THE OTAGO DAILY TIMES SATURDAY, FEBRUARY 18, 1950. MEDICAL TRAINING

Otago Daily Times, Issue 27318, 18 February 1950, Page 6

THE OTAGO DAILY TIMES SATURDAY, FEBRUARY 18, 1950. MEDICAL TRAINING

In his address to the BMA Conference at Wellington, the viceChancellor of the University of Otago, Dr Aitken, stated succinctly the present case for acceptance of students for training in medicine. Admission to the Medical School is, with the exception of certain priority groups, competitive, and the qualifying requirement is high achievement on what the viceChancellor describes as “ a purely intellectual basis.” This appears to be an eminently fair basis of selection, as well as an easily determinable one. But the question is not quite as simply answered as that. There is, for instance, an economic factor involved, which is of considerable importance to the taxpayer if not to the medical academic world. The majority of students now admitted to the Medical School are bursars. That.is to say, the people of New Zealand have to pay a high proportion of the cost of turning them into doctors. The costly preference allowed them rests, therefore, upon their capacity to pass preliminary examinations of the standard type arfd the students’ willingness to be indentured to the State for a stipulated period after graduating. Probably at least as many applicants for admission are rejected whose family circumstances would enable them to train in medicine without direct State aid, and without accepting State bondage. It is worth recalling that this lavish bursary system was introduced by the Socialist Government with the deliberate intention of creating a type of State employeedoctor who would ensure the operation of Socialised medicine. The mature members of the profession, and the people by their vote last November, are convinced that the profession of medicine should be kept free from bureaucratic control. The Qualifying Tests The question whether the best preliminary examination-passer makes the best doctor is a difficult one. Dr Aitken did not commit himself very far when he declared that he could not accept the belief that persons of high intelligence—the “ purely intellectual ” selectees — were less likely to possess the requisite qualities than others, and he rejects the argument of critics of the present system that other besides intellectual tests should be applied to candidates. It is not, of course, suggested by the critics that persons of low intelligence should be admitted to the Medical School, but there is a strong feeling—and Dr Aitken must be aware that it is held largely in the medical profession—that selection by prowess in comparatively elementary and nonspecialised examinations should not alone be the criterion of acceptance for medical training. The elements that make the best medical practitioner, general or specialist, are not necessarily encompassed in a capacity to pass into the school at the top of the class. This can be proven in the simplest manner by reference to the number of fine, unselfish, devoted and often brilliant doctors who graduated at Otago when no competitive system of entry was necesssary. There is no reason for thinking that the standard of graduates has improved under the intense “ purely intellectual ” selective system; on the contrary, there are many—again, among practising doctors as well as the public—who consider it has deteriorated. Psychology Neglected If they are correct, the immediate cause is presumably the introduction of medical benefits under social security, which has made medicine perhaps the most lucrative profession in the country. The income of the doctor is not, under the present system, necessarily a reflection of his skill or his conscientiousness. The practice of medicine has, in fact, become “ easy nioney,” with a consequent emphasis among some graduates upon its financial potentialities, rather than its distinctively noble character. To combat this disastrous concept it is desirable that admission for medical training should be controlled by the most searching tests, with intellectuality not the only requirement. Admitting the difficulty of fixing coeval tests, it is apparent, surely, that a vocational aptitude is desirable in candidates; that their psychological fitness for the calling of their choice should be determined. Socialised medicine, with its rich lures and liability to “ racketeering,” puts temptations in a doctor’s way which he must be capable of recognising and rejecting. The terms of student admission, and of the medical training itself, must alike be adapted to meet the conditions of the day. It must be borne in mind that medicine is not only a study of disease but also of human personality; that the doctor’s approach to his patient, (and to the family of the patient) is of the highest therapeutic consequence. This point Dr Aitken makes by implication when he allows ground for criticism of the emphasis placed on scientific subjects as a prerequisite for medical entry. He could have gone further and emphasised that scientific training in medicine should be accompanied by far greater emphasis on its psychological aspects. It is necessary that students should be instructed in those humbler aspects of the social relationship between doctor and patient which are not comprehended instinctively by all doctors. At a more specialised level of psychology, they should leave the Medical School with a sound psychiatric background. It is a reproach that training in psychiatry, which is assuming everwidening importance in curative medicine, is scarcely skimmed over in the University of Otago Medical School curriculum.