purpose he has easy access to the hospital wards. His "beds" are under his continuous observation from the day his "patient" is admitted until the day of discharge; or, in the event of death, he and the physician ultimately responsible for the steps taken in treatment repair with others to the autopsy-room to bring their knowledge to the test, as Thomas Bond quaintly phrased it. Meanwhile, the clinical teaching has closely followed the development of the case. At brief and regular intervals its status is reviewed. All other members of his group, and the patient too, are at hand when the student presents his report, which forms, once more, part of the permanent record of the case. At every point he has been checked up; the instructor in charge of the clinical laboratory inspects and verifies his work there; the clinical instructor, here. The latter officer reviews everything, pointing out omissions, errors, misinterpretation. The student has always an appeal. He may on second trial convince himself of his blunder. He may,
be only the more convinced he was right, whereupon another look may persuade the instructor that it is he who errs! Subject to this control, complete, of course, from the standpoint of treatment followed, the student is a physician practising the technique which, it is to be hoped, may become his fixed professional habit; learning through experience, as indeed he will continue to learn, long after he has left school,-a controlled, systematized, criticized experience, however, not the blundering, helpless "experience" upon which the didactically or demonstratively taught student of medicine has hitherto relied for a slow and costly initiation into the art of medicine.
In the surgical ward, a similar arrangement is feasible. The student assists in the operation of his own "case" and follows the after-treatment. Obstetrical training pursues analogous lines. After preliminary drill with the manikin, the student first assists, then has charge under an instructor, of the cases in question. He learns in the hospital wards the proper care and manipulations, his experience supplemented, as we have pointed out, by a regularly organized out-patient department, which brings him in the home, in contact with the trying conditions that he will encounter in practice. Pediatrics and infectious diseases are likewise scheduled and organized. A simple method of rotation carries the student in this intimate and responsible fashion through all departments in the course of two years.
Demonstrative teaching necessarily accompanies the method described: in each group of five, only one student personally explores each case.[1] At the next bed a new protagonist comes to the front; and so on, until each man has had his turn. Always, then, four of the five men are getting demonstrative teaching, though of a somewhat intimate kind. The demonstrative method must, for lack of time, also be more widely employed: large sections are sent on ward rounds, in the course of which the instructor demonstrates the salient features of a considerable number and variety of cases. The defects of the method are manifest: it is not sufficiently direct, accountable, and systematic to constitute the sole lasting discipline. At best, the student becomes in
- ↑ In some schools two students have charge of each case, the principle remaining the same.
