• medical education
• medical school

British medical students enter medical school at the age of 18 and qualify 5 or 6 years later at the age of about 24. By that time they have spent their whole adult life—and, indeed, a quarter of their entire life—in one educational establishment. So all-encompassing, so involving, so potentially overwhelming is a medical school that sociologists such as Erving Goffman might classify them with other “total institutions” such as prisons, asylums, monasteries, and barracks where daily life is regimented, where the social world primarily revolves around the institution and its members, and whose ultimate goal is a plan structured as much for the ultimate benefit of society as for the needs of the inmates.

If educational environments really matter, then medical schools should be the ideal place for spotting an effect. So what demonstrable effect is there? Five years at 300 working days a year, eight hours a day (and never mind the nights), is more than the notional 10 000 hours which are said to be necessary to become an expert in a skill. Indeed, there are 2000 hours left over to become pretty skilled in a host of other activities such as playing rugby, drama, music, or any other avocation.

Anecdotes abound about the experience of medical school, and a useful anthology is “My medical school” edited by the doctor-poet Dannie Abse.¹ In his introduction, Abse comments …