Medical education: past, present and future

This article reviews changes in undergraduate and postgraduate medical education since the Flexner report of 1910. I argue that many of the changes in the twentieth century could be viewed as 'post-Flexnerian', and related to the integration of biomedical science in the preclinical medical curriculum. I then go on to argue that recent changes in the health care systems worldwide will force a critical re-examination of our approach to clinical education-a 'post-Oslerian' era. I suggest that one approach would be to decouple clinical education from clinical care, to some degree, and supplement with curricula designed around careful sequencing of simulated cases.