Becoming a doctor
Certificate (possibly a copy) awarding Samuel Argall the degree of Doctor of Medicine, 1649
How do you become a doctor? Some aspects of medical training have remained remarkably constant across the world and over time. Globally, most governments have attempted to license medical practitioners - so that only those who have had a proper, complete and approved medical training can call themselves a doctor. Professional bodies try to maintain standards and professional codes of conduct.
China: government involvement in medicine
In China medical training was well organised by the time of the Chou dynasty (1122-255 BCE). Students were examined on medical theory and practical clinical knowledge, including acupuncture. The state recognised different grades of doctors, specialists and surgeons.
Government support for doctors in the Islamic empireWithin the Islamic empire, between the 800s and 1300s, there were three main ways to become a doctor. Many hospitals had schools attached to them, with lecture rooms, libraries and pharmacies. Students would attend lectures and visit patients with their teachers. Private medical schools were run by well-known practitioners, such as Al-Razi and Al-Zahrawi, who wrote manuals for their students which later became standard reference books. A student could also become apprenticed to a doctor, and learn directly from him. Women generally treated other women, and were trained privately. Practitioners were well respected, with support from government, and many kept their fees low so that any good student could join them. There were also folk healers working outside the established system.
Medical knowledge in religious ordersFrom the late 1000s through to the 1200s, individuals such as Constantine the African at Salerno and Gerard of Cremona in Spain translated Arabic texts and Arabic editions of Greek medical works into Latin. These translations formed the basis for university training in Europe until the Renaissance. Throughout medieval Europe medical knowledge was mostly found within religious orders, with monks and nuns providing much medical care for the general population, especially in rural areas. Monks and nuns would generally be trained within their communities. Formal study of medicine at university was still very limited. Based on Greek and Islamic classics of medicine and literature, it was divorced from the practical hands-on work of surgeons, pharmacists and other healers.
The increase of science in medicine
In the 1700s medical training changed dramatically in Europe. Medicine and surgery learned from each other and the medical curriculum began to include science, practical training and hospital reform. By the late 1800s attempts to make medical degrees more scientific and broader in scope affected students. The cost of this specialised medical education made it difficult for anyone who was not from a middle-class or wealthy background to learn medicine. In America and Britain evening schools of medicine had allowed working students to study part time, but these now began to disappear.
Prejudice in medicine
After the Civil War, freed African-Americans had established segregated schools of medicine, but found it difficult to survive in an era of escalating costs and rising standards of accreditation. Influenced by Abraham Flexner’s investigations, medical training was dramatically reorganised in America and Europe in the early 1900s. But discrimination continued against African-American and female students well into the 1900s.
Related Themes and Topics
BibliographyT N Bonner, Becoming a Physician: Medical Education in Britain, France, Germany, and the United States (New York/Oxford: Oxford University Press, 1995)
W F Bynum & R Porter (eds), Companion Encyclopedia of the History of Medicine (London: Routledge, 1993)
K Calman, Medical Education Past, Present and Future: Handing on Learning (London: Churchill Livingstone, 2006)
A Digby, Making a Medical Living : Doctors and Patients in the English Market for Medicine, 1720-1911 (Cambridge: Cambridge University Press, 1994)
G E R Lloyd (ed.), Hippocratic Writings (London: Penguin Books 1978)
L McCray Beier, Sufferers and Healers. The Experience of Illness in Seventeenth-Century England (London: Routledge & K Paul, 1987)
P E Pormann, E Savage-Smith, Medieval Islamic Medicine (Edinburgh: Edinburgh University Press, 2007)
R Porter, The Greatest Benefit to Mankind (London: Harper Collins 1997)