Time to return medical schools to their primary purpose: education.

The author maintains that the quality of medical education has been dropping for the last few decades as medical schools become less and less focused on their primary purpose of training physicians. Until the years immediately following World War II, the administration of the medical school was carried out by a small staff headed by a dean whose role was to provide leadership in educational matters. Academic departments managed the educational program, and the faculty were expected to be teachers and to participate in educational planning, preparation of teaching materials, advising of students, assessment of students' performances, admission, and all other tasks associated with having a teaching position. Today, the administration of a typical school includes any number of assistants to the dean and a wide variety of other staff dealing not only with educational functions but with grant management, public relations, fund-raising, personnel policy, budgeting, and an enormous and complex parallel structure designed to manage clinical practice and to respond to market pressures. The role of faculty has also changed greatly; faculty are expected to be researchers and clinicians first, and teaching is usually shortchanged. The author explains why he believes these changes have come about; for example, the strong federal support of research after World War II, which encouraged a growing dependence of medical schools on research grants and consequently raised in importance those faculty who could obtain such grants. He concludes with common-sense proposals for reform (such as having the education of medical students in the hands of a small number of faculty whose prime responsibility is teaching), but admits that there are fundamental barriers to such reforms, especially vested interests and resistance to change. In the end, change will come only when those in power recognize that medical schools must be returned to their primary role of training physicians.