579

the patients with primary hyperparathyroidism. Pak

and his colleagues concluded that this modifiedcalcium-infusion test should be particularly useful inthe diagnosis of primary hyperparathyroidism in

patients who are normocalcxmic or slightly hyper-calcsemic. This conclusion was based on the fact thatthe plasma-calcium concentration was normal in 10 oftheir patients with primary hyperparathyroidism andonly slightly raised (less than 12 mg. per 100 ml.) in afurther 8 patients. However, as with all tests based onurine phosphate excretion, this modified calcium-infusion test requires metabolic facilities, and, in par-ticular, accurate collection of timed specimens of urine.(Timing difficulties have been partly obviated byexpressing the changes in urine phosphate excretionwith respect to creatinine.) This modified calcium-infusion test warrants further evaluation in the dia-gnosis of primary hyperparathyroidism, and especiallynormocalcaemic primary hyperparathyroidism.12

THE PREREGISTRATION YEAR" THE problems of the intern year have not been

solved. Does it need legislation ? Should the GeneralMedical Council be given powers to inspect pre-registration posts ? Are local measures needed ?"These are some of the questions Lord Cohen,president of the G.M.C., put to a conference organ-ised by the Council on March 2.The story of the preregistration year is an unhappy

one. In 1944, the Goodenough committee recom-mended compulsory periods in general medicine andgeneral surgery before full registration. " The house

officer", said the report,13 " needs time for thought,for further study, and for the personal investigationof the social and environmental conditions of the

patients with whom he comes into contact." Thenumber of beds in the care of the house-officer wastherefore to be small (not more than 30), and themedical school was to see to it that the appointmentwas suitable. These recommendations were in-

corporated in the Medical Act., 1950, but later it becameclear that many of the posts being approved bythe medical schools were unsuitable. In 1967, theGeneral Medical Council proposed five criteria for apreregistration post, and the Junior Hospital Doctors’Association has now done a survey to see how thejobs match up, five years later.14 The results are

based on answers to a questionary, to which the

response-rate was just over a third. The G.M.C.’srecommendation (a) was that posts should be ingeneral hospitals with adequate pathology and radio-logy departments, and a working library. The surveyshowed that in 13-24% of posts radiology and patho-logy services were inadequate at night and at weekends.Recommendation (b) was that the consultant in

charge of each post should have not less than foursessions a week in the hospital. This criterion wasnot met in 15% of the posts. Recommendation (c)was that each hospital department providing pre-

12. Wills, M. R. Lancet, 1971, i, 849.13. Report of the Interdepartmental Committee on Medical Schools.

H.M. Stationery Office, 1944.14. On Call, Feb. 28, 1972.

registration posts should have at least one non-

resident senior registrar or, failing that, one or moreresident registrars. 25% of the posts had neither.Recommendation (d) was that the houseman shouldnot normally look after more than 30 beds. 58% werelooking after more than this. And recommendation(e) was that the educational nature of the post shouldbe understood by all concerned; that each housemanshould have at least six hours a week for educational

purposes, apart from his free time; and that thereshould be an educational programme for holders ofpreregistration posts. 84% of the posts providedno time for education, and, where there was a pro-gramme, many were unable to attend. Dr. JonathanFisk, who was responsible for this survey, put thesefigures to the General Medical Council’s conference.Not one of the G.M.C.’s criteria was being fulfilled,he declared; why was the Council letting the matterrest ?

Speakers from the medical schools had suggestionsfor tightening up the approval of preregistrationposts. Prof. James Parkhouse wanted more controlover combinations of posts; a random selection didnot necessarily constitute adequate training. He alsothought it was time for some experiments: why not, hesuggested, try a two-year preregistration programmein one or two areas ? The first year could be abstractedfrom the undergraduate curriculum, and continuedsupervision would be possible right up to registration.Dr. M. I. A. Hunter thought it was no longer feasibleto aim for a given range of experience in the pre-registration year; responsibility was of equal or

greater importance. Also, the quality of the postdepended as much on the consultant as on the speci-alty (one speaker thought even more might dependon the senior registrar). Dr. J. E. Cates attested to thesuccess of regional postgraduate centres, and urgedextension of the postgraduate-tutor scheme to

teaching hospitals. He thought much could begained by making housemen more aware of the interestof the universities, and this might be achieved bydevising a more searching certificate of service, whichwould imply that the consultant had taken responsi-bility for teaching. Others spoke of the value ofmatching schemes for house-jobs (computer-run orotherwise), and Dr. J. Revans showed that, in oneregion at any rate, it had proved possible to put allthe G.M.C.’s recommendations into practice.What more should be done ? " Somebody must

be in the position, when things are really bad, tostep in. The G.M.C. should have reserve powers of

inspection and authority to withdraw recognition ofposts." This was the view of Dr. Frances Pigott,former president of the J.H.D.A. Mr. J. F. Martin,of the British Medical Students’ Association, alsowanted a terrier (with teeth) to chivvy the universi-ties into a more active stance. There seemed to be a

responsive gleam in Lord Cohen’s eye. " The G.M.C.has no power to see that its criteria are enforced", hehad said earlier. Now he asked, " Should the G.M.C.seek powers for supervision of the preregistrationyear similar to those it has for the undergraduateyears ?" And the conference gave him a resoundingYes.