The History of Medical Training

Written by john yargo
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The History of Medical Training
A doctor treating a patient. (Doctor image by Monika 3 Steps Ahead from Fotolia.com)

When a contemporary audience reads Geoffrey Chaucer's "The Physician's Tale," they will discover a unique vision of the medical field. In that story, written in the Medieval period, the physician is moralising and knows very little about the human body. Looking closer at how a Medieval physician was trained, we might get a better sense of the physician's perspective. Medical training has a long, complicated history, involving changing priorities and treatment philosophies in medicine.

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Ancient Greek and Roman Medicine

The most influential Greek medical theorist was Hippocrates (460-377 B.C.E.), who advocated rational explanations for physical ailments and theorised the relationship between symptoms and underlying illnesses. His examination of the human body yielded the realisation that some patients had an immunity or resistance to diseases, and he also founded the first medical school on the island of Greece. Today, physicians memorise the ethical pledge to treat patients that he wrote, known as the "Hippocratic Oath." The Roman physician Galen (129-199 C.E.) was one of the most important Roman writers on medicine, contributing analyses of the circulatory system and the methods of dissection. He also created a method of bloodletting, which was taught and implemented all the way through the 17th century.

Classical University Training and Surgeons

According to K.L. Smith, the Medieval university in Europe emulated ideas set forth in ancient Greek, Arab, and Latin medical textbooks. Smith suggests that the physician in Chaucer's tale is typical, as he looks for moral rather than bodily reasons for sickness. Most physicians were trained in ancient languages and moral philosophy and had social prestige but only a shaky understanding of internal medicine. Nancy G. Siraisi argues that surgeons, often employed on battlefields in the Middle Ages, made many of the gains in knowledge of internal medicine. Through their fieldwork, their diagnoses were less informed by ancient medicine and more by a considerable knowledge of the human body. From the 13th to the 18th centuries they earned more social respect and formed guilds.

Renaissance Training

Renaissance physicians drew from the work of Galen and Hippocrates, who both remained influential, but also contributed new work on human anatomy, biology, and pharmaceutical medicine. One of the most important contributors was the Dutch writer Andreas Vesalius (1514-1564), who served as the personal doctor to the Holy Roman Emperor Charles V and wrote "De Corporis Fabrica," an analysis of the human anatomy that revised the work of the ancients.

Medical Training through the 18th and 19th Centuries

Between the end of the Renaissance and the 20th century, medical training and general public health benefited from many scientific innovations. The English doctor Edward Jenner (1749-1823) created the first vaccine, against smallpox. The French chemist Louis Pasteur (1822-1895) developed an understanding of germ theory, which has been used to curb and prevent disease. As each of these discoveries was made and promoted, medical students implemented each of these methods, shifting scientific research and knowledge concerning the body and medicine to the forefront of medical training.

Training in the 20th Century

Dave Schuler explains that modern medical training was furthered by a study conducted by the Carnegie Foundation researcher Abraham Flexner. According to Schuler, Flexner's 1910 report pointed to three problems in medical training: the lack of medical school minimum requirements, the independence of medical schools from universities, and a lack of a standard structure of medical training. Since the release of that report, the number of medical schools and trainees has dropped, as standards have risen. According to Schuler, a bump in physicians occurred during the Kennedy and Johnson administrations but has only kept pace because of the importation of doctors from overseas, with a remarkable 23 per cent of American primary-care physicians trained in other countries.

Residency

Since the middle of the 20th century, residency has become a major component of medical training. General practitioners and specialists have been required to spend a period of one or two years in a supervised, dependent role. Most often a residency is three years long. During a residency, the resident or "intern" holds a degree from a medical school--an MD, a DO, or an MBBS--and gains increasing responsibilities as the residency proceeds.

Modern Specialization

Residency for specialists is longer, with some neurosurgeons taking seven years to complete their training. Sean Nicholson, of the University of Pennsylvania's Wharton School, claims that non-primary care physicians and specialists experience "entry barriers due to cartel behaviour by residency review committees, regulation that until recently required residents in all specialities to receive the same wage, and/or scarcity of teaching material." Nicholson remarks that there is a dearth of specialists, which allows specialists to charge high rates because of the rarity of their services.

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