The years around 1830, as just described, were a turning point in the movement to create a more systematic and uniform approach to the training of doctors. For the next quarter-century, a battle royal raged in the transatlantic countries between those seeking to create a common standard of medical training for all practitioners and those who defended the many-tiered systems of preparing healers that prevailed in most of them. At stake were such important issues as the care of the rural populations, largely unserved by university-trained physicians, the ever larger role claimed for science and academic study in educating doctors, the place of organized medical groups in decision making about professional training, and the role to be played by government in setting standards of medical education. In Great Britain, the conflict over change centered on the efforts of reformers, mainly liberal Whigs, apothecary-surgeons, and Scottish teachers and practitioners, to gain a larger measure of recognition for the rights of general practitioners to ply their trade freely throughout the nation. Ranged against them were the royal colleges, the traditional universities, and other defenders of the status quo. Particularly sensitive in Britain was the entrenched power of the royal colleges of medicine and surgery— “the most conservative bodies in the medical world,” S. W. F. Holloway called them—which continued to defend the importance of a liberal, gentlemanly education for medicine, as well as their right to approve the qualifications for practice of all other practitioners except apothecaries. Members of the Royal College of Physicians of London, the most elite of all the British medical bodies, were divided by class into a small number of fellows, almost all graduates of Oxford and Cambridge, and a larger number of licentiates, who, though permitted to practice, took no part in serious policy discussions and could not even use such college facilities as the library or the museum. “The Fellows,” claimed a petition signed by forty-nine London physicians in 1833, “have usurped all the corporate power, offices, privileges, and emoluments attached to the College.”
Considering Research Outcomes as Essential Tools for Medical Education Decision Making