. Medical schools and they largely just are right here in the city of Chicago and there were fourteen medical school back in nineteen ten and they've been charting of them went out of existence back in nineteen can as a result of the Flexner a report which was sponsored by the Carnegie Foundation and now there's only five bars there's a preschool that we represent in the Chicago medic. Wairoa this was done in part by through questionnaire material that the school must furnish to the accrediting agency but there is a live on committee. Of the American Association of American Medical Colleges and of the Council on medical education and hospitals of the American Medical Association and this live committee makes visits to the school in question and spends a great deal of time and a great deal of care and going over the entire program interviewing faculty members interviewing students looking up the programs looking at the facilities examining the budgets and make their recommendations upon this type of examination very often the medical educator will be invited to go along with such a team of some years ago I think they used to have a lot of these proprietary schools some of them fly by night. Medical schools and they largely just are right here in the city of Chicago there were fourteen medical school back in nineteen ten and the been charting of them went out of existence back in nineteen can as a result of the Flexner report which was sponsored by the Carnegie Foundation and now there's only five of course there's the three schools that we represent in the Chicago Medical School District School of Medicine and oil the university I'd like to come back to the point that you started on that is that. The number of people the number of teachers that it takes to teach medical students in the preclinical years that is the first two years of this student's medical education classes can be relatively large twenty five thirty and whatnot and various devices such as. Television various visual edge can be used to help in the teaching when you get to the last two years of the clinical years and you are. Most have to put one or two students with each clinical teacher to give the sort of education that American medicine is accustomed to we have for example. Over two hundred fifty members of the clinical faculty at the University of Chicago and we have one hundred forty clinical students in the junior and senior year seventy in each design ratio a fairly typical of what I think it is I think that you almost always have more faculty and students is that your experience in our own particular school polio. Fuck all the numbering well over a thousand. Or student enrollment has been. In the freshman class admitting one hundred sixty six students. Of this cycle Leo ever should point out that approximately eight hundred of these building members devote their services to to the school. On a non-so or a basis to stand there protesting our situation is the same as a University of Illinois and we have total of about five hundred twenty students and we have a faculty of over eight hundred now the contribution by these practicing physicians is tremendous for example in our outpatient department alone and calculating and I meant that basis of free service five dollars for an individual below the level of an associate professor and ten dollars an hour for a full professor it figured out some three hundred thousand dollars in contribution to our outpatient clinic by the. Time faculty man and the other school in order to operate effectively smoothly must have a solid core of people who can be there to devote the extraordinary amount of time that is required for committing words for interviewing purposes to make the medical school. These individuals who are. Certain on so are the most contributor Leslie to the program but they can't be expected or would not be able to devote the time the required two. Let's take a look if we may have at the kind of program they. Pursue Allana is quite a formidable program a student must have three to four years of undergraduate education before he's admitted to a medical school and during his undergraduate time he has to fulfill certain requirements which in general are as follows A year in general biology about two years chemistry and about a. Year of physics and then after entering the medical school as work as Dr Roy is referred to as as preclinical work during the first two years consists in studying during the first year anatomy and biochemistry and usually physiology really and then during the second year path ology which is the study of disease Dr Bennett being apologists probably answer that one better. I'm a college E. and bacteriology is the the other subject then they began their clinical work. Such as physical diagnosis and introduction to the various clinical and of these and they go into the hospital and spend a period of time in what we call a clerkship. In the hospital and that would consist of a clerkship in medicine their courtship and surgery to correct different obstetrics and gynecology and in pediatrics and then during the senior year the same type of work only of a more advanced nature with more responsibility thrown upon the student. And in addition outpatient for then I have three is completed to four years undergraduate medical work he must have one year internship which again is served in a hospital now this is a requirement for most states as far as license here is concerned after that the individual if he desires to specialize usually spans from three to five years in especially Also if an individual is to prepare himself adequately for general practice he would very frequently spend at least two years on his internship Well I should think you'd be about ready to retire. Very long process of education is very likely to be beyond thirty and he will have probably accumulated a wife and a few children along with well might not this in itself be an explanation of the of the point we had before US of A while ago if your live in the. Modern times to. Relieve her of the completion of his internship and to the armed forces of the roll your two years in the service. Program of the joint extent does this long program develop from the fact that you're you're getting a lot of specialization within the field of medicine I as the old horse and buggy doctor that I used to know as a child in a rural village in South Dakota disappeared from the scene. I don't I don't believe that the long period at least the first half of it has anything to do with specialization I think that it's difficult to appreciate how what an arduous task it is to take a young man and trying him into being a physician he has he will bear great responsibilities all the rest of his life he has a great body of knowledge to master all of the things that have been learned in the twentieth century and as you can see we are teaching him on an apprentice basis to each student is almost a hand produced custom job we have never worked out a way to mass produce doctors and the public wouldn't want to you know they wouldn't want to be there and so that I think that the average young man finishing our medical system and in the American schools is well qualified to move in any direction he wishes he can become a satisfactory general practitioner or he has the background for any advance specially wishes to follow how would this program compare with medical education abroad are we equipping doctors as well as as other nations England Germany France I think the United States is preeminent in medical education. Ers one the one area that I would like to come out of a little bit further was pointed out for example that in the first two years of led us to learn principles subjects that are studied and in the last two years of Leveson press play clerkships and lettuce and surgery and pediatrics obstruct rates. More and more I think the medical schools of felt that they need in order to conserve the students time and to to do the best within the limited period that we have of trying to work out an integrated program of covering the entire four years of instruction in which some of the clinical work is very early in the program and some of the basic science work is carried forward into the later years and that seems to be a current trend in medical education which I think has improved the bottom line every school here in Chicago has a pilot study on a new type of curriculum to try to improve and integrate as Dr Bennett has pointed out we would be remiss here today not to consider the research functions of medical schools and the service functions of medical schools what's the role of the medical school in research Dr that is. One of a principal. Inducements to a Fuck only member of think to to come on a faculty and stay on the faculty of the medical school is an opportunity to perform research when are you doing basic research or are. Involved so I would say that by and large the research is done by the teachers in the first two years of the curriculum is more basic character and in the field of chemistry or physiology or. Whereas a type of investigative work that is done in the clinical years may be either a basic character or it may be clinical investigation to try and perfect methods of therapy and methods of diagnosis and what we call clinical investigation but we do both types in all parts of the school do you think that these research activity that Dr Bennett has been discussing complements the the other activities of a make or thank a helpful lady doctor or yes I think there's nearly crying to me that it was I think there's no question about it as a matter of fact it is in no manner of speaking it is the reward. To the member of the medical faculty for the effort that he puts in and teaching. Many men would would. Follow other careers and then a full time career in a medical school if it was not for the opportunity of research into schools offer it has another advantage to that the man who is engaged in a research program is very likely to be a more effective teacher. I'm sorry gentlemen but our time is up you have been listening to a transcribed Northwestern revealing Stan discussion problems in training doctors we want to thank our guests for today Dr Granville a Bennett Dean the College of Medicine University of Illinois back in Georgia the leader I associate dean the School of Medicine University of Chicago and Dr Richard H. young Dean the medical school Northwestern University our moderator was James H. McBurney dean of the School of Speech Northwestern University next week the reviewing stand will discuss how should I let it go campaigns be finance our guests will be courteous to make do the Professor of Journalism a do School of Journalism Northwestern University GA McGowan Attorney Ross and O'KEEFE And I'm Natalie and commissionaire of administration state of Minnesota and professor of political science at the University of Minnesota we hope you'll join us next week for our discussion how should political campaigns be finance Northwestern University reviewing stand is broadcast coast to coast every week as a public service feature of mutual here and I'll say Harry Christian. This is mutual The radio network for all America.