Feature Christmas 2008: Formative Years

Not what we used to be?

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a2905 (Published 16 December 2008) Cite this as: BMJ 2008;337:a2905
  1. Peter Rubin, professor of therapeutics
  1. 1Division of Therapeutics and Molecular Medicine, Queen’s Medical Centre, Nottingham NG7 2UH
  1. peter.rubin{at}nottingham.ac.uk

    Did a golden age of medical education ever exist, asks Peter Rubin

    The GMC was established 150 years ago. Of course, things were different then—or were they? A parliamentary select committee on medical regulation was complaining that the profession couldn’t speak with one voice and that the medical royal colleges were failing to provide leadership; the Scottish medical establishment was distancing itself from ideas coming out of London; and the public at large was alarmed by the number of banks going bust because of dodgy deals in America.

    Looking back over those 150 years it is striking how themes keep recurring. For example, the top recommendation of Aspiring to Excellence, the final report of John Tooke’s recent inquiry into Modernising Medical Careers, was that postgraduate training should be more flexible; 30 years earlier Oxford regius professor George Pickering’s Quest for Excellence in Medical Education: A Personal Survey had complained about the rigid nature of postgraduate training. Of all the recurring themes none is more regular than the assertion that things were always so much better before, yet this golden age proves difficult to find on examination of contemporary records. Back in the 1960s medical students were fed up to the point of wanting to give up medicine or emigrate, and in the 1970s career prospects were considered so poor that junior doctors were going on strike.

    The claim that young doctors today just don’t have the knowledge and skills of the previous generation appears in pretty well every decade of the 20th century (box 1). Doctors, it seems, never were what they were. Nor were medical students, who seem always to have enjoyed a rather arm’s length relation with English grammar.

    Box 1: Doctors and medical students never were what they were

    “Medical students have insufficient vocabulary of their own language and facility in composition and correct spelling”

    Sydney Hickson, introducing a debate on the medical curriculum at the BMA’s annual conference, 1920 (BMJ 1920;ii:12)

    “The modern …

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