THE SIMILARITY AND FREQUENCY OF PROPOSALS TO REFORM US MEDICAL-EDUCATION - CONSTANT CONCERNS

Objectives.-To identify the values and agendas underlying reports advo cating the reform of medical education and to account for their simila rity and repeated promulgation. Data Sources.-Major reports regarding undergraduate medical education reform published between 1910 and 1993 were identified through a manual bibliographic search. Study Selectio n.-Nineteen of a total of 24 reports met the two inclusion criteria: t hey directly addressed undergraduate medical education and contained a coherent body of recommendations. Data Extraction.-Content analysis o f 19 reports. Data Synthesis.-All the reports articulate a specificall y social vision of the medical profession, in which medical schools ar e seen as serving society. The reports are remarkably consistent regar ding the objectives of reform and the specific reforms proposed. Core objectives of reform include the following. (1) to better serve the pu blic interest, (2) to address physician workforce needs, (3) to cope w ith burgeoning medical knowledge, and (4) to increase the emphasis on generalism. Proposed reforms have tended to suggest changes in manner of teaching, content of teaching, faculty development, and organizatio nal factors. Reforms such as increasing generalist training, increasin g ambulatory care exposure, providing social science courses, teaching lifelong and self-learning skills, rewarding teaching, clarifying the school mission, and centralizing curriculum control have appeared alm ost continuously since 1910. Conclusion.-The similarity of the reports ' objectives and reforms results not only from a similar body of probl ems, but also from the reaffirmation of similar values. The reports ha ve two implicit agendas that transcend the reform of medical education : the affirmation of the social nature of the medical profession and s elf-regulation of the profession. These agendas help account for the r eports' similarity and their repeated promulgation.