1. Themes
  2. A to Z

Medical Education

Medical education began in 1862 at the University of Melbourne with the arrival of the first professor of anatomy, physiology and pathology, George Britton Halford (1822-1910); the appointment of lecturers in chemistry and in materia medica; and the enrolment of three students. The medical school, the first in Australasia, owed its existence to the tireless promotional activities of Anthony Colling Brownless (1817-96), a stubborn, Scottish-trained medical doctor who, like so many of his colleagues, had migrated in search of better health. In 1857 he demanded a university-based, five-year medical course to correct a severe shortage of doctors, especially in the country, but the Victorian Government refused to support such extravagance, believing that the immigration of consumptive doctors was a much cheaper means of supplying the colony's needs. In 1861, when a few impatient doctors began lecturing in medicine at the government analytical laboratory behind the Public (State) Library, the University decided to establish a medical school without external assistance, despite much grumbling from other academic staff, who knew only too well where the money would come from.

Halford, an experimental physiologist and staunch opponent of Darwinism, was responsible for most of the 'pre-clinical' teaching for the next 20 years or so. He had arrived with some books and a few anatomical preparations, but it took him two years to acquire a microscope. The first lectures were delivered in a shed at the back of his house in Madeline (Swanston) Street, but soon the Victorian Government promised a modest grant for a building on the north-east corner of the University allotment, lamentably far from the (Royal) Melbourne Hospital. James Edward Neild, lecturer in forensic medicine from 1865 until 1904, described the new medical school as 'a poor, paltry, brick and stucco thing, without dignity, without grace'. The pattern of medical education in Melbourne was thus set remarkably early: a rigorous, lengthy course by contemporary standards; the dominance of the medical school by laboratory scientists; perpetually inadequate accommodation and equipment; and a university base, resented by other academic staff, with unsatisfactory relations to clinical teaching in the hospitals.

Despite such difficulties the medical school flourished in the late 1870s and the 1880s. The enrolments neared 200 (about half of all students at the University); the BS (Bachelor of Surgery) was added to the MB (Bachelor of Medicine) in 1879 to keep the surgeons happy; the medical students' society and magazine Speculum were founded; and women joined the men in 1887, with Halford's support and Brownless' disapproval. In 1882 Harry Brookes Allen, a Melbourne graduate, became professor of anatomy and pathology, thus reviving pre-clinical teaching and beginning a brilliant administrative career. The quality of clinical instruction also improved, with the appointment of excellent lecturers in medicine, surgery and obstetrics, even though most honorary staff at the hospitals remained, at best, indifferent to medical education. On the whole, Melbourne was sufficiently well established to withstand competition from new medical schools in Sydney (1882) and Adelaide (1884).

Not until the 1890s were medical students introduced systematically to laboratory work in physiology (including biochemistry) and pathology (including bacteriology). C.J. Martin, professor of physiology (1896-1903), began training his students in experimental method, and his successor W.A. Osborne, and others, continued to emphasise laboratory research, even though they found little time to do any themselves. Accommodation still was poor, and equipment scarce. By 1911 the division between the pre-clinical sciences and clinical clerking was fixed, and the basic structure of the course, stretched to six years in 1923, would remain intact until 1999.

The Medical School at Melbourne had begun to train outstanding scientists, including two Nobel Prize winners, 1920s graduates Frank Macfarlane Burnet and John Eccles. Its most serious defect was the persistent separation of university and hospital, with a consequent failure to develop academic clinical work. Apart from the appointment of a professor of obstetrics in 1929, clinical instruction continued to depend largely on the goodwill of hospital honoraries, many of whom were splendid teachers, some of whom were not. But after the Royal Melbourne Hospital moved to a Parkville site in the 1940s, and the later relocation of pre-clinical departments to the south-west corner of the University, one of the clinical schools was at last close to the medical faculty. Still, professors of medicine and in surgery were not appointed until 1955, more than 40 years after their positions were first proposed, and unusually late for any modern medical school. In the postwar years, clinical teaching was standardised, post-graduate diplomas proliferated, medical research expanded, and the demand for student places prompted the introduction of a quota.

In the late 1950s the need for a new medical school in Victoria became obvious. Initially, a proposal for a school at the Alfred Hospital, following the London example of hospital-based medical training, found favour. Instead, a new medical school opened at Monash University in 1961, led until 1976 by R.R. Andrew, formerly a senior physician from the Alfred Hospital. The new school derived largely from the Melbourne model, except that the 'para-clinical' sciences (pathology and microbiology) were located in the hospitals. Otherwise the similarities were uncanny: under-graduate entry; an emphasis on 'basic medical sciences'; the same division between pre-clinical and clinical teaching; and the separation (until the 1980s) of the university and the teaching hospitals. Andrew had begun organising the curriculum in a potting shed at Clayton, but unlike Halford, he had access to a lecture theatre from the start. A more significant difference was an early appointment in social and preventive medicine, but Andrew later regretted the deviation from basic sciences, having recognised 'the danger of graduating a charming and compassionate idiot who will become a costly iatrogenic menace'.

Many who graduated during this period will attest that inculcating charm and compassion was not a preoccupation at Melbourne or Monash, though students received a rigorous, if somewhat disconnected, training in biomedical science and clinical skills, a legacy of those who had sacrificed their research careers, and sometimes their private practices, in order to establish two great teaching schools. More recently, though, the scope of medical education has expanded. Since the 1970s some clinical training has been located in the community; students have received more teaching in public health; and more recently still, rural health, women's health, medical humanities, and indigenous health, rather tentatively, have entered the curriculum. Medical students are far less likely to be male scions of the Melbourne establishment: there are more women than ever before, more children of migrants, more international students. Having served Melbourne so well for so long, the medical schools are now learning to adjust to the medical needs of the rest of the world.

Warwick Anderson

Russell, K.F., The Melbourne Medical School, 1862-1962, Melbourne University Press, Melbourne, 1977. Details