Medical education: how is change to come about?†

The challenge to medical education as we enter the last decade of the century and face the next millenium is how to utilize the new knowledge of human learning to train medical students in applying the fruits of rapidly advancing science and technology to the moral imperative of fulfilling social needs. To bring about the reforms defined in the Edinburgh Declaration, adopted as globally applicable by the World Conference on Medical Education, intrinsic and extrinsic elements must act in synergy. The intrinsic elements are teachers, students and institutional frameworks; the extrinsic elements political will, administrative commitment and societal pressure. In the developing world, while there is much that medical schools themselves can do through intrinsic changes, their dependence on government support is so pervasive that such government support becomes an essential prerequisite for change. The creation of a cohesive organizational framework involving health and education ministries, the academic sector and professional bodies for a systematic and continuing study of medical education and for inducing and sustaining change are essential to facilitate the change process.