Published: 30-06-2011, 06:45

Hospitals - American Education

In education, institutions not only for treating the sick and injured but also for medical research and the training and education of future physicians, surgeons and health practitioners. The hospital as an institution for research and instruction as well as for the delivery of medical services dates back to 1884, when WILLIAM HENRY WELCH, a professor of pathology and anatomy at the Bellevue Hospital Medical College in New York, was named professor of pathology at Johns Hopkins University. At the time, medical education consisted of one to three years of lectures and study at propriety medical schools organized and staffed by local practitioners.
Welch developed a new, four-year medical curriculum—the first in the United States—that consisted of laboratory study of preclinical subjects including anatomy, physiology, pharmacology and pathology, followed by two years of in-hospital study of the clinical subjects of medicine, surgery and obstetrics. To that end, Welch was instrumental in founding the Johns Hopkins Hospital in 1889 and the Medical School in 1893, where he served as the first dean. He linked the two institutions by recruiting such distinguished physician/researchers as Sir William Osler (1849–1919) and renowned surgeon William S. Halsted (1852–1922) to staff both institutions. He thus made the hospital’s first great physician/teachers central to the life of the medical school, but made the medical school’s laboratory and library facilities equally central to the research needs of the hospital and its physicians.
Welch strengthened those ties even more by creating an appointment system that made professors in the medical school serve as heads of their departments in the hospital, thus making them responsible for delivery of medical services as well as the organization of medical instruction. Their combined duties led to their integrating advanced medical education with practical hospital routine, as they led their students on daily rounds of hospital wards, translating student textbook and laboratory knowledge into actuality. As John Shaw Billings, the physician who had drawn up the plans for the hospital explained it, “The sooner [the student] can begin to profitably receive instruction by the bedside of the sick, or rather to instruct himself there, the better. Nothing can take the place of this; if it not be obtained afterward at the expense of the first patients who present themselves.”
The teaching standards and methods established at Johns Hopkins—and the four-year medical degree—made it a model for teaching hospitals that sprang up in major cities across the United States. By the end of World War II, with the emergence of new types of health services, the hospital’s role as an educational center had expanded to include instruction in nursing, rehabilitation, pharmacy, clinical psychology, public health work, hospital social work and hospital administration.