BEYOND CLINICAL - 4-DIMENSIONAL MEDICAL-EDUCATION

Medical education is in crisis. Undergraduates experience an excessive burden of information, develop attitudes to learning that are based o n passive acquisition of knowledge than on curiosity and exploration, and suffer from progressive disenchantment with medicine(1). There is also a serious problem of providing adequate clinical experience far m edical students at existing teaching sites, largely because of reducti on in bed numbers, increased patient throughput and clinical specializ ation(2). This problem was identified over a decade ago in London(3) b ut has not been solved by the merger of medical schools. A recent surv ey in one London teaching hospital showed underemployment of students and limited patient contact(4). A review of clinical clerkships in an Australian medical school revealed that one-third of teachers were per ceived as unconcerned, discouraging, derogatory or hostile, and only o ne-half were rated as effective educators(5). One consequence has been the development of a wide-ranging debate on changing medical educatio n(6-9). Traditionalists have diminishing room for manoeuvre in defence of existing educational practices, as cautious bodies like the Genera l Medical Council (GMC) opt for fundamental reform(1).