The reform of medical education: a Canadian model.

Abstract

Summary The Flexner reforms of the early 20th century were successful in correcting a mismatch between medical education and the newly available knowledge from the laboratory sciences. At the same time, they set in motion changes which have resulted in another mismatch, this time between medical education and society's needs. Five major corrective changes are described, with particular reference to the role of family medicine (general practice) in attaining them: (1) a change in the environment of learning, (2) a reawakening of concern with the subjective aspects of medicine, (3) a shift of emphasis from content to process, (4) a change in our concept of health and (5) a rapprochement between personal and population medicine. New medical schools have had an important influence on the reform of medical education. However, it is important also to study examples of successful adaptive change in older institutions. Changes at the University of Western Ontario are described as an example of successful adaptation. Some reasons are given for the failure of many institutions to adapt. Five conditions are necessary if a medical school is to adapt successfully to change: (1) the school should penetrate the entire health care system, (2) all sections of the profession should be represented on the faculty, (3) the school should be strongly rooted in its region, (4) it should have a flow of information from the ‘grass roots’ and (5) society should have some means of ensuring that its needs are met.