Editorials.

The last major review of medical education in Great Britain conducted by the Royal Commission’ makes no mention of gerontology as a relevant subject, and geriatric services are seen mainly as a development of general practice. It is remarkable therefore that less than 15 years after the publication of the Commission’s report a conference of teachers of geriatric medicine should be able to note’ that the subject is now taught in all but two clinical medical schools and that nearly half have autonomous or semi-autonomous academic departments. The need to devote greater attention to the medical care of the elderly has not been a matter of choice-an ageing population has made it imperative. But the pioneers of geriatric medicine, working in the main outside teaching centres, have rightly insisted that the ageing process deserves study in its own right, and this has led to a better understanding of the health needs of an increasing section of the population. The enthusiasm and commitment of the geriatricians have converted an irritating ‘bed blocker’ into a professional challenge as interesting and demanding as the unravelling of a complex biochemical abnormality or the management of an acute illness in a young adult. Their recognition that ageing is not just another disease has led to significant changes of attitude towards the nature of medical care, with as much emphasis on preventive as on curative medicine and a new spirit of cooperation with other health professions. The report of the conference contains interesting descriptions of the introduction of gerontology and geriatric medicine into the curricula of a variety of medical schools, but the main weight is given to more fundamental issues of medical education. Over-emphasis on formal teaching is recognized as a traditional fault in many undergraduate courses; concentrated teaching is shown to modify attitudes, but the fact that these changes are not sustained is seen as a clear endorsement of the importance of continuing education. Competition for curriculum time focusses on the need for an integrated teaching programme, with geriatricians’ contributions limited to certain aspects of the care of the elderly which call for their particular knowledge and experience. Despite a refreshing interest in educational processes the emphasis throughout the report is along the traditional line of what a student should be taught-policed by a formal examination-rather than on what the student wants to discover for himself; that few opt for an elective period in geriatric medicine evokes little comment. Ewan’s approach to the teaching of gerontology,’ described on page 132 of this issue, is wholly different; she starts with the need to create a desire to learn, by showing students positive examples of the effective care of the elderly and by involving them personally with elderly people as individuals rather than as patients with medical case histories. She stresses the need for students to come to terms with their