Student Information Course Selection 2013-2014 April 26, 2013.
STUDENT SELECTION
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418 seems that there will be enough jobs to go round ; for, though we do not yet know what proportion of hospitals will be approved, the majority of newly qualified men and women already do at least one or two house-jobs as a matter of course. It may indeed prove hard to fill those posts which, for one reason or another, are con- sidered unsuitable. Here a more experienced and fully registered man could be appointed with advantage. More people spending more time in resident hospital work will do much to ease the situation where house- surgeons and house-physicians are at present hard to get. Moreover, it is expected that when similar legislation comes into force in Eire on Jan. 1, a number of new Irish graduates will be unable to find suitable jobs at home.3 Many of them will no doubt come to this country to obtain the experience required for full registration. 4 3. Ibid, 1952, i, 882. PRECLINICAL SUBJECTS: A WIDER APPROACH MANY deans believe that the education of a boy should be as wide and general as possible before he enters a medical school. This view has been accepted at most universities and by the headmasters of most schools, but circumstances have combined to hinder its practical application. The parents of the prospective medical student feel that if he studies science while he is at school, he will gain an advantage which may mean the saving of a year in the medical curriculum ; the students themselves feel that they must choose to be on the science side of the school if they are eventually to do medicine ; and the masters believe that a place is more likely to be given to a student who has shown ability in scientific subjects. Scholarships and county and other awards often encourage this move towards science at the earliest possible moment. The result has been that a large number of applicants for places in the medical schools have taken chemistry, physics, and biology in their matriculation or matriculation-exemption examination ; they have specialised in these subjects from then on, taking them in their higher school certificate to obtain exemption from the 1st M.B. Thus from the age of thirteen or so their interest and time have been largely devoted to chemistry, physics, and biology. Many students are keen on science and may develop into fir,t-class scientists, but this alone is an inadequate recommendation. There is, of course, a place for pure scientists in medicine, but the general practitioner needs a far wider interest in men and affairs than is usually found in the pure scientist. The student of medicine will he concerned with science for the rest of his life, and if ht- lias failed to acquire a knowledge and liking for other aspects of learning he will have suffered an irreparable loss. Many of the regulations for admission to medical schools and for the 1st M.B. examination positively discourage a broader outlook, and in an attempt to improve matters the University of London has devised a new plan for preclinical education. The new regulations aim at two things : to make it impossible to gain exemption from the 1st M.B. examina- tion at school : and to ensure a fuller integration of the preclinical courses. The regulations abolish the 1st and 2nd M.B. examinations and replace them by a preclinical examination. Thi-- preclinical examination will be divided into two parts—the urst to be taken one year after entering the medical school and the second eighteen mouths later. The original scheme was designed to include biology with elementary human anatomy, physics with elementary physiology, and chemistry with organic and elementary biochemistry : but the regulations published so far do not go into any great detail. They only say : " The papers will include questions- on elementary anatomy and physiology." and, for part 11. " The papers will include questions on the application of biology and physics to medical science." On these points at least. it’ seeing that no radical change will be involved. Rut manv of the London medical schools have decided to modify their preclinical programmes in the light of the new regulations, and in the Students’ Guide on other pages of this issue several deans refer to what is being done in this way. It will still be possible to enter some of the London medical schools under the old regulation... and therefore to gain exemption from the 1st M.B. and to pass straight on to anatomy and physiology with the saving of one year. At those schools which have adopted the new regulations, the passing of an examination which would formerly have given exemption from the 1st M.B. examination will not, of course, be a bar to entry, but it will save no time. The second. part of the preclinical examination differs from the old 2nd M.B. examination in certain important ways. Firstly, instead of a single examination in physio- logy and biochemistry, this examination has been divided into two parts ; and secondly, the pharmacology exami- nation has been allotted extra time, and unless the student attains a certain standard in pharmacology he is not referred in this subject but failed in the whole examination. In biochemistry too, a candidate may fail the whole examination or be referred at the discretion of the examiners. A full estimate of the new London regulations must be deferred until we have seen them in operation ; but it does seem, on paper at least, that the preclinical student may have his hands even fuller than before. Certainly his task is none the easier, as many would like to see it, for nothing has been omitted from the syllabus. On the other hand, he will enter the medical school after an education from which one of the main incentives to early specialisation has been removed. He will be encouraged to give more time to history, literature, and languages while at school-a diversion that will undoubtedly make him a happier and better doctor in the end. But less restriction to his school work may bring a more immediate benefit ; he may turn from his excursion into other subjects with a greater facility for grappling with the mass of scientific knowledge that will soon press upon him. 1. The Selection of University Students. By F. W. WARBURTON Manchester University Press. 1952. Pp. 46. 4s. 6d. STUDENT SELECTION THE number of students in our universities has just about doubled since before the war, and there seems little reason to expect a falling off in the next few years. The question of how best to choose from the tremendous number who apply for admission is as pressing as ever. and indeed Mr. F. W. Warburton, PH.D., who has just written a useful survey of the subject,1 points out that what may have been regarded at first as a temporary post-war problem must now be considered a permanent responsibility. From his examination of existing method!- of selection Warburton concludes that much more research is needed to measure the -efficiency of these methods. Higher school certificate results, headmaster ? reports, the information given in the application form. and the personal interview are commonly taken a8 reliable guides to the quality of an applicant ; but he would like to see more evidence of their value as judged by the subsequent performance of the undergraduate. He also suggests that " new methods such as mental tests and group interviews should be tried out on borderline candidates." On another page of this issue Dr. J. T. Aitken and Dr. M. L. Johnson describe their experiences in choosing medical students at University College, London. They found that an entrance examination (consisting cf intelligence tests and an essay) gave little indication of the performance of students in later examinations. They then decided to give three interviews to each candidate who survived the initial pruning (a difficult business in itself) : : two individual interviews to assess intelligent and personality respectively; and a group interview.
Transcript of STUDENT SELECTION
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seems that there will be enough jobs to go round ; for,though we do not yet know what proportion of hospitalswill be approved, the majority of newly qualified menand women already do at least one or two house-jobs asa matter of course. It may indeed prove hard to fillthose posts which, for one reason or another, are con-sidered unsuitable. Here a more experienced and fullyregistered man could be appointed with advantage.More people spending more time in resident hospitalwork will do much to ease the situation where house-
surgeons and house-physicians are at present hard to get.Moreover, it is expected that when similar legislationcomes into force in Eire on Jan. 1, a number of newIrish graduates will be unable to find suitable jobs athome.3 Many of them will no doubt come to this countryto obtain the experience required for full registration.
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3. Ibid, 1952, i, 882.
PRECLINICAL SUBJECTS: A WIDER APPROACH
MANY deans believe that the education of a boy shouldbe as wide and general as possible before he enters amedical school. This view has been accepted at mostuniversities and by the headmasters of most schools, butcircumstances have combined to hinder its practicalapplication. The parents of the prospective medicalstudent feel that if he studies science while he is atschool, he will gain an advantage which may mean thesaving of a year in the medical curriculum ; the studentsthemselves feel that they must choose to be on the scienceside of the school if they are eventually to do medicine ;and the masters believe that a place is more likely tobe given to a student who has shown ability in scientificsubjects. Scholarships and county and other awardsoften encourage this move towards science at the earliest
possible moment. The result has been that a largenumber of applicants for places in the medical schoolshave taken chemistry, physics, and biology in theirmatriculation or matriculation-exemption examination ;they have specialised in these subjects from then on,taking them in their higher school certificate to obtainexemption from the 1st M.B. Thus from the age ofthirteen or so their interest and time have been largelydevoted to chemistry, physics, and biology.Many students are keen on science and may develop
into fir,t-class scientists, but this alone is an inadequaterecommendation. There is, of course, a place for purescientists in medicine, but the general practitioner needsa far wider interest in men and affairs than is usuallyfound in the pure scientist. The student of medicine willhe concerned with science for the rest of his life, and ifht- lias failed to acquire a knowledge and liking for otheraspects of learning he will have suffered an irreparableloss. Many of the regulations for admission to medicalschools and for the 1st M.B. examination positivelydiscourage a broader outlook, and in an attempt to
improve matters the University of London has deviseda new plan for preclinical education.The new regulations aim at two things : to make it
impossible to gain exemption from the 1st M.B. examina-tion at school : and to ensure a fuller integration of thepreclinical courses. The regulations abolish the 1st and2nd M.B. examinations and replace them by a preclinicalexamination. Thi-- preclinical examination will be dividedinto two parts—the urst to be taken one year after
entering the medical school and the second eighteenmouths later. The original scheme was designed to includebiology with elementary human anatomy, physics withelementary physiology, and chemistry with organic andelementary biochemistry : but the regulations publishedso far do not go into any great detail. They only say :"
The papers will include questions- on elementaryanatomy and physiology." and, for part 11. " The paperswill include questions on the application of biology andphysics to medical science." On these points at least.it’ seeing that no radical change will be involved. Rut
manv of the London medical schools have decided to
modify their preclinical programmes in the light of thenew regulations, and in the Students’ Guide on other
pages of this issue several deans refer to what is beingdone in this way. It will still be possible to enter someof the London medical schools under the old regulation...and therefore to gain exemption from the 1st M.B. andto pass straight on to anatomy and physiology with thesaving of one year. At those schools which have adoptedthe new regulations, the passing of an examination whichwould formerly have given exemption from the 1st M.B.examination will not, of course, be a bar to entry, but itwill save no time.The second. part of the preclinical examination differs
from the old 2nd M.B. examination in certain importantways. Firstly, instead of a single examination in physio-logy and biochemistry, this examination has been dividedinto two parts ; and secondly, the pharmacology exami-nation has been allotted extra time, and unless thestudent attains a certain standard in pharmacology he isnot referred in this subject but failed in the wholeexamination. In biochemistry too, a candidate may failthe whole examination or be referred at the discretion ofthe examiners.A full estimate of the new London regulations must be
deferred until we have seen them in operation ; but itdoes seem, on paper at least, that the preclinical studentmay have his hands even fuller than before. Certainlyhis task is none the easier, as many would like to see it,for nothing has been omitted from the syllabus. On theother hand, he will enter the medical school after aneducation from which one of the main incentives to earlyspecialisation has been removed. He will be encouraged togive more time to history, literature, and languages whileat school-a diversion that will undoubtedly make him ahappier and better doctor in the end. But less restrictionto his school work may bring a more immediate benefit ;he may turn from his excursion into other subjects with agreater facility for grappling with the mass of scientificknowledge that will soon press upon him.
1. The Selection of University Students. By F. W. WARBURTONManchester University Press. 1952. Pp. 46. 4s. 6d.
STUDENT SELECTION
THE number of students in our universities has justabout doubled since before the war, and there seemslittle reason to expect a falling off in the next few years.The question of how best to choose from the tremendousnumber who apply for admission is as pressing as ever.and indeed Mr. F. W. Warburton, PH.D., who has justwritten a useful survey of the subject,1 points out thatwhat may have been regarded at first as a temporarypost-war problem must now be considered a permanentresponsibility. From his examination of existing method!-of selection Warburton concludes that much more
research is needed to measure the -efficiency of thesemethods. Higher school certificate results, headmaster ?reports, the information given in the application form.and the personal interview are commonly taken a8
reliable guides to the quality of an applicant ; but hewould like to see more evidence of their value as judgedby the subsequent performance of the undergraduate.He also suggests that " new methods such as mentaltests and group interviews should be tried out on
borderline candidates."On another page of this issue Dr. J. T. Aitken and
Dr. M. L. Johnson describe their experiences in choosingmedical students at University College, London. Theyfound that an entrance examination (consisting cf
intelligence tests and an essay) gave little indication of theperformance of students in later examinations. Theythen decided to give three interviews to each candidatewho survived the initial pruning (a difficult business initself) : : two individual interviews to assess intelligentand personality respectively; and a group interview.
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This routine has only been in use for the past two yearsso it is impossible to estimate its merits fully ; but,judged solely by the 2nd M.B. examination results, theinterviews did not give as good a prediction as assessmentsbased on the details given in the candidate’s applicationform 9r on the report of a referee. But this only meansthat the good examinees were chosen. The perennialquestion is : do they make the best doctors ? The groupinterview gives promise of a more comprehensive answer ;for it enables the assessors to see a candidate’s reactionto various situations in which his personality is as
important as his factual knowledge, and in which hisattitude to his contemporaries, as well as to his seniors,can be taken into account. The method clearly demandsmuch care and time from.the selectors, not only at eachinterview but, if its real value is to be known, through-out the subsequent career of every successful candidate.The group interview has received good testimonialsfrom those who have used it in other ways--e.g., in
selecting people for the Civil Service and for industrialjobs-and we should certainly get to know more about itsapplication to medicine.
1 Parnell. R. W. Lancet, 1951, i, 731. See also Conlerence of theHome Universities 1951: Report of Proceedings: p. 81.
TUBERCULOSIS IN STUDENTSParnell found that the two most important causes
of prolonged absence from work in students were mentalillness and tuberculosis. His results referred to studentsof all faculties ; and, while there is no reason to believethat mental disorders are more common in medicalthan in other students, it has been suggested that tuber-culosis is to some extent an occupational risk of medicalstudents. In this issue Dr. Batty Shaw describeshis study of tuberculosis in medical and dental students,but he was unable to find a group of non-medicalstudents in which the methods of detection used wouldhave allowed accurate comparison. He rightly pointsout that students belong to an age-group in whichtuberculosis is common. The amount of tuberculosisin such a group is largely attributable to age rather thanto any added risks of infection. However, the veryfact that students do belong to a susceptible age-groupis a sufficient reason for ensuring that adequate plansare made for the prevention and detection of the diseaseamong them-particularly among medical students,who run a greater risk of infection.Most medical schools now have schemes like the one
Batty Shaw describes at Guy’s Hospital : they shouldcertainly be universal. The precise details are unimpor-tant, but the arrangements should be under the direc-tion of a permanent member of the hospital staff who-i- in a position to see that all students are, in fact,examined at proper intervals. The essential featureis an X-ray examination of the chest on entry and atintervals of not more than one year. Tuberculin testingis a useful addition, for the vulnerable tuberculin-negativestudent may then receive e special attention-namely,!!:ure frequent X-ray examination and the offer ofB.C.G. inoculation. Any added risk of tuberculosis inmedical students may be explained, in part at least, bytlm high conversion-rate among the initially tuberculin-negative when they come into contact with tuberculouspeople. Other students are exposed more gradually, and forthem the period during which there is a risk of developingtuberculosis from a primary infection is much longer.
4,ivc-n efficient methods of prevention and detection,the medical student is in a privileged position : his risk"f coutracting tuberculosis may be fractionally greater,but should he do so the disease will be found at an early
, stage when it is amenable to treatment by modernmethods; and facilities for full investigation and treat-ment are immediately available to him. Most occupa-tions involve some hazard : it seems probable that a veryightly increased risk of tuberculosis is one of thehazards of the early stages of a medical career. This
calls for all reasonable preventive and control measures,but the risk involved must be kept in perspective.Rist (quoted by Batty Shaw) said that medical studentswho have had tuberculosis are undoubtedly betterdoctors for the experience. At all events, it is unlikelythat any of them would choose another profession ifthey had their time again.The British Student Tuberculosis Foundation was
formed last year to help students who are convalescingto pick up the threads of their studies before they arefit enough to return to full work. Dr. Nicolas Malleson,hon. secretary of the foundation, recently described itsaims and plans in our columns.2 Further information
may be had from the office of the foundation at 6, GordonSquare, London, W.C.I.
2. Ibid, July 12, 1952, p. 91.3. Hires, L. E., Kessler, D. L. Surg. Gynec. Obstet. 1952, 95, 123.
SINGLE CASE-REPORTSALTHOUGH the statisticians may grumble about the
reports of single cases that are regularly published, fewwould deny that these reports have often proved of
great value-in describing new diseases, for example,and in calling attention to important variations inestablished disease patterns. Nevertheless, there are
undoubtedly dangers in drawing clinical conclusions fromisolated cases, and, as Hines and Kessler have justpointed out, these pitfalls are not generally recognised.They give examples of what they call " the whimsy ofa single case-report " where authors make presumptuousclaims. One writer whom they quote says : "It is
suggested that scleroderma is truly another of thediseases of the collagen system " ; Hines and Kessler
gleefully comment " the term suggested ’ indicatesconservatism ! " Another declares : " A fatal case of
myocardial contusion exemplifying our concepts of themode of injury, pathology, diagnosis and treatment hasbeen presented " ; Hines and Kessler remark : " Indeeda modest conception !
" And again : " The necessityfor removing symptomless intrathoracic tumors is
emphasised by the fatal outcome of this case " ; Hinesand Kessler observe : "An emphatic appeal for moresurgery because one patient died ! " In another reportthey found this statement : " A case of proved lymph-o-blastoma is reported which had not responded to othertherapeutic measures and was progressing to its terminalphase, but with the use of cortone showed a dramaticimprovement in physical status, blood picture andgeneral well being " ; and their comment is: " Whena terminal phase is not terminal ! "These waspish thrusts, however, are made by impartial
and humble men. They too had a single case, in whichsensitivity to penicillin apparently " caused generalisedurticaria and probably an associated cerebral lesion "(angioneurotic oedema). A man of 56 had a generalisedclonic convulsion six days after an injection of penicillin.He had had hay-fever for years, and there had been anattack of giant urticaria after oral penicillin in the past.He quickly recovered from the fit, but three weeks laterurticaria developed, and neurological signs appearedsuggesting a lesion of the left temporal lobe. However,when he was brought before a clinical meeting as apossible example of " an urticarial lesion of the brain,"he was promptly recognised by a visiting doctor as amember of an epileptic family. The patient had, in fact,withheld a long history of previous fits. He declinedtreatment, but he was heard of again two years laterwhen he was taken to hospital after another fit. Hinesand Kessler conclude : " Perhaps we have presented acase of angioneurotic oedema of the brain complicatedby idiopathic epilepsy "-a commendable example ofthe reasonable and cautious conclusions that they wouldlike others to draw from single case-reports.
Sir WILSON JAMESON has been elected master of theSociety of Apothecaries of London.
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