Tuesday, May 13, 2008

The future of medical education, as seen in 1961: town v. gown

As I have previously mentioned, the archives recently received a collection of papers belonging to the pioneering Oregon neurologist Robert S. Dow, M.D., back in February of this year. Part of that collection is a series of bound volumes containing (apparently) all of the papers and presentations delivered by Dow during his career, from 1938 through the 1990s. It's a fascinating compilation of documents outlining the course of Dow's research efforts, as well as his interests in the broader field of medicine.

In 1961, Dow gave an invited talk on Medical education in the United States: past, present, and future, to the Sellwood Moreland Lions Club here in Portland. After a disparaging glance back at the spotty early years of American medical education, he moved on to a consideration of the challenges facing American medical schools. Even then, in 1961, Dow saw an impending physician manpower crisis, a need for schools to produce more physicians to care for an ever-growing, ever-aging, ever-prospering population. He noted that a nationwide increase in medical schools, from 76 in 1931 to 85 in 1959, was helping address the problem, but wondered "What further can be done locally in this respect, short of increasing federal and state taxes to enlarge the tax-supported institutions now primarily responsible for the training of physicians?" (I wonder what he would have thought, had he lived to see the steady and precipitous decrease in state financial support of the medical school at OHSU. I don't think he would have been at all surprised.)

His suggestion: "One action would be to strengthen and utilize to a greater degree private non-tax supported hospital facilities in certain centers. Some of our private hospitals in Portland are already rising to meet the demand for more educational opportunities for post-graduate medical education. I am proud of the progress that my hospital has made in the last few years and I speak now of Good Samaritan Hospital."

He continued: "I think these non-tax supported, privately endowed institutions should be encouraged by all who can do so to broaden their activities in this field. A great deal of teaching and research talent can be gleaned from the private physicians in this community who formerly donated many hours to the medical school and whose services are used less and less as the school continues to expand its 'full-time' salaried faculty."

This mid-century perspective on the town-gown tensions within the Portland medical community, from the viewpoint of "the town," serves as a nice compliment to the implicit assumption in many contemporary university documents that the educational establishment must be confined to sanctioned classrooms and/or clinical settings. Indeed, the ideal educational environment is most likely situated somewhere right between wholly private and wholly university-based settings, and many OHSU postgraduate programs seek to find the best of both worlds by mandating rotations through a variety of local healthcare settings, as well as the university hospitals and clinics.

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