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underwent either temporal lobe resections (76%) orfrontal lobe resections (23%); these are thecommonest operation sites in most centres, so theinformation provided by this series is very useful forgeneral clinicians. Patients undergoing temporal loberesection do better than those undergoing frontalresection and patients with a definite pathologicallesion do better than those with non-specific changesor no definite pathological abnormality.The overall conclusion of Rougier et al forms a

realistic basis for advice: if a beneficial result fromcortical resection for epilepsy is regarded as completefreedom from seizures, with no additional handicapcompared with the preoperative interictal state, thenthe chances of achieving this at 6 months, 1 year, 2

years, and 5 years after surgery are, respectively, 58 %,51%, 48%, and 56%. Consequently, such surgery isan effective treatment for over 50% of longlastingmedically intractable epilepsies.

1. Rougier A, Dartigues J-F, Commenges D, Claverie B, Loiseau P,Cohadon F. A longitudinal assessment of seizure outcome and overallbenefit from 100 corticectomies for epilepsy. J Neurol NeurosurgPsychiatry 1992; 55: 762-67.

2. Penfield W, Paine K. Results of surgical therapy for focal epilepticseizures. Can Med Assoc J 1955; 73: 515-30.

3. Engel J. Outcome with respect to epileptic seizures. In: Engel J, ed.Surgical treatment of the epilepsies. New York: Raven, 1987: 553-71.

4. Elwes RD, Dunn G, Binnie CD, Polkey CE. Outcome following resectivesurgery for temporal lobe epilepsy: a prospective follow-up study of 102consecutive cases. J Neurol Neurosurg Psychiatry 1991; 54: 949-52.

5. Van Buren JM. Complications of surgical procedures in the treatmentand diagnosis of epilepsy. In: Engel J, ed. Surgical treatment of theepilepsies. New York: Raven, 1987: 465-75.

6. Jensen I, Larsen JK. Mental aspects of temporal lobe epilepsy: follow-upof 74 patients after resection of a temporal lobe. J Neurol NeurosurgPsychiatry 1979; 42: 256-65.

7. Mace CJ, Trimble MR. Psychosis following temporal lobe surgery: areport of six cases. J Neurol Neurosurg Psychiatry 1991; 54: 639-44.

8. Guldvog B, Loyning Y, Hauglie Hanssen E, Flood S, Bjomaes H.Surgical versus medical treatment for epilepsy, I: outcome related tosurvival, seizures, and neurologic deficit. Epilepsia 1991; 32: 375-88.

9. Guldvog B, Loyning Y, Hauglie-Hanssen E, Flood S, Bjornaes H.Surgical versus medical treatment for epilepsy, II: outcome related tosocial areas. Epilepsia 1991; 32: 477-86.

Doctors to be: kingdom or exile?One end of the spectrum says that British medical

education, beginning in the dissecting room/laboratory and moving to the bedside, is a piece ofglory. This view is attested by the many thousands ofelective students who clamour each year for a slice ofthe experience, notably from the continent of Europecentred on overfull lecture rooms. At the other end is

rampant discontent: the General Medical Council’seducation committee wishes to reform an outmodedmedical student curriculum, and the preregistrationyear is a disaster. People will soon be glued to theirtelevision sets for weekly instahnents of the BBC seriesDoctors To Be. A group of St Mary’s Hospital MedicalSchool students was filmed from first interview for aplace to house officership 6 years later. The verdict islikely to be that it is not a royal progress. The bookaccompanying the series is reviewed on p 1023.Medical schools have been blessed with an army of

applicants: eager, gifted, moved by curiosity as well as

altruism. We cannot expect such bright coinage to stayuntarnished over 5 years of very hard work, but theideals of eventual service, from laboratory scholar tobedside apprentice, stay remarkably intact in theseries. The GMC has proposed three main lines ofreform to improve the curriculum: (a) fostering thespirit of inquiry rather than dull learning byautomatons; (b) reducing an overloaded timetabledictated by departmental interests; and (c) combiningbasic with clinical sciences throughout. Intellectualhunting rather than hoarding, a core-plus-optionscurriculum, and vertical integration of the course allsound splendid aims; putting them into practice isproving a big headache as schools come to grapplewith the challenge. What is core? How do you run stafffor options changing each year? It will take time.The real let-down comes with the preregistration

year. During it two of the ten individuals filmed doubtwhether they will go on as doctors. Disillusion is

general. The good intention was that the apprenticesshould come into their kingdom at last, ready to lookafter their own patients under close supervision.Instead, they find themselves skivvies of all hours, onwhose heads, shoulders, and sleep the whole complexdross of running frontline hospital medicine has beenallowed to settle. House officers are not work-shy:they are ground down by a round-the-clock dogsbodyexistence that makes a mockery of the previous 5years’ striving. For one of the subjects what was meantto be the culminating year of a university educationturned out to be comparable to the life of a Victorianchimney boy.There is little doubt that the preregistration year is

the wound crying out for immediate attention. ProfPeter Richards (also of St Mary’s) has led a deans’ callfor imaginative reform:1 shorten the medical studentsyllabus by 6 months, and extend the preregistrationperiod to 2 years. Each house officer post will then beshared by a first and second year doctor. The essentialmotives are educational: supervision of the less by themore experienced, proper teaching programmes, andalleviation of destructive hours. Difficulties rear up atonce, with funding as the most obvious. And how arethe GMC’s proposals, hard enough in themselves, tobe fitted into a shortened student curriculum?A national health service has to face up to the

problems made graphic here for every living room. Itsideals of service to others have so far persuaded sixthformers in droves that becoming a doctor is one of themost attractive callings. The best NHS traditions haveflourished on that base of talent and verve. Doctors tobe do not wish to give the lie to such aspirations, butmany will be in quiet sympathy with Oscar Wilde’s"Everyone is born a king, and most people die inexile". The universities, NHS, government, the

populace round the TV sets will have to do somethingto bring our new medical graduates home again.

1. Richards P. Educational improvement of the preregistration period ofgeneral clinical training. BMJ 1992; 304: 625-27.