Time to heal medical education?

In Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care, Kenneth Ludmerer presents a penetrating narrative and analytic account of the daunting economic, organizational, social, and value problems facing medical education that are threatening its excellence and its sense of purpose. The new conditions have the potential not only to seriously undermine the scientific and clinical quality and vibrancy of the education that medical students and housestaff receive, but also to subvert the development of core elements of a "Samaritan" concern for the care, the suffering, and the well-being of patients and of dedication to the public good. American medical schools have a long tradition of trying to improve medical education through periodic curriculum reforms. Since the famous and influential Flexner report in 1910, at least 24 other major reports advocating such reform have been issued, and they have been strikingly similar in their prescriptions. The resulting modifications have, however, been "reform without change" because of medical educators' failure to address the basic social, organizational, and financial problems with which medical schools have been progressively confronted. Ludmerer considers that today's problems, however formidable they may be, are not as profound as those that faced medical educators a century ago--and that there is time and opportunity for visionaries and leaders to act. This may be true but only if they can properly diagnose the present problems of medical education, amply understand their roots, identify effective means to remedy them, and galvanize medical educators to make the systemic, institutional changes, locally and nationally, that are called for.