The reform of medical education: an outsider's reflections.

After reviewing some of the major structural changes that have altered American medical education over the last 80 years, the author depicts the recent climate that has fostered a number of proposals for educational reform to better prepare physicians for the next century. He lists the five major types of reform that have been suggested (for example, the integration of basic sciences and clinical knowledge) and then reflects on each type, asking questions about implementation such as: Who will accomplish the reform? How will it be carried out? What and where are the financial, knowledge, and other resources that will be needed? What must be overcome to accomplish the reform? He then discusses the forms of instruction that should accompany the proposed reforms in educational content (such as decreasing lectures and increasing small-group discussions). He observes that there is often a serious conflict between the need to provide students some free hours and departments' perceptions of the time needed to educate students properly. He closes with a review of some aspects of reform that have been neglected or minimized, such as the length of time and the costs that medical students must face to complete their education, and the economics of educational innovations.