The place of science in the health professions

The central premise of this paper is that medical education today is being driven by intellectual and social imperatives to make fundamental changes in the way it prepares students to be the doctors of tomorrow. Fully aware that over the past 50 years at least eight major national commissions in the USA alone have made similar claims, the present reality is such that the pressure for change has greater force than at any time since the beginning of the century, when the overall form of modern medical education was set. The new science base of medicine requires the activation of its students. Although medical educators have recognized for at least half a century that active student learning is preferable to the passive student roles of didactic methods, we no longer have a choice. Not only is the activated student a requisite for learning that is intrinsic to the new intellectual paradigm, it is necessary for its application in clinical practice. At the same time, it is important to recognize that the social organization of medical education is structured to resist the kinds of changes that are inherent to the basic knowledge and practice requirements of contemporary medicine. The modern medical centre contains vested bureaucratic and financial interests, shared by both scientists and practitioners, which form a highly resistent structural barrier to change.