William Osler - Assessment

Assessment

Perhaps Osler's greatest contribution to medicine was to insist that students learn from seeing and talking to patients and the establishment of the medical residency. This latter idea spread across the English-speaking world and remains in place today in most teaching hospitals. Through this system, doctors in training make up much of a hospital's medical staff. The success of his residency system depended, in large part, on its pyramidal structure with many interns, fewer assistant residents and a single chief resident, who originally occupied that position for years. While at Hopkins Osler established the full-time, sleep-in residency system whereby staff physicians lived in the Administration Building of the Hospital. As established, the residency was open-ended, and long tenure was the rule. Doctors spent as long as seven or eight years as residents, during which time they led a restricted, almost monastic life.

He liked to say, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." His best-known saying was "Listen to your patient, he is telling you the diagnosis," which emphasises the importance of taking a good history.

The contribution to medical education of which he was proudest was his idea of clinical clerkship – having third- and fourth-year students work with patients on the wards. He pioneered the practice of bedside teaching making rounds with a handful of students, demonstrating what one student referred to as his method of "incomparably thorough physical examination." Soon after arriving in Baltimore Osler insisted that his medical students attend at bedside early in their training: by their third year they were taking patient histories, performing physicals and doing lab tests examining secretions, blood and excreta.

He reduced the role of didactic lectures and once said he hoped his tombstone would say only, "He brought medical students into the wards for bedside teaching." He also said, "I desire no other epitaph … than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do." Osler fundamentally changed medical teaching in the North America, and this influence, helped by a few such as the Dutch internist Dr. P.K. Pel, spread to medical schools across the globe.

Osler was a prolific author and a great collector of books and other material relevant to the history of medicine. He willed his library to the Faculty of Medicine of McGill University where it now forms the nucleus of McGill University's Osler Library of the History of Medicine, which opened in 1929. The printed and extensively annotated catalogue of this donation is entitled "Bibliotheca Osleriana: a catalogue of books illustrating the history of medicine and science, collected, arranged and annotated by Sir William Osler, Bt. and bequeathed to McGill University". Osler was a strong supporter of libraries and served on the library committees at most of the universities at which he taught and was a member of the Board of Curators of the Bodleian Library in Oxford. He was instrumental in founding the Medical Library Association in North America and served as its second President from 1901–1904. In Britain he was the first (and only) President of the Medical Library Association of Great Britain and Ireland and also a President of the Bibliographical Society of London (1913).

Osler was a prolific author and public speaker and his public speaking and writing were both done in a clear, lucid style. His most famous work, 'The Principles and Practice of Medicine' quickly became a key text to students and clinicians alike. It continued to be published in many editions until 2001 and was translated into many languages. (See Osler Library Studies in the History of Medicine vol. 8.) It is notable in part for supporting the use of Bloodletting as recently as 1923. Though his own textbook was a major influence in medicine for many years, Osler described Avicenna as the 'author of the most famous medical textbook ever written.' He noted that Avicenna's Canon of Medicine remained 'a medical bible for a longer time than any other work. Osler's essays were important guides to physicians. The title of his most famous essay, Aequanimitas, espousing the importance of imperturbability, is the motto on the Osler family crest and is used on the Osler housestaff tie and scarf at Hopkins.