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Academic Medicine:
doi: 10.1097/ACM.0b013e3182084225
Letters to the Editor

Osler, Guilds, and Community

Fins, Joseph J. MD

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Chief, Division of Medical Ethics, professor of medicine, professor of public health, and professor of medicine in psychiatry, Weill Cornell Medical College, New York, New York; jjfins@med.cornell.edu.

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To the Editor:

I just read the article on the Osler Fellows at McGill by Steinert et al1 and thought it inspiring. Their ability to build a community of teacher/scholars around a select and substantive shared fellowship is a wonderful remedy for the alienation that many feel as the academy becomes more corporate. By returning to notions of guildlike fellowship, McGill's educational approach somehow right-sizes the educational dynamic and makes it personal by making it communal.

The close connection between communal life and the arts and trades is reaffirmed in the origins of the word company, or compagnia, as related in Iris Origo's2 classic The Merchant of Prato. In this depiction of daily life in a late Medieval/early Renaissance Tuscan town, Origo describes the origins of Tuscan companies “and the immense credit they came to enjoy”:

The compagnia was originally a small family partnership—between father and son, or several brothers—men who lived in the same house, who broke the same bread (as the word compagno implies), whose interests were identical…. Subsequently, these companies were extended to include members outside the family circle.

The images of early artisans and guildsmen breaking bread together, having common experiences, and sharing a common cause came to mind as I read about the McGill experience. I think Steinert and her colleagues rediscovered something quite important about how ordinary people are transformed into doctors and how that professionalism is nurtured over time. They remind us it is not a solo venture but one undertaken in community, not for isolated scholars but a journey best done in the company of fellow travelers. Simply put: There is something powerful and synergistic about working and collaborating, building relationships, and fostering a sense of shared mission and intergenerational obligation. Osler3 understood this and wrote of the necessity of a “fraternal attitude” in medical education, reminding us that:

You have all become brothers in a great society…. A fraternal attitude is not easy to cultivate—the chasm between the chair and the bench is difficult to bridge…. When a simple earnest spirit animates a college, there is no appreciable interval between the teacher and the taught—both are in the same class, the one a little more advanced than the other. So animated, the student feels that he has joined a family whose honour is his honour, whose welfare is his own, and whose interests should be his first consideration.

Joseph J. Fins, MD

Chief, Division of Medical Ethics, professor of medicine, professor of public health, and professor of medicine in psychiatry, Weill Cornell Medical College, New York, New York; jjfins@med.cornell.edu.

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References

1 Steinert Y, Boudreau JP, Boillat M, et al. The Osler Fellowship: An apprenticeship for medical educators. Acad Med. 2010;85:1242–1249. http://journals.lww.com/academicmedicine/Abstract/2010/07000/The_Osler_Fellowship__An_Apprenticeship_for.32.aspx. Accessed November 18, 2010.

2 Origo I. The Merchant of Prato. London, UK: Penguin Books; 1963.

3 Osler W. The Student Life and Other Essays. London, UK: Constable and Company, Limited; 1928.

© 2011 Association of American Medical Colleges

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