"Reform without change": update, 1998

As a result of the Flexner Report in 1910, proprietary medical schools disappeared and science taught by researchers became a part of every medical school curriculum. Medical research produced products that improved health and brought large profits to health-related industries. Research became the currency most valued within the organizational power structure of medical schools, overshadowing the educational mission. Almost 90 years and multiple calls for the educational reform of medical education have failed to bring about true change in medical education because of researchers' conflict of interest--that is, the time spent providing effective education equals time away from the research necessary to maintain their careers. Basic scientists have kept teaching in medical schools efficient by giving discipline-related lectures that allow them to maximize their research time. Planning for meaningful learning with integration of disciplines and small-group teaching requires an investment of time that researchers are unwilling to make because it does not further their careers. Separation of scientific research from medical school teaching is necessary for reform of medical education. Medical students need to be taught by teachers who are not researchers.