THE SOCIAL-CONTRACT CHALLENGE IN MEDICAL-EDUCATION

Medical education has been criticized for loss of touch with the healt h needs of society. A social contract implies that medical schools, th eir students and teaching staff have certain rights and privileges in return for serving society. Commitment to this important reciprocal re lationship makes it necessary to ensure that medical students gain und erstanding of the basic health needs of the communities they will serv e. Health, Illness and the Community (HIC) is a mandatory course in th e first and second years of the curriculum at the University of Toront o. Its goal is to provide students with community learning experiences by involving over 300 community agencies as learning sites. The cours e takes place one half-day per week throughout first and second year. All 177 students initially work with patients in their homes and in pu blic health units and related agencies. Students are then assigned to agencies using health determinants and health promotion strategies. In the second year, each student selects an agency in the community, and carries out for the entire year a major project focused on the intera ction of a health problem with a social issue. This educational initia tive has been received well by community agencies and patients. Teachi ng staff have been enthusiastic and students have performed very well. A major obstacle has been the negative attitudes of some students to community-based learning, but these appear to be improving with time. Involving multiple agencies as learning sites is a feasible method for enabling students to learn about community health needs.