Medical education: progress and retreat.

In summary, there have been significant educational improvements, particularly during the first two years of medical school. Students today are more accomplished, more diverse, and there is now a focus on the highly relevant basic science of medical practice, including medical ethics and public health. The curriculum has been centralized and coordination between various departments has vastly improved as a result. The number of lectures has been reduced, replaced by more effective small-group, problem-solving seminars. Support services for students have made medical school a much more enjoyable experience. On the other hand, the dramatic shift in the nature of hospitalized patients has adversely affected traditional bedside teaching that was such an important part of clinical education in the past. Extensive diagnostic evaluations now take place in an ambulatory setting. Hospitals and medical schools have not yet found a satisfactory way to integrate trainees into these venues. Finally, there has been a marked decrease in the number of graduates seeking careers in primary care, a phenomenon influenced by huge educational debts, the attraction of being able to master a defined discipline, and the desire to combine a medical life with a reasonable life-style. On balance, although the overall education of our future doctors has definitely been improved in the past fifty years, the erosion in fundamental clinical skills has been a disappointment.