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all their lives, but the laboratory sciences as a rule only during the medical course. It is a pedagogical mistake to cut off the students from the fundamental sciences after a contact of only one year and a half with them.
A valuable part of medical education is the contact of advanced and biginning students with each other. This is lost in the divided school.
The beginners get enthusiasm and interest from the proximity of the clinic. This is lost in the divided school.
There is a movement to begin clinical teaching earlier in the course. If this experiment should prove successful, the students in a divided school will be at a disadvantage.
2. Effect on the faculty.—(a) The laboratory men need contact with the clinical men and with the hospital in order to keep laboratory teaching and research in practical lines. The fundamental subjects should be taught primarily as sciences, but nevertheless, by contact with clinical teachers, the laboratory men can learn what to emphasize in order that their students may be properly prepared for the practical work of the junior and senior years. They can also learn of practical questions for research.
(6) The clinical teachers need the laboratory teachers. It is a tradition that pathology should work hand in hand with clinical medicine. This is because pathology developed in the hospital and dead house. No one would think of divorcing pathology from practice; and if the last half of the sophomore year should be taken from Rosedale to Lawrence, it would be necessry to teach pathology in both places.
But the clinical teachers need the other preclinical branches as much as they need pathology. Medicine becomes more and more biochemistry and physiology, and less and less pathological anatomy. The bacteriologist, the biochemist, and the physiologist should all have their contacts with the hospital. Even the anatomist needs hospital relations in order to get fresh material. If there was no other argument for the united school than the need which the clinical branches have for the preclinical, it would be more than ample. A purely clinical school is a purely practical school. Without the preclinical departments the medical school can not have the academic atmosphere, the university spirit, the research habit, and the altruistic idealism which attach to departments where full-time men make teaching and research their life work. Only the whole-time laboratory men can bind the part-time clinical faculty into a coordinating working body.
A divided faculty really means two faculties, neither of which can function properly. You can not divide a race horse into fore and hind halves and expect to win the Derby.
3. Educational policy.-Medicine consists of those parts of biology, physics, and chemistry (and practical psychology) which may be used in understanding human disease and in diagnosing, treating, and preventing human disease. These parts of biology, physics, and chemistry are known by special names, such as anatomy, physiology, biochemistry, when one is thinking of pure sciences. They are known as surgery, medicine, pediatrics, etc., when one is considering applied science. It is an educational mistake to separate the pure sciences from the applied sciences.
Suppose one should propose that botany, bacteriology, chemistry, and physics be taken away from Manhattan and that only the practical applications of these should constitute the agricultural college, you would have the educational anomaly that now exists as regards medical education in Kansas university.
All members of the faculty and doctors interviewed at Kansas City, except two, believe that the school should be united at Kansas City. There is a strong but not unanimous sentiment among the preclinical teachers at Lawrence in favor of such action. Medical educators in general do not favor the divided school. Several schools which began that way have later been united.
Your inspector believes that the duplication of equipment necessary for teaching physiology and bacteriology to university students at Lawrence (when the main departments are moved to Kansas City) will be insignificant, this work being elementary in character.
POLICY AS TO CLINICAL DEVELOPMENT.
The medical school has been located within two blocks of the Missouri-Kansas line. Only one reason can justify this location, namely, the determination to develop a metropolitan medical school, using the facilities and clinical material of “Greater Kansas City.”
Recommendation 3.—The policy of a metropolitan medical school making use of the hospitals and clinics of both Kansas City, Kans., and Kansas City, Mo., should be formally adopted. Cordial relations on both sides of the State line should be fostered. The idea that medical education is an interstate and national service should be promulgated. Private donations to the school as a "Greater Kansas City” institution should be solicited. Gentlemen's agreements, if formal contracts are not possible, should be entered into with the hospital managers on the Missouri side.
Your inspector took great pains to ascertain whether such arrangements would be possible. It was the unanimous opinion of medical and business men in Kansas City, Mo., that amicable and workable relations can be brought about and that public and alumni sentiment in that city will support the university in getting the necessary agreements with the hospitals.
The best teachers should be chosen, regardless of residence. The organized medical profession of Kansas should back up this policy of metropolitan development.
POLICY AS TO SUPPORT OF UNIVERSITY HOSPITAL. Every hospital exists primarily for the care of the sick and their restoration so far as possible to useful citizenship. This being true the support of the patients in the State university hospital should not be a charge on the educational funds of the State. The university may, however, properly pay for teachers and for teaching and research equipment in such a hospital.
Recommendation 4.-The policy of developing the hospital on room and ward charges against patients who are able to pay and on State payment for patients who are indigent should be adopted. As soon as possible the university should discontinue the use of educational funds for the support of patients. The so-called county law is founded on wrong psychology and should be abandoned. The county as a unit for the care of all types of indigent sick is as antiquated as is the county unit for that special class of sick known as insane. An effort should be made at once to secure a statute providing that sick and crippled children may be sent to the university hospital at State expense. Gradually, as in Iowa, the people will come to recognize the great value of such service and be willing to extend and support it.
Kansas should establish hospitals for crippled and deformed people, for eye and ear, for venereal diseases, and for mental diseases, not as separate institutions but as pavilions of the university hospital. A psychopathic pavilion, or hospital unit, cooperating with the courts, insane hospitals, and all the official machinery for handling mental deficiency and delinquency should be an early development. Above all, the relation of all these social advances to medical education should be kept in view.
THE OUTPATIENT DEPARTMENT. The outpatient department should be fostered in every way. Nothing is worse than such an emphasis on hospital teaching that the student goes out trained chiefly in unusual diseases and major surgery, and dependent on the hospitals for carrying on his practice. The hospital should not overshadow the dispensary. The best professors and teachers should be kept at work in the latter department, and the students should be given ample time there.
RELATIONS WITH KANSAS CITY, KANS. The medical school should be an institution which the chief city of Kansas should be proud of and which it should cooperate with and
support in every way. It is fortunate that Rosedale is now a part of the large municipality. The establishment of good means of communication between the main part of Kansas City, Kans., and Rosedale should be hastened.
Kansas City, Kans., should develop its facilities for the care of the poor in connection with the medical school. Its health department should be the laboratory and field outlet for public health teaching
Recommendation 5. The proposal that the old hospital at Rosedale be used for contagious diseases and tuberculosis (perhaps also for maternity cases) for Kansas City, Kans., should be consummated. The hospital should be supported by the city, which needs facilities for the above classes of patients. The medical school should furnish the staff.
Kansas City, Kans., should not develop any hospitals apart from the medical school. It should strengthen in every way the State institution within its borders. Thereby it will accomplish its own purposes better and at less expense.
So far as I could learn the premedical requirements are well enforced. Everybody acquainted with the facts states that the standards of scholarship in the medical school have steadily advanced during the past six years. The graduates are fairly well trained. Men who had served internships in the East, in contact with graduates of the best schools, state that they held their own in the competition. This does not mean that there is no room for improvement. It means that the medical school has made progress and should be commended and supported.
The budget is small. Whether it is proportional to the total revenue of the university I can not say, but it ought to be increased.
I have no suggestions except that the payment of any considerable salaries to part-time clinicians should be discouraged in the present state of the school. Men should be sought who are willing to do the work for the advantage of medical education and their own advancement through the school relation. This does not apply to young men who may be willing to give practically full time for a few years. Such men may be paid, but they should step out as soon as their private practices begin to increase. The fundamental departments must be provided for before the clinical. Strong laboratory departments are indispensable.
ST. MARGARET'S HOSPITAL. From accredited accounts this institution has much good clinical material not adequately used by the medical school. The distance is a disadvantage, but a workable plan should be formulated. Perhaps something like the Minnesota student-internship might be developed for this hospital and some of the other institutions of the two Kansas Cities. The university might support residents (fellows) for the principal services in St. Margaret's Hospital.
RELATIONS WITH THE MEDICAL PROFESSION.
I believe the Kansas State Medical Society is friendly to the school and will help it. Broadly looked at, a good medical school and a good State hospital will help the profession much more than they will hurt it. I am certain that this view holds among the leaders of the profession in Kansas.
Meanwhile the university should do its best to be of service to the profession by short courses, by extension work, by public education in medical matters, and by setting good standards. Both sides should labor for cordial understanding and cooperation by frequently meeting together.
GENERAL CONSIDERATIONS. It is a mistake to permit a medical school to develop as an institution primarily for the training of physicians. This ideal leads to the criticism that medical education is expensive, that it is for the benefit of a limited class, and that it should not be supported by the State.
The agricultural college is supported because it leads to the production of better crops and better domestic animals. The medical school should produce better human beings. Both schools apply the same sciences, namely, biology, chemistry, and physics, the one to animal, the other to human needs. The medical school has an even closer relation to the happiness and prosperity of the State than the agricultural school, for what will avail any amount of economic prosperity in the absence of health ?
The medical school should not be content with the negative duty of caring for people when they are sick and of preparing physicians for the traditional career in curative medicine. It should have a positive program of public health and preventive medicine; that is, hygiene in its broadest sense. To this end the medical school should foster all forms of educational activity, both intramural and university extension which will produce doctors with ideals of public service and which will bring to the people a knowledge of the applications of science in combating disease and supporting human efficiency.
The medical school should administer all curricula based primarily on the medical sciences. These are the medical course, the dental course, the nursing course, medical social service, and the public health course.