TIME TO RETURN MEDICAL-SCHOOLS TO THEIR PRIMARY PURPOSE - EDUCATION

The author maintains that the quality of medical education has been dr opping for the last few decades as medical schools become less and les s focused on their primary purpose of training physicians. Until the y ears immediately following World War II, the administration of the med ical school was carried out by a small staff headed by a dean whose ro le was to provide leadership in educational matters. Academic departme nts managed the educational program, and the faculty were expected to be teachers and to participate in educational planning, preparation of teaching materials, advising of students, assessment of students' per formances, admission, and all other tasks associated with having a tea ching position. Today, the administration of a typical school includes any number of assistants to the dean and a wide variety of other staf f dealing not only with educational functions but with grant managemen t, public relations, fund-raising, personnel policy budgeting, and an enormous and complex parallel structure designed to manage clinical pr actice and to respond to market pressures, The role of faculty has als o changed greatly; faculty are expected to be researchers and clinicia ns first, and teaching is usually shortchanged. The author explains wh y he believes these changes have come about; for example, the strong f ederal support of research after World War II, which encouraged a grow ing dependence of medical schools on research grants and consequently raised in importance those faculty who could obtain such grants. He co ncludes with commonsense proposals for reform (such as having the educ ation of medical students in the hands of a small number of faculty wh ose prime responsibility is teaching), but admits that there are funda mental barriers to such reforms, especially vested interests and resis tance to change. In the end, change will come only when those in power recognize that medical schools must be returned to their primary role of training physicians.