THE SIMILARITY AND FREQUENCY OF PROPOSALS TO REFORM US MEDICAL-EDUCATION - CONSTANT CONCERNS

Objectives.-To identify the values and agendas underlying reports advocating the reform of medical education and to account for their similarity and repeated promulgation. Data Sources.-Major reports regarding undergraduate medical education reform published between 1910 and 1993 were identified through a manual bibliographic search. Study Selection.-Nineteen of a total of 24 reports met the two inclusion criteria: they directly addressed undergraduate medical education and contained a coherent body of recommendations. Data Extraction.-Content analysis of 19 reports. Data Synthesis.-All the reports articulate a specifically social vision of the medical profession, in which medical schools are seen as serving society. The reports are remarkably consistent regarding the objectives of reform and the specific reforms proposed. Core objectives of reform include the following. (1) to better serve the public interest, (2) to address physician workforce needs, (3) to cope with burgeoning medical knowledge, and (4) to increase the emphasis on generalism. Proposed reforms have tended to suggest changes in manner of teaching, content of teaching, faculty development, and organizational factors. Reforms such as increasing generalist training, increasing ambulatory care exposure, providing social science courses, teaching lifelong and self-learning skills, rewarding teaching, clarifying the school mission, and centralizing curriculum control have appeared almost continuously since 1910. Conclusion.-The similarity of the reports' objectives and reforms results not only from a similar body of problems, but also from the reaffirmation of similar values. The reports have two implicit agendas that transcend the reform of medical education: the affirmation of the social nature of the medical profession and self-regulation of the profession. These agendas help account for the reports' similarity and their repeated promulgation.