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Previous Volume 355:1375-1376 September 28, 2006 Number 13 Next

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Providing the "right" physician for the health care of the future will require substantial changes in the way doctors are educated. This view was voiced in a report from the Institute of Medicine's Committee on the Roles of Academic Health Centers in the 21st Century¹: "Among all of the academic health center roles, education will require the greatest changes in the coming decade. We regard education as one of the primary mechanisms for initiating a cultural shift toward an emphasis on the needs of patients and populations and a focus on improving health, using the best of science and the best of caring." Although there exists a reasonable consensus on the need for change and considerable agreement regarding the main directions of change, there is much less understanding of the optimal mechanisms for moving the educational process forward. This lack of clarity is due, in part, to the complexity of the current health care environment and to a clinical learning environment in which education must compete for resources with clinical and research missions in academic health centers. Another important factor, however, may be that physicians are unaware of new and emerging information about medical education that could help provide a solid foundation for reform.

In this issue of the Journal, we begin a new series on medical education that we hope will promote introspection across the levels of medical education. The series will highlight some of the important issues and opportunities facing medical educators today and is designed to bring some of the current ferment in the field out from relative obscurity in education specialty journals and into the wider visibility of physicians generally. The articles that will appear during the coming months are meant to engage the general readership of the Journal in a dialogue on the state of the art of medical education today.

If the "tattered social contract between medicine and society is to be repaired,"² we believe it is incumbent on the profession to develop and field test new models of medical education. In this spirit, the Journal welcomes letters addressing the important and sometimes controversial issues to be raised in the forthcoming articles. The reform of medical education will surely benefit from broad-based debate.

In the long run, however, substantive reform will be possible only if there is a strong willingness to support the educational mission. Visionary leadership will be needed to change the prevailing culture, along with demonstration projects that include assessments of long-term outcomes, which are necessary to convince skeptics and policymakers alike. At the same time, serious reexamination of the financing of medical education³ and medical education research⁴ will be essential in order to set in motion and sustain reform. Only when we have solid educational research will we be able to convince an increasingly skeptical public that our graduates are equipped with "the best of science and the best of caring"¹ to improve the health of the public.

No potential conflict of interest relevant to this article was reported.

Source Information

From the Office of Academic Affiliations, Veterans Health Administration, Washington, DC (M.C.); Harvard Medical School, Boston (M.C.); and the Department of Medicine, University of California, San Francisco, and the Carnegie Foundation for the Advancement of Teaching, Stanford, CA (D.M.I.).

References

1. Institute of Medicine. Academic health centers: Leading change in the 21st century. Washington, DC: National Academy Press, 2003:116. 
2. Ludmerer KM. Time to heal: American medical education from the turn of the century to the era of managed care. New York: Oxford University Press, 1999:399.
3. Reinhardt UE. Academic medicine's financial accountability and responsibility. JAMA 2000;284:1136-1138. [Free Full Text]
4. Reed DA, Kern DE, Levine RB, Wright SM. Costs and funding for published medical education research. JAMA 2005;294:1052-1057. [Free Full Text]

PDF PDA Full Text Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article by Cooke, M.

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