In my final year in college I was happily notified of acceptance by Harvard Medical School on the one hand and by Johns Hopkins
Medical School or the other. After much soul searching, the decision was made to leave Harvard, where I had already had four
years in any case. In retrospect the reasons for such a choice seem more clear than they did at the time. I had many friends
in the Harvard Medical School when I was a senior at Harvard College, and learned through them that the first year program
at least was characterized by fortnightly written quizzes, and according to my friends this was the source of many tensions.
At Hopkins, on the other hand, my grapevine indicated that the policy was one of no written examinations or quizzes except
those at the end of the first two years and at the end of medical school. When I began classes at Hopkins, this proved to
be true in the main, and, as one would expect, there was a wonderful freedom to concentrate on whatever each of us thought
was important. There was also, for a time at least, a relaxed and serious attitude on the part of most of the students. This
policy has been largely abandoned at Hopkins now, I understand, for what reasons I do not know. To most of us it was some
time before we learned to pace our suddenly independent study privileges without the spur of the more customary fortnightly
examinations, but we established patterns of study before the end of the first two years which appear to me to have been lifetime
Science in general, and medicine in particular, are uncovering new and exciting discoveries far too fast for any man long
to be a good doctor without such independent habit patterns of study. The transition to it appears rarely to develop before
our students enter the medical school, and it is something which must develop before embarkation on practice if one is to
remain adequate. There are tremendous differences in the pattern of approach to this transition from one school to another
and from one department to another in any particular school. This is a point about which you might well make careful inquiry
before deciding where you wish to apply, for your happiness and accomplishment in and after medical school may be critically
In discussing what to expect in the medical curriculum, I could go through course by course what is ordinarily presented and
what you should expect from each. I think, however, each of you could learn more from any good medical school catalog. The
basic philosophies underlying this assembly of individual courses are more worthy of discussion here.
I believe my best departure in discussing the curriculum lies in outlining in some degree the research programs upon which
medical students in many of our medical schools are encourages to embark. In our own medical school, about two-thirds of the
students become engaged in research projects either in regularly scheduled elective time during the school years or during
the summer vacations. Such investigative studies may be undertaken in every one of the 14 departments of the school. In our
own Department of Surgery, we had an even 25 students involved during the summer of 1963, and 30 are registered to work with
members of the Department this year. This requires a re-organization of the faculty vacation schedules, and this activity
has resulted in the summer months being among the heaviest in the programs of many of the faculty. In some instances, faculty
vacations are foregone to permit pursuit of active research guidance for the students.
Why is all this effort made? What is gained by it? The reasons are many, but the dominant one is that for which the program
was originally conceived. To this I will return in a moment.
During the past 30 years, there has been an explosion of scientific progress with no previous counterpart in the history of
mankind. The advances are too rapid to be grasped by even the most brilliant mind, and the panorama about us in the sciences
in general, and in medicine in particular, is changing with breathtaking and exciting rapidity. The reasons for such an explosion
need not concern us here other than to note that it has arisen in major measure from embarkation on basic, fundamental, investigative
pursuits by men from all areas of the scientific world.
A corollary of this rapid expansion of scientific activity, unfortunately, is an almost insatiable urge to publish. In the
field of medicine alone, the number of publications is so enormous that there exists now a special monthly journal devoted
merely to publishing the tables of contents of the current journals. He who endeavors to keep abreast is forced to circumscribe
his interests to an area which he finds intellectually encompassable? In all this wealth of published material, is it true
that everything represents a new discovery, or a worth while contribution, or even a demonstrable fact? Unfortunately, this
is not the case. It is that scholar with an intellect critically trained and cultured in the processes of sound, scientific
investigation who can best sift the real from the unreal, the true from the untrue, the too frequently spurious claims of
the advertising aimed at the medical profession from the scientifically established fact.
True education is a process in which the factual knowledge is but incidental to the acquisition of the ability accurately
to utilize that factual knowledge as the tools with which to work. Students may achieve honor standing in many areas of so-called
education by the development of what may be referred to as "flypaper memories". It is this type of medical educational
institution which the Council on Medical Education of the American Medical Association and the Association of American Medical
Colleges rightly shun in giving their stamp of approval.
The alternate pattern that of the basic introduction to the methods of research, to the patterns of thought of research, and
to the patterns of acquisition of information in research helps to gain for the student the same critical analytical approach
to everything he may seek to learn in the medical world. This is not something most of us can learn as members of large groups.
It is something we learn as individuals working under the personal close guidance of someone experienced in the scientific
method. Even though the classes in some of our medical schools may number up to 200 students, our schools in major measure
endeavor to break the student body down into groups small enough so that each student becomes fairly intimately acquainted
with at least one member of the faculty in nearly all major departments. In such small groups the diagnostic and therapeutic
problems of individual patients are approached as though they also were research projects.
It is the belief of many of us in our medical school faculties that a background of approach of this character to scientific
and, in particular, to medical learning can best prepare our students for the rapidly changing new panorama of advances to
which I have already alluded. In the course of utilization of such approaches, the student finds himself motivated to assimilate
with rather surprising ease an immense amount of factual material. He now can see a purpose in having this factual material
at his fingertips, and he utilizes it as it comes within his grasp. In pursuing a research project in each of several areas,
he may learn immensely more of factual material than his subsequent medical career may minimally demand, but since he will
have used this material with interest and excitement and frequently with real accomplishment, most of it his forever.
If I may go back to another consequence of the scientific explosion of the past 30 years, I would like to call attention to
the importance of scientific research on basic fundamental levels. The concentration on such fundamental types of investigation
has been so intense that the curriculum committees of some medical schools appear to me to have become confused. One medical
school has made all of the basic science obligatory while surgery is an elective. From the position in which I stand, I cannot
help looking with some bias on such a program. I find that the great bulk of the research work in progress in the clinical
departments in my own medical school is of a very fundamental nature. Most of us do our major experimental work in the experimental
animal laboratories as physiologists, biochemists, theoretical chemists, immunologists, basic physicists or members of other
fundamental fields. I myself have a Ph.D. degree in Surgery and Physiology and a Master of Science degree in physiology before
completing my surgical residency, Many of our recent advances in basic physiology and biochemistry have thus come from individuals
not formally members of basic science departments. The clinical sciences, therefore, maintain basic science parameters, and
in our good educational centers the clinical departments prepare graduate and undergraduate students alike for doing basic
work as well as so-called purely clinical work. In addition most medical schools provide an opportunity to drop out of medical
school for a year or two to gain an advanced degree in one of the medical sciences before completion of requirements for the
Having gone this far, perhaps I should tell you some of the things that you will not find in the usual medical school curriculum.
If you are members of the medical profession wish to prepare yourselves to be in the forefront of new advances, there are
certain steps that can well be taken before matriculation at medical school. During the past decade, the interaction between
the medical and basic medical sciences, on the one hand, and the fundamental sciences of physics, atomic physics, theoretical
chemistry, electronics, and the newly burgeoning science of computers, on the other, has made many aspects of scientific medical
progress extremely difficult without a thoroughly sound foundation in these latter areas as well. I finished medical school
in 1935 and was well prepared in none of these areas. I have paid a heavy price for that lack of preparation. This is true
in part because of time spent in trying to gain sufficient knowledge in these areas at a stage of a career in which the undergraduate
student's freedom to concentrate upon such study has been no longer present. It is also true because of failure in investigative
programs solely by virtue of failure of such adequate preparation. You will rarely find such subjects in the medical school
curriculum, and it is a wise student who masters at least some of them before entrance.
There is a second absence from most of our medical school curricula, namely flexibility. I regret to state that in very few
schools in the United States is it possible for a brilliant student to proceed at his own pace and perhaps finish medical
school in two and one-half years instead of four. In pitifully few schools can a hard-working, thorough, but somewhat slower
student remain in good standing and take five years to finish medical school, even though the potential of an excellent physician
is there. We have begun exploring at our school the possibility of introducing such flexibility into our curriculum. Some
of us believe the time span from college matriculation to completion of internship could well be seven years instead of the
standard nine. Those of you who know yourselves to be at one extreme or the other of the intellectual spectrum of those entering
medical school might do very well to investigate this aspect of the curricula too.
Finally, I should like to comment on the third subject which you will rarely find in medical school curricula. I have heard
the statement repeatedly and with awe-inspiring emphasis that the "future of medicine lies in the laboratory". The
future of medicine is dependent upon the laboratory, that is true, but not upon that alone. Too often we hear reference to
a "case" in the hospital and are provided with a history, a detailed physical examination, an awe-inspiring presentation
of complicated laboratory data, and a brilliant display of deductive reasoning, culminating in a diagnosis of delightful precision.
This is not the whole story. I prefer to hear the subject of all this inquiry referred to not as the "case" but as
the "patient", for the patient is a person, with feelings, fears, hopes, and a family similarly endowed. Those who
have had much illness become keenly aware of the importance of the kindly concern of the physician, of the importance to morale
of the cordial physician-patient relationship, and of the forthright and thoughtful communication to the patient of as full
as possible an understanding of his disease processes and problems all the way from proper patterns of ethical practice to
the knowledge of presence of malignancy. Our medical profession is in grave danger from those who would impose a bureaucratic
control upon it and thus threaten to stifle its growth and the personal aspects of medical care. Our best friends are our
patients and the best of all are those who have been treated with full consideration that a man is something more than a mere
biochemical mechanism and according to the golden rule. These things are important, and recourse solely to the laboratory
to the exclusion of the warmth of proper human relations is to deny the very Hippocratic oath upon which medicine is founded.
In summary, I believe it fair to state that you will find very little didactic teaching in our strongest medical school curricula.
You will find a measure of opportunity for independent but guided study which to some may prove a stressful experience, but
which I should hope may present a welcome and exciting challenge to most. Before going to medical school, I would suggest
not only a good foundation in the humanities as basis for a warmth of understanding in the handling of the ill, but a much
broader foundation in fundamental physics, chemistry, and mathematics than I have seen outlined in any medical school catalog.
With this armamentarium, the possibilities before you in a medical career are almost unlimited.