General Training Urged For Medical Students

Press, Volume XCVIII, Issue 28822, 17 February 1959, Page 11

General Training Urged For Medical Students

The general practitioner should be integrated into the medical teaching service; at the present time each specialist teacher viewed a phtient from a particular angle, and the student was apt to see the patient as a mosaic of systems not integrated into the whole man, Dr. H. M. Saxby, of Sydney, said in a lecture to doctors in Christchurch. He advocated the establishment of general clinics, staffed by general practitioners, in teaching hospitals.

Dr. Saxby is secretary of the Australian College of General Practitioners, and his address was to the biennial conference of the New Zealand branch of 'the British Medical Association

“Clinical teaching is carried out by specialists in the various disciplines of medical, patholo T gists, physicians, surgeons, obstetricians and the rest,” he said. “Each views the patient from a particular angle and the student is apt to see the patient as a mosaic of systems not integrated into the whole man.

"At' one time, the general physician gave an essential unit to the under-graduate’s approach, but nowadays general physicians seem to -have given place to cardiologists, neurologists and gastro-enterolbgisis who find it difficult to see past the heart, the central. nervous, system or the stomach-. '2:.. ... J ’’Thir’Studcffif fends to look it his patient through a proctoscope or laryngoscope -and bases hrs judgment on the shadows of the radiologist or the test tubes of the pathologist. This is a sorry but almost inevitable state of affairs under present conditions.'* Dr. Saxby said that it was essential that a leaven of clinical teachers should not be specialists. "Perhaps the general practitioner is that leaven which will leaven the whole lump,’’ he said. General Clinic Dr. Saxby said that obviously the general practitioner was not competent to teach a specialty, however, it was possible, and perhaps necessary, for the general practitioner to be integrated into the teaching pattern of a university hospital. “Every teaching hospital could establish what may be called a general clinic staffed by general practitioners," he said.

“Such a clinic would be responsible for the admission and allocation of all patients to the in-patients’ and specialised outpatients’ departments of the hospital, and would be responsible for the general oversight of the patient and for the collation of his treatment by the various services of the hospital.” Discharges would take place through the general clinic, which would be responsible for advising

the patient’s own doctor regarding his treatment in the hospital and making recommendations for his future, he said. Home Environment

Dr. Saxby said that possibly a home care service could be established in connexion with the general clinic. . The home care service could be organised to provide nursing, physiotherapy and occupational therapy, almoner and perhaps domestic services to the patient in his home. The student could accompany the patient’s own doctor on his visits and learn at first-hand the patient in his home environment.

Valuable experience for students was given in the University of Edinburgh general practice teaching unit which taught methods and an approach applicable to general practice. Visits were paid by the student to patients in their homes. The unit was an integral part of the curriculum in Edinburgh. Extramural teaching of undergraduates by general practitioners had been carried out by a number of medical schools in Australia, the United Kingdom and other countries. In a few schools such teaching was compulsory but in the majority it was voluntary. The usual pattern was that the student visited the practice of a general practitioner, who acted as his praedeptor, for a series of week-ends or for a week or two weeks during vacations. In New South Wales, there was a successful scheme whereby arrangements were made for senior students to spend two or more weeks during vacations resident in country hospitals staffed by general practitioners. This scheme was popular with all. Week-end Visits “In the newest medical school in Australia—Western Australia — Professor Saint has in mind several interesting plans.” said Dr. Saxby. In one it is proposed that a teacher should, from time to time, take two or three students for a week-end visit to a country centre. “Here, the local practitioner presents his difficult cases to the visiting teacher in consultation. The teacher, the local practitioner and the students work together towards a solution of the problems of diagnosis and treatment. "A second Western Australian plan envisages a second-year student being present at a baby’s birth. This baby becomes the student’s ‘clinical god-child’ and he follows its vicissitudes during infancy and early childhood—presumably in close co-operation with the family doctor until he graduates. "Perhaps the personality and attitude of the general practitioner will have a greater effect on moulding the professional character of the student than on his academic training,” Dr. Saxby said. “But it is quite certain that academic attainment alone does not make\the good doctor. Probably the general practitioner has much to give the formation of the good doctor; only the full opportunity for service is lacking,” Dr. Saxby said.