Re: Medical education

Dr Ashley Krisman speaks with authority when he decries the transfer of medical and nursing education from the hospital bedside to the university and college classroom (BCMJ 2003;45[5]:210). He has experienced both systems and witnessed the transition when the Honourable Ralph Loffmark moved nursing to BCIT in the late 1960s and made it a division of the Department of Education.

Gone forever is the formidable sister tutor, with her starched collar and cuffs, her broad belt, almost as wide as a cummerbund, secured by a massive silver clasp resembling the portcullis of some medieval castle. Her charges were, by her flinty gaze, shielded from the soft words and seductive advances of the wily medical students. Flattery and artifice bounced off her like hail off the barrel of a cannon.

Do others not recall with pleasure the experience of seeing patients in small clinical groups? Perhaps a Dr Huggard, then recently retired as a Lt. Colonel in the RAMC, striding swiftly down the polished linoleum of Shaughnessy Hospital followed by his gaggle of white-jacketed students. As we passed the nursing station the surgical resident, Dr Hartley, looked up from his chart and said “Left, right, left, right, jump, jump, higher, higher.” A student was invited to examine an aged Second World War veteran, and did so in her usual competent manner. She was then asked whether or not there was fluid in the abdomen. Overawed, she hesitated to give an opinion whereupon I was ordered to examine the unfortunate gentleman. “Is there fluid in the abdomen?” demanded Dr Huggard.

“Yes.”

“How much?”

“Exactly 3325 mL,” I replied and added, “Sir.”

Huggard scowled and then grinned and said, “Good to have people around who know their own mind, even though they’re wrong.”

Does Dr Krisman not take pride in his skill as a teacher and in the regard in which he is held? Does he not feel an obligation to those by whom he himself was taught? Certainly they were not offered an honorarium, not even a paltry one. Perhaps Dr Krisman was influenced in his formative years by the Oxford cleric in Chaucer’s Canterbury Tales. “And gladly wolde he learn and gladly teach.” However “Ful threadbare was overeste courtepy” [The thread upon his overcoat was bare].

It has been my experience that the finest teachers have been consistently the hardest working and most successful members of the profession. To offer significant remuneration for their time would prove hugely expensive to the university. To offer a trivial sum, after maximum taxation, would be insulting.

Sir William Osler wrote, “We must all be students, learning and unlearning until life’s end.”

Must all professional activity be seen in materialistic terms?

—H.E. Woolley, MD
Vancouver