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).