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May 10, 1993

Changes in Undergraduate Medical Education: A Critique

Author Affiliations

Department of Medicine John A. Burns School of Medicine University of Hawaii 1356 Lusitana St, Seventh Floor Honolulu, HI 9681

Arch Intern Med. 1993;153(9):1045-1052. doi:10.1001/archinte.1993.00410090011002

MOMENTUM FOR fundamental change in the education of American medical students is mounting. Alterations of training are suggested as a logical solution for uneven quality of care, lack of primary physicians, and even widespread disability from long-term disease.1 There is strong sentiment that such modifications also would improve the personal values, attitudes, and professional behaviors of physicians.2 Statements supporting this impetus include the following: "the nation is in a health care crisis, [and] to meet this challenge, change in the education of physicians is required";3 and there have been "no important changes in the organization of medical education over half a century."4 Tarlov5 summarized this philosophy in an eloquent plea for a "revised conceptual frame-work" in which behavioral, sociocultural, and biologic phenomena cast a new configuration for physicians; if adopted, his suggested structure would require substantial changes in medical education. Such pronouncements are persuasive and