On the Second Reading of this Bill I think it would be well if I gave you a brief resume of the events which led to the decision to introduce it. The British Government set up in 1942 a committee known as the Goodenough Committee, to inquire into the organisation of medical education in Great Britain. That committee, which reported in 1944, recommended that in future medical graduates should be required to spend a year in residence in an approved hospital before they would be permitted to practise their profession independently. The General Medical Council in Great Britain adopted this recommendation and it was later accepted by the British Government. We in this country set up a committee in 1947 to report to the Minister for Health on any changes which were required in the curricula and organisation of medical education here. This committee in its report recommended that medical graduates in this country also should be required to undergo a period of practice in a hospital under the supervision of more experienced doctors prior to being fully registered on our Medical Register. This recommendation was in consonance with the views which the medical teaching bodies had already expressed regarding the desirability of a period of residence after qualification when the Goodenough Report was sent to them for their comments by the General Medical Council.
In 1949 the British Government suggested that there should be discussions between this country and Great Britain regarding the measures which would be necessary in order to continue the arrangements for reciprocal registration which have always existed. The Government were aware at the time of the general feeling among the teaching bodies and the medical profession that the existing arrangements should be continued, and agreed therefore to these discussions. A conference took place in December, 1949, at which it was agreed that reciprocity of registration between the two countries should continue. The complications which the introduction of the period of pre-registration hospital experience entailed made it necessary that legislation should be enacted in both countries, and the agreement reached at the conference provided that such legislation would be introduced. The British, in their Medical Act of 1950, carried out their side of the bargain; this Bill is designed to carry out ours.
The major change which the Bill introduces in medical training in this country is, of course, the requirement of a period of approved hospital training before full registration is granted to a medical graduate. While the length of the period has not been finally determined, it is likely that it will be one year. During this year the graduate will acquire experience in the practice of medicine, surgery and midwifery under the supervision of senior hospital medical officers. During the course of their hospital training the graduates, or interns as they are commonly called, will have the right to practise medicine, but only in so far as will be necessary to enable them to carry out their work in the hospital. They will not be allowed to undertake general practice outside the hospital.
This is the main change which this Bill makes. There is also provision in it to enable the Medical Registration Council to appoint visitors to attend the courses of instruction given by medical schools. The council has, under the Medical Practitioners Act, 1927, power to send inspectors to qualifying examinations to satisfy themselves that the standard of knowledge required at these examinations is adequate. Under this Bill the council will be in a better position to satisfy itself that the courses of instruction given in the medical school during the whole of the students' career are not in any way defective and, therefore, to make recommendations regarding the undergraduate medical courses.
The Medical Practitioners Act, 1927, provided for reciprocity of registration between this country and Great Britain. It was provided in that Act that any person who was registered in the British Register would by virtue of that fact be entitled to be registered on the Irish Register. It has always been doubtful whether or not that proviso extended to those practitioners who had become registered in the British Register by virtue of a reciprocal arrangement between Great Britain and a foreign country, and we are taking this opportunity of clearing up that doubt. In future, only those persons who are registered in the British Register by virtue of a qualification obtained in Great Britain will be entitled, by virtue of their British registration, to become registered in the Irish Register.
In the Dáil, some speakers were inclined to the view that medical education was becoming too expensive and too lengthy and thought that, with the introduction of the requirement of internship, there should be a compensating shortening of the course of study, if such were found possible. I have much sympathy with this point of view and intend to ask the Medical Registration Council to consider the suggestion and see if anything could be done to effect such a shortening without lowering standards. In any event, the lengthening by one year of the time which it will take to become a doctor will not add—to any extent at any rate—to the cost of training. It is expected that salaries will be paid by the hospitals to the graduates during the "intern period".
The Medical Registration Council has, for some time past, been considering the availability of accommodation in the hospitals for graduates wishing to do their intern period. It is estimated that about 300 students will graduate and become provisionally registered each year. This number can all be fitted in in voluntary and local authority hospitals in this country, if necessary though possibly with numbers greater than the optimum in some institutions for a few years until the hospital building programme bears fruit. It is likely, however, that a number of graduates will go to Britain for their internships and this will ease the problem here.
I am satisfied that the innovation introduced by this Bill will lead to an even higher standard of medical education than we have had in this country to date. The standards maintained by the medical profession in this country have always been high; the rapid extension of medical knowledge, however requires that we should not be content to rely on existing methods merely because in the past they have produced satisfactory results, and the introduction of this Bill shows that the medical profession and the medical schools in this country are aware of that fact and wish to ensure that our methods of education in this country are abreast of the latest developments elsewhere.
