THE UNDERGRADUATE MEDICAL CURRICULUM - CENTRALIZED VERSUS DEPARTMENTALIZED

The authors describe the advantages and disadvantages of central gover nance of the undergraduate medical curriculum as contrasted with tradi tional departmental approaches, based upon their schools's experience with a new, centrally governed curriculum during the preceding four ye ars. Central governance has more advantages, but also more costs, comp ared with traditional departmental approaches. Central governance does what it was intended to do: it provides rational and integrative mech anisms for ensuring a broad general education in medicine focusing on the doctor-patient relationship. It also provides an effective mechani sm for dealing with ''turf'' and time issues in the curriculum while a llowing for and encouraging changes and providing mechanisms for evalu ating those changes. However, as the allocation of resources and rewar ds remains more departmentally than centrally based, a major challenge of central governance has been to help faculty resolve a ''conflict o f loyalty'' (the sense of serving two masters) between school and depa rtment, particularly in the evaluation and reward of teaching. On bala nce, central governance provides a powerful means of introducing broad -based reforms into all elements of the undergraduate medical curricul um, but it requires ongoing collaboration with faculty and chairs to a ssist them in negotiating competing pressures and priorities as they s trive to become excellent teachers.