June 1998

Medical Education in Finland and the UK. Symposium held at the Finnish Institute in February 1998

Entente medicale

By Peter Richards

"The Surgical Art", wrote Christian Tilnaus, Professor of Surgery in Amsterdam in 1840, "is within measurable distance of being perfect". Nice thought, surgeons always were inclined to be optimistic. Alas, the art and science of medicine and education for the profession still have a long way to go 160 years later. At least the educational deficiencies are becoming openly recognised (and not only by our patients) with the result that a great deal of rethinking is going on around the world. As President Kekkonen once said when accused of changing his mind: "since when has it been wrong to learn from experience?"

Britain, its Empire and Commonwealth have traditionally had a strongly practical and personal patient-based mould of medical education which has stood the test of time. Times, however, are changing. North America developed medical education along similar lines but with somewhat more scientific emphasis: in the USA Medicine is a postgraduate course of study. While successful practitioners played a large part in Britain, medical education in continental Europe was dominated by distant and dictatorial professors, who made the professionally hierarchical British system look positively friendly and informal by comparison. Professors overburdened students with theory, while practitioners had a much closer eye on what doctors needed to know and be able to do, even if they also overburdened them. Time for reflection was at a premium. Further north in Europe, especially in the Netherlands and Nordic countries, the pattern of medical education is a mix of the Anglo-Saxon, American and European – and none the worse for that.

Many Finnish doctors have pursued part of their postgraduate medical education in the USA, Britain or the Continent, largely in research posts but with the opportunity to develop specialist skills. Few medical students went abroad for a serious part of their medical education and even fewer foreign students came to Finland for part of their course, not least because of language. Then came the European Union. Medical degrees became interchangeable, admittedly by political dictat rather than by demonstration of equivalent knowledge and skill. Perhaps, however, that great European, Sir Ralf Dahrendorf, was being a bit hard when he referred to the "harmonisation" of medical training through "identical pre-clinical and clinical hours (but not curriculum) throughout the community" as an "approach … as characteristic of European bureaucracy as it was contrary to the best interests of Europe".

In the belief that harmonisation may be better achieved bottom up than top down and conscious of the value of starting the process with like-minded colleagues, because both sickness and medical practice have large cultural components, a small group of British and Finnish medical academics and students met to discuss how we might work together.

Recommendations were framed for future action. Perhaps the most exciting outcome was the realisation that no one had attempted to measure whether the university medical degree/licensing examination was in fact equivalent in practice across frontiers in Europe. Although it is difficult to know precisely at what point equivalent knowledge, skills and attitudes can be expected, if that point could be identified might it be feasible to test British and Finnish students simultaneously with a joint panel of examiners? The experiment could become a milestone in the harmonisation of professional standards in the EU.

The symposium was also supported by the British Council in Helsinki.

A copy of the Report of the meeting can be obtained from Dr Peter Pritchard at Peter_Pritchard@MSN.com. Peter Richards is Emeritus Professor of Medicine in the University of London. He is currently Medical Director of Northwick Park & St Mark’s Hospitals, London, and in October 1998 will become President of Hughes Hall, Cambridge.

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