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THE MEDIGAL CORRIDOR.*

T. FORTESCUE FOX, (Editor, The Lancet, London.) I

AM delighted to be here, on any p r e t e x t - - o r none. But I think it an odd, though charming, custom of y o u r Society to allow an outsider to propose that y o u r President-elect be thanked for his address. Is y o u r l a n d so full of prophets that you no longer dare acknowledge any of them unless a s t r a n g e r vouches for his wisdom? I f that were so, I could assure you that Professor O'Meara's words this evening will command attention f a r beyond this island. B u t no, the real reason must be that this motion of mine virtually moves itself, and can therefore be entrusted to anyone at a l l - - p r o v i d e d it is seconded, as it is going to be. We have h e a r d a remarkable a d d r e s s - - r e m a r k a b l e particularly, I think, for its courage and its precision--the precision of its thought, the precision of its language, and the precision of its proposals. I t bears witness to a breadth of knowledge and teaching experience that is nowadays quite unusual. The trouble is t h a t lack of such knowledge has never yet stopped anyone talking about the c u r r i c u l u m ; and it won't s~op me. Personally, I don't much like the c u r r i c u l u m ; so I s t a r t e d by comt)aring it ~o a dragon. The student's task is to kill this dragon in six years. A f t e r a y e a r of learning and s t r a t a g e m he strikes off one limb: and l a t e r another; and so he goes on until he delivers the lethal stroke, marries the distressed damsel who has been waiting for him, a~d thereafter makes a living b y the sale of small mementos fashioned f r ~ m 'the dragon's body. As this comparison did not seem to take us much further, I turned to the derivation of the word. I n late L a t i n at least, c u r r i c u l u m was used for a race-chariot--in modern terms a curricle, gig, or jaunting car. The various professors fill this with packages of luggage for the student's join-hey; and, whenever one of them proposes that some other professor's package should be taken out, he invariably refers to " the ah'eady overburdened curriculum ". But this comparison is not very satisfactory either; and I sugge:~t that it would be well to stop using the word c u r r i c u l u m altogether and refer in future to the " medical c o r r i d o r " . This corridor, leading f r o m hope at one end to the sunshine of achievement at the other, is at present v e r y dark, and at least six years l o n g - - w i t h emergency exits on the way. W h e n a boy or girl knocks at the entrance and s a y s : " I want to be a doctor ", the door is opened a fraction and someone drops a portcullis. I f the boy is still outside, he retires h u r t ; but if he has darted in he finds himself in an ill-lit passage, out off which three rooms open---one labelled " Biology "; one (rather darker) labelled " Chemistry "; and one (positively Stygian) labelled " Physics ".

Speech in proposing vole of thanks to President-elect for his address to Dublin University Biological Association, October 30, 1954.

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The walls of each are lined with cupboards containing vast quantities of facts and ideas, often d u s t y and unsorted; and the student spends a y e a r or more collecting as m a n y of these facts and ideas as he can carry. His view down the corridor is b a r r e d by a hurdle, called an examination, which has to be surmounted before he can make f u r t h e r progress. I t is an Alice-in-Wonderland kind of hurdle, because the more you are c a r r y i n g the easier it is to j u m p ; moreover it resembles the obstacles used in a r m y training, in that when you go near it there m a y be explosions and smoke and painful electric shocks. W h e n the student gets over the hurdle he finds himself in another l a r g e r but equally obscure section of the corridor, with rooms labelled " Physiology ", " A n a t o m y " , and " Biochemistry ". A n d so it goes on.

W h a t Professor O'Meara is proposing is that the student shall be welcomed at the door as a f u t u r e colleague and shall at once be shown where he is going. The whole corridor will be b r i g h t l y lit so that he can see to the end, and the rooms f o r each subject will also be illuminated so as to display better those facts and ideas which a doctor will want. Selection of the most useful information will be aided by concise new catalogues or textbooks f o r each room, and the attendant teachers will spend less time in routine recitation and more in personal guidance. Also, in the fi~st year or ~wo, the amenities of the corridor will be improved by providing several small rooms in which the student m a y s t u d y other subjects, such as languages or mathematics, to refresh his mind and widen his mental range. All this, I feel sure, would be a vast improvement. But I do r a t h e r wish that a little more had been said about the examination hurdles; for, in E n g l a n d at any rate, progress down the medical corridor seems to me to d e m a n d f a r too much in the way of feats of jumping. I can't believe in any system in which, in the final year at least, the student m a y not be interested in what will make him a good doctor--because he is interested only in what will get him over his next examination. Last m o n t h I visited two Russian medical schools, and was astonished to find t h a t in the Soviet Union there are no w r i t t e n examinations for students: all are oral, and they are mostly conducted by the students' own teachers. Nobody in fact seems to lose much sleep over examinations; and in t h i s - - t h o u g h not in m u c h elsc---we have something to learn, I think, f r o m the Russian schools. I f a curriculum is good, and if the teaching is good, surely we should expect the student to pass his various tests almost as a m a t t e r of course, provided he is conscientious, has been well selected, a n d has been given the requisite basis of knowledge a n d method before he comes to medicine. On this last point Professor O'Meara (one could not help noticing) struck a r a t h e r pessimistic note. B u t then most of the more senior of us have lost a little of our first fine careless optimism. (Indeed the chief difference between an optimist a n d a pessimist nowadays seems to be t h a t whereas the pessimist lies awake w o r r y i n g about our being destroyed by h y d r o g e n bombs, the optimist lies awake w o r r y i n g about our dying f r o m starvation when population finally outruns food-supply.) I can't conceal f r o m myself or f r o m you t h a t we are not yet actually living in the millennium; and, until we do so, the education and be-

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haviour of most of us will remain imperfect ill one way or another. This being so, I t r y to take some comfort in a h m g e r view. I recall Nora W a l n ' s story of how, in the 1930"s, she was walking one day t h r o u g h the countryside in China, when she was horrified to see a poor m a n robbed and m u r d e r e d by a bandit. On being told of this incident, her Chinese hosts expressed distress, but added by way . f explanation t h a t in China there is generally a period of disorder between dynasties. " I t usually lasts ", they said, " about sixty years " Some of us have passed most of our life in such a period, but the younger among us m a y reach less troubled times. And the changes we have seen are by no means all bad. I believe it inevitable, for instance, that those who live in large and densely populated communities should accept more organisation than was necessary in the past. I n medicine we are undergoing our Industrial Revolution, and this means t h a t we must henceforth do much of our work in teams. But to be a m e m b e r of a team is by no means necessarily the same as being a c o g - - t h e word so alarmingly used by the President-elect; and we must take all possible care to see that in medicine it d¢res not become so. F o r the more highly the life of the people is organised, and the more the patient is exposed to scientific techniques, the more essential it is t h a t the doctors who take care of him should themselves be more than technicians. The doctor, more than ever, must have strength of character, must be willing to take personal responsibility, and must have a knowledge both of things and men. H e must in fact be an educated person. The test of an educated person is t h a t he likes what is best of its kind. I f he likes jazz, he likes good jazz; if poetry, good poetry; if whiskey, good whiskey. The best is almost always an acquired taste, and people have to educate themsel.ves--often with much labour, not to mention expense. Nevertheless a curriculum, an environment, can do much to help or hinder this self-education; and I believe that the changes Professor O'Meara suggests would do much to give us better doctors. I agree with him too about the lead that Dublin can give. I n m a i n t a i n i n g and i m p r o v i n g the standards of learning and civilisation the smaller countries can to-day make a contribution out of all p r o p o r t i o n to their size, and here in I r e l a n d you have both a great tradition in medical education a n d the o p p o r t u n i t y to experiment. We should all, I think, be grateful to Professor O'Meara for showing a way.