The "health of the public" approach to medical education

The author examines the growing discontinuity between medical education and the general health needs of society. He explains and illustrates this failure of the academic medical center in several ways: by a parable; by reporting the results of his informal survey of faculty and residents; by presenting the findings of an international conference on medical education; and by giving a detailed description of the design and impact of the "Health of the Public" program, launched by the Pew Charitable Trusts and the Rockefeller Foundation in 1986. He maintains that there is an imbalance in the training of physicians and other health professionals because academic medical centers are dominated by supply-side thinking--which is driven by new knowledge and technology and the resulting need to find patients to fit the interests and technical capabilities of specialists and the equipment and services of hospitals--and have under-emphasized demand-side thinking, which concerns the patient and the health expectations, needs, and trends in the community. The author maintains that academic medical centers can continue to achieve the recognition they seek, but can do so by making the changes needed to better balance the driving forces of supply and demand. Only by doing this will they fulfill their fundamental mission of fostering the health of the public.