Research in medical schools: rationale, priorities, roles and balance.

Although medical schools traditionally rest on the "three-legged stool" of research, education and service, it may often seem to the outsider that research is ascendant. In the past 50 years, medical schools' research success has been abundant; they are often most secure in contemplating their indispensable role in this domain. Recently, however, growing criticism of educational programs and increased competition for service responsibility (and the attendant revenue) from the nonacademic and private sectors have fuelled asymmetry. Research may well be the best bulwark against diminished importance or mediocrity, but it should be fortified by a new balance in which the medical schools' mission in education and service is reinforced. Unipolar concentration on the understanding of disease mechanisms must be eschewed in favour of a blended program of basic, clinical and population health sciences. Medical schools must pay greater attention to their responsibilities for training graduate students in a variety of health-related disciplines; in the future, nonphysician health care professionals will increasingly share the scientific preparation and views of physicians as they work in multiprofessional teams. Research will continue to thrive in the medical school of the future, but success will come from a careful assessment of current realities and a strategic resetting of priorities.