An Overview of Reform Initiatives in Medical Education

INTEREST in alternative educational, organizational, and financing strategies for the education of the next generation of physicians is growing as medical care costs escalate and access to basic health care declines. To assess the impact of major initiatives for improving undergraduate medical education, we reviewed 15 major studies conducted between 1906 and 1992 (Table).¹⁻¹⁵Eleven of these studies originated with councils or commissions whose appointed members reviewed the ideas and opinions of leaders in medicine about medical education¹,¹⁰,¹⁴; four were detailed field studies,¹¹⁻¹³,¹⁵,¹⁶consisting of on-site observations of the structure and function of specific medical education programs. Of the 15 initiatives, 13 reported specific recommendations,¹⁻¹³which can be grouped in three categories: the method of medical school instruction, ie, the curricula content and process of instruction; the internal structure of medical schools; and the relationship between medical schools and external organizations and agencies. The recommendations are