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While we can welcome A Major Milestone (Under the Elms, March/April) in the form of a $100 million gift to the medical school, one can only hope that Brown will begin to prepare new doctors for the fact that, while were spending twice as much per capita as any other nation, the World Health Organization has ranked us No. 37 in the effectiveness of our health-care non-system.

In the meantime, medical education has, to a degree, been crippled by a standardized curriculum and the National Board examinations, which result in enormous debt, excessive pressure, and teaching to the test instead of helping kids become sensitive and question-asking doctors, something most apt to happen on the wards, i.e., on the job, rarely in lectures, and never during that put-em-on-the-spot-with-obscure-questions-coming-out-of-left-field maneuver so dear to the heart of senior doctors. Not to mention the fact that we havent the foggiest idea as to what any one medical student is going to need to know in the future, beyond some basic history-taking and physical-examination skills plus the ability to ask the right questions and access the information needed when we need to know it.

Thus, some of us have proposed that the entire field of medical science could, in medical school, be revealed in ninety days or less, after which the students could begin some integrated and meaningful learning (as a kind of an intern). As Harvard Dean Daniel Tosteson told U.S. News in 1993, Theres no way for young persons to acquire the knowledge necessary to practice effectively throughout their careers during a four-year stint at the beginning.

Robert E. Kay 53

Philadelphia

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