Læknablaðið - 01.12.1963, Page 57

LÆKNABLAÐIÐ
177
icine or surgery has been re-
placed by a whole army of
superspecialists.
By reason of tliis, tbose wbo
would seek a broad training
have difficulty in finding any
single liospital service in which
a wide spectrum of disease can
be seen and tbey must tliere-
fore adopt some system of rota-
tion through a whole series of
specialist units.
Now let us turn to the next,
the intermediate stage in the
training of our young doctor.
Bv now lie has determined his
career. In the United Kingdom
it is the period during which
he prepares himself for one of
the higher diplomata which
signify, not the completion of
his training as a specialist, but
the acquirement of a sufficiency
of basic knowledge in greater
deptli to justify him specializ-
ing. This is a point whicli is
sometimes ill-understood out-
side the United Ivingdom. For-
merly this training usually was
achieved by working as an as-
sistant in a liospital. The com-
petent student working in as-
sociation with an understand-
ing and wise mentor in a unit
with a sufficiently broad spec-
trum of clinical material and by
private reading and study, was
usuallv able to obtain his higher
diploma at tlie end of a period
of two to three years. Tliis ap-
prenticeship method is becom-
ing more difficult, partly as I
have already indicated, by the
effects of specialization and
partly hy the increasing empha-
sis which is placed upon further
studies in the hasic sciences, to
a degree which cannot readily
be achieved in a clinical unit.
For the student less favourably
placed and for those who come
to, the United Ivingdom from
other countries it is necessary
for an integrated programme of
studies to be arranged, and I
believe this may well become
soon the universal pattern for
even tlie best students from our
own universities.
Such a programme should be
broad in concept. There must
be continuing clinical experi-
ence in the broader specialist
fields of general medicine, sur-
gery or gynaecologv and oppor-
tunity for further studies in the
basic sciences and paraclinical
subjects and an introduction to
research methods.
In the past we have been in-
clined to regard as the only
people who would seek this
further training those who were
entering clinical or laboratory
specialities, but we must re-
cognise the general practice to-
day as a full speciality so tliat
suitahle provision must also he
made at this intermediate stage
for the general practitioners of
the future.
The final and most advanced