Undergraduate medical education towards health for all: progress, pitfalls, perspectives

I discuss aspects of undergraduate medical education related to primary health care and analyse innovative programmes, with emphasis on problem-based methods and community-based education. Assessing the impact of these programmes shows problem-based learning is an interesting didactic exercise but not a necessary or sufficient condition for the adequacy of programmes to the Health for All (HFA) policy. Community-based education is pressed by several obstacles inside and outside educational institutions that put at risk its effectiveness as a real agent of change. Amongst these obstacles are political difficulties in building linkages amongst teaching institutions, services, and community; logistical problems in facilitating faculty and student work in the community; reactions from faculties; poor research opportunities in primary health care; pressures for more socially, professionally, and economically rewarding careers; biases in training the present generation of teachers; attempts to fulfill the social, behavioral, epidemiological, and preventive knowledge requirements for medical education by adding to an already overloaded information base; and shortage of relevant and significant sources of information for the medical students. Building corporations representing 'innovative' programmes, on one side, and 'conservative', 'traditional' ones, on the other, is not helpful and probably false. Each programme should be assessed in its strength and weaknesses in the light of political decisions committed to change in unequal, poor-quality health systems.