RESPONSIVE MEDICAL PROFESSIONALISM - INTEGRATING EDUCATION, PRACTICE,AND COMMUNITY IN A MARKET-DRIVEN ERA

Revolutionary changes in the nature and form of medical practice insti tutions are likely to reverberate backward into medical education as l eaders of the new practice organizations demand that the educational m ission be responsive to their needs, and as these demands are increasi ngly backed by market power. In the face of this pressure, medical edu cation's traditional response-that it should have autonomy in defining its mission-is no longer viable. Instead, more explicit, formal, and systematic linkages between practice and educational institutions are inevitable. The crucial question is whether these linkages will reflec t the values of the market, oriented by economic self-interest, or the values of medical professionalism, oriented by the obligation tea sac rifice economic self-interest in the service of patients. The authors maintain that the realization of the normative ideal of professionalis m in medical education within the emerging market environment requires that a vision be articulated that is distinct from that of either aut onomy or the market, and that combined lay-professional institutions h e established to integrate-and perhaps merge-education and practice, a nd to foster responsiveness to lay values and community needs. The aut hors conclude by briefly describing examples of current efforts in thi s direction.