Take back medical education--the "primary care" shuffle

This editorial is based on an ethnographic case study of a six-year (1992-1998), $6 million project at Michigan State University and three surrounding communities. The project was called the Community/University Health Partnerships (C/UHP). Its overarching goal was to transform health profession education to create more community-oriented primary care practitioners. Community participation was a paramount goal in all areas of project life. Underwritten by the W. K. Kellogg Foundation, it was part of a larger $50 million effort in seven U.S. states. The C/UHP challenged biomedicine's orientation toward curative care, professional rivalry, specialization, and hospital-based medical education. Change was sought in areas such as primary care research, public health, social policy, and biopsychosocial service provision. This editorial highlights significant instances of hegemony and counterhegemony between the medical schools and the communities in the doomed project.