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HEALTH AND WELFARE SERVICES, 1965THE Minister of Health’s annual review 1 shows that

his department has been hard at work, and that progresshas not been confined to negotiating a settlement of thepay-structure for doctors and dentists. Of especial interestis the setting-up of an informal group to help the Ministerin planning the long-term future of the health and welfareservices.

HOSPITAL SERVICES

At the end of 1965 there were 469,763 hospital beds-2276fewer than in 1964. But the average length of stay fell, so thatthe number of inpatients rose by 2%, to 4,818,233. For thefirst time there was a significant rise (18%) in the number ofday-patients (from 19,748 to 23,398). These patients-most ofthem attending the psychiatric, geriatric, and chronic-sickdepartments-undergo a planned course of treatment, as

though they were inpatients, but they are able to go home eachnight. Despite the more intensive use of resources, the waiting-lists rose in all specialties.

Hospital admissions for psychiatric patients totalled 171,000,of which 89,000 were first admissions. At the end of 1965,93%of the psychiatric-hospital population of 190,000 were beingtreated as informal patients.

NURSES AND MIDWIVES

The Ministry’s campaign to recruit more nurses seems to bepaying off, for between September, 1964, and September, 1965,1. Annual Report of the Ministry of Health for the Year 1965. Cmnd

3039. H.M. Stationery Office, 1966. Pp. 188. 19s.

the number of whole-time nursing staff rose by 3-9;0, and ofpart-time staff by 9-4%. The introduction of the new grade ofsenior enrolled nurse was at first slow to attract recruits, but bythe end of September over 2000 appointments had been made,and a further 2167 posts have been designated. By contrast, thenumber of domiciliary midwives fell slightly; but this fall waslimited to part-time midwives and was counteracted by a rise inthe number of whole-time staff, so that the whole-time equiva-lent remained at 1964’s figure of 5298. There were slightlyfewer domiciliary confinements in 1965: this was due partly toa decline in the number of births (the first for some years) butmainly to the spread of hospital confinement with early dis-charge. 11 % of mothers were discharged within 3 days ofdelivery, compared with 9%, in 1964.

SCREENING FOR CERVICAL CANCER

A few years ago there seemed little hope of establishing anation-wide screening service for detecting cervical cancer, andthe striking progress made in the past year is therefore veryencouraging. Virtually all areas of England and Wales have aservice for patients with symptoms, and screening projects forsymptom-free women have now been started in most parts ofBritain. Between December, 1964, and December, 1965, therate of testing throughout the country rose from 39,000 a monthto nearly 64,000. During this time the number of pathologiststrained in cervical cytology rose from 200 to 280, and the num-ber of technicians from 150 to 382. A further 30 pathologistsand 140 technicians were in training. By the end of 1966screening should be available to well over half the womenat risk.

The Student SpeaksDIRECTOR OF

UNDERGRADUATE EDUCATION

R. F. HELLERMEDICAL STUDENT,

CHARING CROSS HOSPITAL MEDICAL SCHOOL, LONDON W.C.2

WHILE at school, one works to a set pattern and routinelaid down in every detail by the teachers. On leavingschool the medical student starts the preclinical coursewhere this system of working continues. A specificsyllabus is provided-the student works from week toweek and from term to term learning the topics specifiedby the anatomy, physiology, and biochemistry teachers.The student passes the 2nd M.B. exam., has a very short

holiday, and immediately is expected to start a new wayof learning. He has to learn for himself. No longer isthere the threat of next week’s anatomy viva, but thevague idea that in a few years he must have picked upenough knowledge to pass a final exam. His learningis not directed. He follows a chosen consultant round the

wards, into the outpatient department, and into the

operating-theatre. When the consultant has the time

(for he must also have ward rounds, outpatients, andtheatre in various other hospitals) he teaches. The con-sultant may teach well or badly-because at no time hashe been taught how to teach. Often he does not teach to aset pattern, but rather what he happens to think of at thetime. Between sessions with the consultant, the studentattends lectures. Often these are not associated eitherwith what the consultant is teaching or with what theother lecturers are saying.

So, from the ordered (if less enjoyable) world of schooland the dissecting-room, the student finds himself in aclinical world which is a good deal less well ordered. At nostage in his career has he been taught how to learn for him-self. His teachers have not been taught how to teach. There

does not appear to be an integrated scheme to directboth the student’s learning and the teacher’s teaching.

Perhaps this description is an exaggeration of the

situation, but this is how it appears to many medicalstudents. Even in an education system such as this, onemust emphasise that medical students do learn medicineand the standard of doctors produced in this country isgenerally thought to be high. However, because the

system already produces good doctors, it does not meanthat one cannot and should not make suggestions to

improve it. The suggestion I would like to make is thateach medical school should appoint a Director of Educa-tion. This is not a new idea-such men organise thepostgraduate education of doctors in many Americanuniversities.The Director of Education would be a doctor of

consultant status. He would be head of a department-his department being that of education. He could keepsome clinical responsibility, but would be a full-timemember of the staff of the one hospital. His job would beto direct the teaching of medicine to the students. Thiswould mean the most drastic step of all-that each head ofdepartment surrender his sovereignty so far as teaching isconcerned: he would have to teach along the lines suggest-ed by the Director of Education. The Director would bechairman of a curriculum committee composed of headsof department and student representatives. He would beresponsible to the dean of the medical school and to thegoverning body of the medical school. The Directorwould not usurp the position of the dean; he would beable to do what the dean cannot possibly have time to do.The two men would work in close conjunction.

In what way would a Director of Education be able tocorrect the faults discussed earlier ? Firstly, the appoint-ment would recognise the fact that medical education isnot just something to be done in the spare time of busydoctors. In which other university discipline does thissort of thing happen ? Obviously, a hardworking con-