Medical education in the later 19th century: the science take-over

Established in 1858, the General Medical Council was responsible, inter alia, for improving the standard of medical education in Britain. It was agreed on all hands that there were serious deficiencies: there was far too much book-learning and not enough practical knowledge; students graduated who were wholly ignorant of important areas of medicine; there were 19 licensing bodies and the criteria for admission to practise differed widely. Debate continued from 1860 to 1890. A major question was, What sort of education should the student have received before he entered medical school? There were four common answers: (1) he should have received the preliminary education of 'a well-educated gentleman'; (2) he should know a good deal about everything; (3) he should have a better knowledge of science--but how to define science?; (4) he should have done well at school, never mind what he had studied. A second major question was, How should science and practical instruction be combined in the medical curriculum? Many defended the old and not quite dead apprenticeship system; a practical 'sandwich course' was even suggested. The debate ended with the Report of the GMC's Education Committee in 1890, which increased the length of the medical course from 4 years to 5 and brought chemistry, physics and biology into the early years. The amount of clinical work, however, although it was supposed to increase, remained very small.