The education of medical students: sounds, alarums, and excursions

The core of good doctoring--what everyone must learn in medical school--is a set of behaviors that link the physician's professional, scholarly, and personal preparation with patients and society. Five general criticisms concern the academic medicine community. These criticisms concern the complexity of the health care system; the difficulty of integrating advances in science and technology into medicine; ethics; the doctor-patient relationship; and the importance of the individual student. Several medical schools use innovative curricula and organization in responding to these concerns, and other schools should study the assessments of these efforts and borrow anything useful. The problems of cost, access, and quality of care in the U.S. system are not primarily the fault of academic medicine and cannot be solved readily by it, but medical education can contribute to the solutions by preparing students to engage the problems.