Medical Education at St. Bartholomew's Hospital, 1123-1995 (review)

Medical Education at St Bartholomew's Hospital traces the evolution of medical education at the hospital from its foundation in 1123 to the college's merger with the London Hospital and Queen Mary and Westfield College in 1995. Traditionally regarded as a conservative institution, resistant to change, St Bartholomew's in this account was surprisingly often a pioneering institution, particularly in regard to curriculum change and the introduction of science into medical teaching. The story that Keir Waddington tells is not one of steady or heroic progress, but of periodic episodes of discontinuity punctuating longer periods of continuity.

Waddington's story is based on an exhaustive review of the hospital's archives and a thorough examination of published primary and secondary sources. The major theme is the institutional evolution of the school, from the earliest years when students were permitted to walk the wards in the hospital, through the creation of a formal hospital-based medical school, and finally to the creation of a scientific medical school affiliated with the University of London. Other important themes include the evolution of the curriculum, the introduction of scientific subjects into the teaching, and the creation of a research culture among the faculty.

To readers familiar with medical education from the American perspective, numerous differences in British medical education, seen through the prism of St Bartholomew's, are immediately present. Chief among these are the tradition since medieval times of students walking the wards, the hospital-based nature of the medical school in the eighteenth and nineteenth centuries, and the relatively slow introduction of scientific teaching into the curriculum and development of a research ethos among the faculty in the late nineteenth and twentieth centuries. Indeed, in the twentieth century, the Johns Hopkins Medical School became the model for St Bartholomew's, and an influential report by Abraham Flexner on British medical education helped encourage medical educators at St Bartholomew's to follow a more scientific model of medical education, much as Flexner's celebrated critique of American medical education did in the United States.

Of course, medical education has many generic similarities across countries and cultures. Issues of the proper basis of premedical education, the nature of the curriculum, the proper role of the scientific subjects and their relation to clinical instruction, and the importance of research to the medical school, so familiar to students of American medical education, are apparent in the history of St Bartholomew's as well. So are many other familiar tensions in medical education, such as turf battles among departments, town-gown feuds, and the strained relationship between the medical school and the university, to name just a few.

The strength of this book is its exhaustive review of sources and its equally exhaustive tracing of the institutional and administrative evolution of the school. However, this strength is also a weakness: the narrative is written in such detail that I found the reading slow and tedious. In addition, broader themes pertinent to medical education—its relationship to the university, to medical practice, to the health-care delivery system, and to the cultural and social context—are largely absent from the story. As a result, the book is dry and bloodless, lacking a pulse and a flow. Lastly, the focus is entirely on undergraduate medical education; the story of postgraduate and specialty education is not told here.

Medical Education at St Bartholomew's Hospital is a highly detailed account of the evolution of undergraduate medical education at this historic institution. Readers interested in the subject will find it a useful and authoritative reference.