Developing a social contract between the medical school and the community

Medical schools are under considerable pressure to reform their conventional curricula. Problem-based and community-oriented instruction are the predominant choices of change. The focus on the community as a teaching resource has occurred partly in order to make medical education relevant to community health needs, and partly in an attempt to replace the declining teaching opportunities available in specialized tertiary care hospitals. This paper offers a theoretical perspective on community-oriented initiatives by examining how one such initiative has been developed in an attempt to establish a social contract between a medical school and a community. An evaluation of the experience is described as a means to assess the success of the social contract at an early stage of its development.