EDUCATION AND TRAINING I N CANCER CENTERS

SHERMAN M. MELLINKOFF, MD”

N THE EVOLUTION OF COLLEGES TO UNIVER- I sities in the Middle Ages, one can see the forerunner of a modern medical school’s dilemma. The curriculum at Padua, Paris, or Oxford was at first about the same for all stu- dents. Knowledge was so thin that almost any bright, assiduous scholar could master several fields. Thus, i t should not be surprising that even as late as the 16th century the great astronomer, Copernicus, was a physician. In the following century, John Locke, celebrated philosopher and political scientist, was also a licensed physician. By that time, however, the Renaissance was well developed, and it was no longer easy for one student to cover so many subjects.

By 1758, the situation was more complicated still, as reflected in Blackstone’s “Commen- taries,” in which that eminent legal scholar points out why various laymen (i.e., nonlaw- yers) should also study law:

For the gentlemen of the faculty of physics, I must frankly own that I see no special reason why they in particular should apply them- selves to the study of law, unless in common with other gentlemen and to complete the character of general and extensive knowledge: a character which their profession, beyond others, has remarkably deserved. They will give me leave, however, to suggest, and that not ludicrously, that it might frequently be of use to families upon sudden emergencies, if the physician were acquainted with the doctrine of last wills and testaments, at least so far as relates to the formal part of their execution.

Sir William’s acerbic perception that ap- parently disparate disciplines are, after all, relevant to each other, would be welcomed today by most medical curriculum commit- tees. What happened at Oxford in several centuries happened to medical biology in sev- eral decades. With new specialties appearing so swiftly, it is no wonder that medical faculties seem now in nearly constant turmoil over whose responsibility it is to teach what. There is a constant pulling of centrifugal and

* Professor of Medicine and Dean, UCLA School of Medicine, Los Angeles, Calif.

centripetal forces. Basic science departments emerge dealing with gross anatomy, histology, ultrastructure, physiology, pathology, bio- mathematics, biochemistry, genetics, embry- ology, microbiology, immunology, and phar- macology, but several are coalesced in some places under such rubrics as cellular biology.

There is a waxing and waning in the num- ber of departments in various surgical and medical specialties. Sometimes the addition of a new specialty, such as transplantation sur- gery, paradoxically brings previously diverg- ing branches closer together because new in- terests, such as tissue typing, become a com- mon concern.

I t is our view at UCLA that these move- ments should be neither cursed nor blessed but rather examined. We are wary of overly passionate labeling and of overly zealous mis- sionaries who generically profess to be either “lumpers” or “slitters.” As far as we know, it is not an immutable law of nature that on- cology must be taught in one department or in 10. What is important is that neither on- cology nor any other important subject be neglected because of arbitrary administrative boundaries, because of paralytic pessimism, because of aesthetic aversion, or because of the syndrome of two fielders watching a fly ball drop between them.

The concept of the “cancer center” seems to me ideally suited to coping with the prob- lem of centrifugal and centripetal forces for several reasons:

1. The “cancer center” does not require a separate “department” or “division” or any other entity which is likely to be legally defined in one rigid way or another by local institutions. Neither are these organizations excluded by the term “Cancer Center.” The name provides maximum adaptability and, therefore, maximum utility to any institution with a critical mass of scholars in this field.

2. A “cancer center” may reside in a single building or in many places, but it surely must reside in many minds. The problem of cancer is too complex to be contained in any single discipline, and the “Center” wisely provides for communication among different groups without attempting to impound them all in

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No. 4 EDUCATION IN CANCER CENTERS * Mellinkofl 83 1

a single unit. Thus, for example only, the fol- lowing groups at UCLA are concerned with various aspects of cancer: the Molecular Biol- ogy Institute, faculty in virtually all the De- partments of the School of Medicine, the Nurs- ing School, the Dental School, the UCLA Hospital and Clinics, and the UCLA Regional Medical Program and its connections with hospitals in an area with a population of over 5 million. All of these groups are represented on one or more of the following coordinating committees: Research Committee, Clinical Investigation Committee, and Committee on Practical Applications.

3. The “cancer center” concept can facilitate teaching at every relevant level and interface. This includes the education of all under- graduate medical students, smaller groups of medical students who take depth electives in subjects related to cancer, dental students, nursing students, house officers, and other graduate students in all clinical branches of medicine, physicians in practice as well as other allied health personnel concerned with cancer, young scientists engaged in research and, perhaps most important of all, the fac- ulty who learn from all these students as well as from one another.

4. The exact way in which the “cancer cen- ter” is adapted to some or all of these edu- cational responsibilities is of far less impor- tance than is the opportunity itself and the spirited desire to learn and to teach. It is precisely for this reason that the Cancer Cen- ter can be a great educational resource; it allows good teachers and students to com- municate with one another through an al- most unlimited number of mechanisms, but it enforces no particular mechanism. Thus, at UCLA, educational programs in this field could be facilitated by a Cancer Center in five different schools, in a dozen different de- partments, in interdepartmental electives, in the wards and in the clinics of several hos- pitals, through postgraduate education, and in research laboratories. I n other universities and schools, the situation may well be differ- ent. But the excitement of education thrives on differences.

The cancer center requires no uniforms nor standard haircuts. It is a happy triumph of intellectual ferment over bureaucratic anes- thesia. As one interested in medical education, I can only hope that what is happening in this field becomes contagious.