The concept and practicability of a core curriculum in basic medical education.

The core curriculum is defined as that which is common rather than essential. It is considered at different levels: institutional, national and global. As its size is inversely proportional to variability in healthcare needs, the core becomes smaller as the geographical unit becomes larger. A rationale for identifying the core is established at all three levels. The risk of stereotypy among curricula and dampening of innovation can be avoided if a significant part of the curriculum is elective, and if schools are free to determine how the core should be achieved. Focusing exclusively on the minimum discourages excellence. Many of the potential disadvantages of a core curriculum can be avoided if the core is combined with options. The core should emphasize higher-order cognitive and process skills and should be reviewed intermittently in the light of trends in healthcare and education. It should be developed in consultation with curriculum implementers using a competency-based approach. In developing international standards, societal relevance of the curriculum should not be sacrificed at the altar of standardization. The scientific bases of medicine, process skills and desirable practices in educating the basic doctor are fertile areas in which to look for international standards.