The Non-University Teaching Hospital and Postgraduate Medical Education *

The evolution of postgraduate medical education has been a most interesting one. If one remembers that before 1900 it was quite possible for a person of average intelligence with a diligent attitude toward his work to encompass rather completely the known field of medicine and that since then increasing specialization has been necessary because of the rapidly broadening horizon of medicine, many of our present-day problems in postgraduate medical training are more understandable. Before 1900 only a small percentage of medical school graduates either felt the need of postgraduate training in the form of an internship or were forced by state law to serve an internship. Today, even though an internship still is not demanded in some states, practically 100 per cent of medical school graduates serve such a period of postgraduate training and some medical schools do not award the M.D. degree until the end of this period of training. World War I gave added impetus to specialization and since 1920 a constantly increasing number of residencies, superimposed upon the internship training period, have been necessary in order to provide men thoroughly trained in the specialties of general surgery and its subspecialties, internal medicine and its subspecialties, obstetrics and gynecology, pediatrics, neurology and psychiatry, etc. Before 1920 the great majority of interns were trained in university hospitals under the close supervision of the faculty of the medical school; since 1920 an increasing number have been trained in non-university hospitals where their supervision and training ranged from good to indifferent to poor, depending upon the quality and interest of the hospital staff. Before 1930 there were more medical school graduates annually than there were good internships available; but gradually (between 1930 and 1940) an even larger number of hospitals were approved for intern training (many of which in retrospect had inadequate staff and facilities for intern training) with the inevitable result that now we have approximately 5,600