Becoming a Physician: Medical Education in Great Britain, France, Germany, and the United States. - book reviews

USA Today (Society for the Advancement of Education), Jan, 1997 by Francesco Cordasco

Not since the 1925 pioneering work of Abraham Flexner, Medical Education: A Comparative Study, has a book as ambitious as Thomas Neville Bonner's Becoming a Physician appeared. Much more comprehensive than Flexner's book (and infinitely more detailed), Bonner's volume is an encyclopedic history of Western medical education.

In a series of interrelated chapters (each of which may stand as an individual entity), Bonner deals with medical education in the late 18th century and the changing patterns of medical study; the lives of medical students and their teachers in the late 18th and early 19th centuries; the development of new goals in medical education; the clinic and laboratory in the mid 19th century; the spread of laboratory teaching and the continued struggle for the evolving laboratory curriculum to the end of the 19th century; the development of a university standard in medical education; the changing student populations in medicine in the late 19th and early 20th centuries; and the emerging stability and new challenges in medical education to the mid 20th century.

It is a remarkable historical tableau, and Bonner presents the evolving and eclectic patterns with extraordinary detail as he skillfully weaves together the British, French, German, and American experiences. He candidly admits that, as much as change has occurred, much still remains the same. In a disquieting "Closing Word," Bonner observes: "Despite all the changes in undergraduate medical education ... especially in its Gore of scientific training, it had actually shifted only slightly by the end of the 20th century; if a student from an earlier era sat down in the classrooms and clinics of the 1990's, he or she would still find much that was familiar in the teaching methods, conduct of clinics, bedside training, laboratory instructions, and the educational preparation of fellow students."

As to pressing contemporary concerns to "humanize" physicians in an increasingly technological age, Bonner equally complains about the lack of student experience in dealing with normal patients, the estrangement of the hospital and medical school, the fear that medical training has become too specialized, and students learning too much of the science of medicine and too little of its art.