Institutional obstacles to educational reform.

For the full implications of health care reform to be implemented in health professions education, there will need to be a radical rethinking of educational missions and goals, as well as a careful analysis of the obstacles to educational reform that are currently extant within our academic centers and health professions schools. A series of steps should be taken to encourage the development of a collegial spirit among faculty and students across the major health professions. As costs of education become distinct from those of service and research, certain organizational steps will become apparent, such as: 1) developing separate postgraduate and undergraduate medical schools; and 2) forming a regional educational network to respond to the workforce demands of the region.