How long does it take for a degree in medicine

How long does it take for a degree in medicine

Medical Training: How long does it take to make a doctor?

The Georgians took 14 years, the Victorians were happy with 5, and the French Revolutionaries thought patients should decide. As an argument brews about the length of medical training, Vanessa Heggieexplains how we got our current system.

In 2013 an independent review of medical training, chaired by Prof. Dr David Greenaway, suggested that the length of post-graduate training could be reduced. Today the Royal College of Physicians and the British Medical Association have expressed concerns that this reduction might harm patient safety.

The existing core system of medical training in the UK is around a century and a half old; the medical undergraduate degree was made the main way for doctors to qualify in the late nineteenth century, and postgraduate education has been slowly added to the system through the twentieth century. If we go back further than that things start to get complicated. To become the most elite sort of doctor in the eighteenth century, a physician and Fellow of the Royal College of Physicians (RCP), you generally had to complete an MD at either Oxford or Cambridge. This included a masters in liberal arts, followed by a licence and a doctorate in medicine, which could take up to fourteen years to complete. Most of this time was spent learning Greek and Latin, studying ancient texts and classic works, quite a lot of philosophy and rhetoric, and extremely little in the way of natural sciences or practical medicine.

Other options were available: if you wanted a licence to practice, rather than to become a fully fledged ‘Fellow’ of the RCP, you could take your degree overseas, or at one of the Scottish universities, where courses were shorter (in the case of Aberdeen, almost non-existent as you could often buy your degree), and more likely to include practical training in pharmacy, botany and anatomy. Meanwhile, surgeons and apothecaries (people who made and dispensed drugs) usually trained through an apprenticeship, lasting five to eight years for surgeons, and around five for apothecaries.

What makes things complicated is that there were no national licensing systems: the Colleges of Physicians only controlled doctors working in and around the cities in which they were based, London, Edinburgh, etc. The best jobs were in these cities, but across the rest of the country doctors were more affected by the rules of local guilds of apothecaries; so doctors might do part of a university course, study overseas, do apprenticeships, and take a variety of educational pathways to practice. This changed in 1815 with the Apothecaries Act, which required everyone who wanted to dispense drugs to take a basic minimum of formal education (courses in chemistry, anatomy and botany), as well as a five year apprenticeship.

A North-South Divide in Education

This Act was supposed to coordinate and standardise apothecary practice; but the problem with it was that it applied to everyone, which meant that elite, Oxbridge educated members of the Royal Colleges were, in theory, supposed to train with an apothecary for five years before they were legally allowed to give drugs to their patients. These gentlemen did not think this was a fair requirement. As the president of the Royal College of Surgeons put it in 1833:

….the physician and surgeon of the highest possible attainments, are thus treated by the Apothecaries’ Society, like toads under a harrow

It wasn’t just elite doctors who were dissatisfied with training and licensing; by the early nineteenth century a middling sort of doctor had begun to appear – men who often practiced as surgeon-apothecaries with a licence from both organisations, who later became known as ‘general’ practitioners. They did not have Oxbridge degrees and most worked outside London, and their main concerns were the twin problems of corruption in the Royal Colleges, and unfairness in access to training and education. In particular there was a problem with surgical training, because in order to pass the Licence of the Royal Society of Surgeons, a doctor had to do 12 months training in a Londonhospital. Getting these apprenticeships took connections, and was expensive and difficult for provincial doctors.Advertisement

Campaigns that highlighted this unfairness, and increasing criticism of the Oxbridge degrees that contained almost no practical training at all, finally led to the 1858 Medical Act. This created a medical register (so to be a legal practitioner you had to be on the register), which you could only get on with a license from the Apothecaries Society, or one of the Royal Colleges of Physicians or Surgeons. It also began to standardise the medical education system. Instead of courses of lectures offered by private individuals, apothecary training colleges, and schools of anatomy, the medical curriculum began to be consolidated into a single, medical school-based, course of training. By the end of the century this was a five year degree, in most cases, with about two years of academic courses, and three of more practical on-the-job training.

Revolutionary Medicine.

Some of this new education was inspired by reforms in France: the Revolution had little time for ‘Royal’ colleges of medicine, and abolished medical licensing so that in theory anyone could practice as a doctor. Many revolutionaries said citizens should be completely free to choose their own healers, and it was tyranny for the government to try to control medical practice; for others the ideal society they were going to create would have no sickness and disease, so doctors and hospitals were not even necessary.

The reality was somewhat different, and in 1794 the chemist Antoine-François Fourcroy introduced a new medical education system. Book-based learning in Latin and Greek was dismissed as old fashioned and elitist, and instead he designed a new system that emphasised practical training, especially hospital-based experience. This proved very popular with students from outside France, as other Europeans and even Americans came to Paris to experience this new form of medical training.

Back in Britain, they made sure that the new medical degree included plenty of this sort of practical science and hospital experience. This meant that many medical schools had to affiliate or merge with universities and science colleges in order to get access to laboratories and lecturers in chemistry or physiology; they also had to create links to hospitals to provide practical training. This three-legged system is essentially what exists in British medical training today, with medical schools embedded in universities and associated with one or more local hospitals.

As the scientific and practical content of medical training increased, post-qualification education was introduced to extend and build on the original five-year degree. New Colleges of Medicine, societies and associations were formed to control this education and offer licences and diplomas in specialist subjects. Ophthalmology and Radiology had specialist societies by the 1890s, the British Paediatric Association formed in 1928, the British College of Obstetricians and Gynaecologists in 1929, an Association of Anaesthetists in 1932, and the General Practitioners finally got their Royal College in 1952.

Currently doctors in the UK may train for up to 16 years before qualifying. 5 years for their degree (or six if you intercalate and take a useful subject like, say, History of Medicine), 2 years for a post-graduate foundation course, and then 3 to 8 years in specialist training. The length might impress the Georgians, but the content wouldn’t – how many doctors now are able to quote Aristophanes in the original Greek? How standards have slipped