
                       HAMILTON'S HUMANITARIAN HEALTH

                            By SUZANNE MORRISON
                             Hamilton Spectator

     HAMILTON - When Dr. Eric Hoskins took his medical skills to war-
     torn Iraq in March it was the sort of thing you'd expect from a
     graduate of McMaster University's medical school.

     The humanitarian concern demonstrated by the public health
     specialist as a member of a Gulf peace team is the essence of what
     the internationally renowed McMaster tries to teach.

     Good health, according to the school's philosophy, depends on much
     more than just freedom from disease.

     It also requires warmth, shelter, good food, education, a
     supportive environment and strong social networks.

     ``McMaster was one of the first toeholds that was by made by those
     who see academic medicine as having a different kind of
     responsibility - not just to study the individual and curative
     approach to disease but also to look at the whole sweep of public
     health issues,'' says Dr. Stuart MacLeod, dean of the faculty of
     health sciences.

     The ``crown jewel of medical education'' is how a top international
     health official once described McMaster's program for training
     doctors.

     The philosophy has become famous and is being copied by medical
     schools around the world. Doctors from Chile, Indonesia, Uganda,
     Kenya, Malawi and Angola are all currently consulting McMaster
     about how to revise their programs at home.

     Harvard has already adopted McMaster's ideas while in Canada the
     model is guiding a revision of the medical curriculum at the
     University of Toronto, which has the largest medical school in
     North America.

     ``McMaster has certainly had an influence internationally on
     medical education,'' says Dr. Kenneth Shumak, chairman of the U of
     T's curriculum review task force.

     ``The founding fathers had some vision and were ahead of their
     time. Credit has to be given where credit is due.''

     The ``McMaster approach'' is distinct not only for what it teaches,
     but also for the way in which the teaching is done.

     For applicants, there are no premedical course requirements and
     high academic achievement is considered less essential than
     appropriate personal qualities and work experience.

     At 25 years of age, students are slightly older than the Canadian
     average and come from a variety of backgrounds. They include
     engineers, housewives, nurses and ministers. This year, there are
     74 women among the 101 first-year students.

     As for their training, students begin seeing patients almost from
     the moment they walk into the 33-month program.

     Strong emphasis is placed on problem-solving to develop lifelong
     learning skills. Working in small groups, students learn how to
     teach themselves and each other, and to tap the resources they need
     - books, faculty members, teaching aids and lab reports.

     There are few lectures and, unique for Canada, no exams.

     By contrast, the traditional model for medical education features
     first-year lectures on very basic science - biochemistry, anatomy,
     physiology - followed by pathology and pharmacology in the second
     year. By the third year, students try to apply basic science and in
     their fourth they deal with patients and work on wards.

     At McMaster, all these things are learned simultaneously.

     Although off the mark on timing, Abraham Flexner, a progessive
     medical educator in the U.S., predicted almost 80 years ago that a
     change in medical education was imminent.

     Rather than concentrating so much on developing miracle cures for
     disease, medical schools would increase their recognition of the
     social and preventive side of health, he said in a 1910 report.

     When it came to the founding of McMaster's medical school in 1969,
     Flexner was finally proved right.

     Addressing the whole range of social problems - everything from
     poverty to environmental issues - will ultimately translate into
     better health, says Dr. MacLeod.

     As health experts in Canada weigh choices for the future of an
     increasingly costly and heavily burdened health care system, there
     is increasing agreement that McMaster is right.

     But is a McMaster-trained doctor different?

     Right from the start, it seems that they are. Take the example of
     Dr. Hoskins, who took not only medicine to Iraq but worked to raise
     Canadian awareness about the horror and tragedy of the Gulf war.

     Dr. MacLeod, the McMaster dean, tries to duck credit for Dr.
     Hoskins' actions.

     ``One would like to argue that he was influenced by his education
     but the fact is that Dr. Hoskins is a Rhodes scholar who went on
     from McMaster to study international health,'' says MacLeod.

     ``It's who students were before they came to us rather than
     anything special we do to them.''

     But there's also no denying that the McMaster philosophy draws and
     encourages students who believe likewise.

     ``We do tend to attract applicants who have a high level of
     awareness of the responsibility of the health professions,'' says
     Dr. MacLeod.

     A recent survey showed that once McMaster graduates enter medical
     practice they tend to see only 85 per cent of the number of
     patients as their contemporaries from other medical schools,
     although they work the same number of hours.

     ``Obviously, they are spending 15 per cent more time with each
     individual patient,'' says MacLeod.

     McMaster's medical students also appear to maintain their
     enthusiasm for medicine and are probably much more flexible about
     implementing new approaches to health care than traditionally
     trained doctors, says Dr. William Spaulding, one of the medical
     school's founding fathers.
