Defining a generalist education: an idea whose time is still coming

Generalist education is different from the traditional medical curriculum as it has developed over the past 40 years. For example, in their training doctors must develop the appropriate skills, knowledge, and attitudes to understand patients' specific expectations, address wellness rather than illness only, be familiar with concepts of clinical epidemiology, concentrate on interpersonal communication, and strive to control costs. The University of Illinois College of Medicine at Rockford was established to provide community-based medical education. Beginning in their second year, all Rockford students have extensive clinical training in one of three community health centers operated by the Department of Family and Community Medicine. Several kinds of evaluation have been conducted to assess the reaction to and impact of this clinical training on the students and faculty, and follow-up studies have tracked the students after graduation. The Rockford experience has shown that the entire curriculum must give uncompromising support for generalist education, all primary care faculty must have a common knowledge base in the theory and practice of generalist medicine, and the shift to generalist education will require shifts in attitude and behavior throughout the academic medicine community at the institution.