427ANNOTATIONS

that the Commonwealth countries will be able to takean increasingly small proportion of doctors trainedin this country.

It is to Canada, then, that the young doctor looksmost hopefully (or with least discouragement, somemay say) when he cannot readily see the oppor-tunity he is seeking at home. And the news of thosewho have gone there from this country in the pastfew years is on the whole cheerful. A visitor justreturned says that those he met had settled downwell. The work is absorbing, hospital equipment isgood, and the chances of getting new capital for

necessary improvements or additions are better thanthey would be in this country. For a wife things maynot at first be easy : a new home with many unaccus-tomed features, little or no domestic help (not sucha striking change perhaps !), extremes of climate,and high housekeeping costs, may weigh more heavilyon her than her husband. An income that soundedwell on paper may during the early years proveinadequate to supply many of the things like refrigera-tors, dish-washers, television sets, and lakeside

cottages that Canadians have often come to regardnot as luxuries but essentials. These considera-tions will weigh more heavily with some familiesthan others; and many may judge that the oppor-tunities later on will make up for relatively humbleyears to begin with. It is certainly a very ill-advisedimmigrant doctor who expects to leap at once fromstriving insolvency at home to easy affluence inCanada. Canada does not offer that ; but she offersmuch to those prepared to work hard in a hard-working country.

Annotations

THE PREREGISTRATION YEAR

WHEN the Minister of Health spoke to the annualgeneral meeting of the British Medical Students’ Associa-tion last November he said that the time had come toconsider the results achieved by the regulations that cameinto force on Jan. 1, 1953, and provided for a year ofhouse appointments before full registration. And Mr.Macleod invited the association to give him its views.Accordingly, when information and opinions had beenrequested from all medical schools in Great Britain andNorthern Ireland, these were discussed by the executivecommittee of the association and the main points wereembodied in a memorial which was presented to theMinister.The results of the inquiry showed that the large

majority of medical students readily accept the pre-registration scheme ; but there were several criticisms.One was that some people have had real difficulty inobtaining preregistration appointments-a difficulty towhich we referred at this time last year.2 Few complaintswere received of unavoidable delay in getting a firstappointment, but second appointments were in generalless easily found ; it seemed that a considerable numberof doctors were taking two months or more to find asecond post. This, the B.1.S.A. suggested, could beavoided to a large extent if all medical schools were tofollow the progress of their graduates, to advise themwhen to begin to make applications, and to suggest suit-able posts. This advice could be based on cooperationwith local hospital boards, who could supply detailswhich would be helpful to graduates in making theirchoice of hospital. These details, together with the

1. Brit. med. Stud. J. 1955, 9, 4.2. Lancet, 1954, ii, 413.

advice of their dean, would perhaps enable graduates tomake a more confident approach to appointments innon-teaching hospitals. But, as the association points out,it is not always easy for a dean to keep close track of allhis students. Thus, one London dean said that he wasable to follow the progress of students who qualify withthe London M.B., but those who take Oxford or Cam-bridge degrees or the Conjoint diploma have to be signedup by their various registrars and easily lose touch withhim. He would prefer, he added, to sign up all hisgraduates for both their house jobs. He knew his gradu-ating students better than the registrar in, for example,either Oxford or Cambridge, and thus had a personalinterest in helping them.Most of the information that the association gathered

confirmed that approved posts provided the experienceintended by the Act. Teaching-hospital jobs may offerless responsibility, but many graduates considered thatthis was offset by the value of the teaching-indeed of theintrinsic value of a teaching-hospital testimonial. Butin some approved posts too much time was taken up byroutine administrative duties, and housemen were not ableto take full advantage of the clinical experience available.

In his reply to this clear and helpful document, theMinister pointed out that over the country as a wholethere were many more house jobs than people to fillthem. Wherever the Ministry had heard of graduatesbeing unable to find suitable posts, the regional hospitalboards had been notified. Mr. Macleod did not know of

any cases which had not been satisfactorily dealt with.It was important that applications for second postsshould be made well before the first post ended. TheMinister added that he was not aware of any proposalthat the length of the preregistration period be extended.

POSTGRADUATE STUDY FOR GENERAL

PRACTITIONERS

ONE of the conditions of membership of the College ofGeneral Practitioners is that a certain time be spentevery year on postgraduate study. As a result, many moregeneral practitioners are seeking opportunities for post-graduate training ; and there has been a big increase inthe variety of courses held, both in the teaching centresand elsewhere, during the past three years. The 24faculties of the College in the British Isles (includingSouthern Ireland) make it their duty to discover andstimulate the needs of members in this respect, and tomake contact with other members of the profession whocan help. Each faculty has its own postgraduate educa-tion committee, and cross-representation between thefaculty boards, the teaching staff of medical schools,committees of medical societies, and so on, is increasing,so that, by combining knowledge of the family doctor’seducational requirements and the ways they can be met,a suitable programme can be prepared for each region.The courses which have been most successful have beenthose designed with close cooperation between the Collegefaculties and the teaching bodies. New experimentalteaching methods are being developed. All courses inwhich the College has played a part have been open tonon-members. In London the hon. registrar of the

postgraduate education committee of the College councilenjoys the hospitality of the British Postgraduate MedicalFederation at their headquarters at 2, Gordon Square,ZT.C.l ; and here a record is kept of the doings of thefaculties, the medical schools, and societies all over thecountry.

This month a questionary has been sent to all membersof the College to discover their particular needs, whatplaces of study are within their reach, and what contribu-tion they can make to help their fellow practitioners inthis woik. Information is also being sought about theexperience and suggestions of members in the matter oftraining assistants and trainee practitioners.