This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (70)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Constant Concerns

Nicholas A. Christakis, MD, PhD, MPH

JAMA. 1995;274(9):706-711.

Abstract
Objectives.
—To identify the values and agendas underlying reports advocating the reform of medical education and to account for their similarity and repeated promulgation.

Data Sources.
—Major reports regarding undergraduate medical education reform published between 1910 and 1993 were identified through a manual bibliographic search.

Study Selection.
—Nineteen of a total of 24 reports met the two inclusion criteria: they directly addressed undergraduate medical education and contained a coherent body of recommendations.

Data Extraction.
—Content analysis of 19 reports.

Data Synthesis.
—All the reports articulate a specifically social vision of the medical profession, in which medical schools are seen as serving society. The reports are remarkably consistent regarding the objectives of reform and the specific reforms proposed. Core objectives of reform include the following: (1) to better serve the public interest, (2) to address physician workforce needs, (3) to cope with burgeoning medical knowledge, and (4) to increase the emphasis on generalism. Proposed reforms have tended to suggest changes in manner of teaching, content of teaching, faculty development, and organizational factors. Reforms such as increasing generalist training, increasing ambulatory care exposure, providing social science courses, teaching lifelong and self-learning skills, rewarding teaching, clarifying the school mission, and centralizing curriculum control have appeared almost continuously since 1910.

Conclusion.
—The similarity of the reports' objectives and reforms results not only from a similar body of problems, but also from the reaffirmation of similar values. The reports have two implicit agendas that transcend the reform of medical education: the affirmation of the social nature of the medical profession and self-regulation of the profession. These agendas help account for the reports' similarity and their repeated promulgation.

(JAMA. 1995;274:706-711)

Author Affiliations
From the Departments of Medicine and Sociology, University of Chicago (Ill).

Footnotes
Corresponding author: Nicholas A. Christakis, MD, PhD, MPH, The University of Chicago Medical Center, 5841 S Maryland Ave, MC 6098, Chicago, IL 60637.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Education Techniques for Lifelong Learning: Lifelong Learning in the 21st Century and Beyond1
Collins
RadioGraphics 2009;29:613-622.
ABSTRACT | FULL TEXT  

Modern Veterinary Graduates Are Outstanding, But Can They Get Better?
May
jvme 2008;35:573-580.
ABSTRACT | FULL TEXT  

Shared Moral Work of Nurses and Physicians
Storch and Kenny
Nurs Ethics 2007;14:478-491.
ABSTRACT  

"Continuity" as an Organizing Principle for Clinical Education Reform
Hirsh et al.
NEJM 2007;356:858-866.
FULL TEXT  

Changing premed requirements and the medical curriculum.
Emanuel
JAMA 2006;296:1128-1131.
FULL TEXT  

Shaping the Future of Academic Health Centers: The Potential Contributions of Departments of Family Medicine
Newton and DuBard
Ann Fam Med 2006;4:S2-S11.
ABSTRACT | FULL TEXT  

Cultural competence and the culture of medicine.
Fox
NEJM 2005;353:1316-1319.
FULL TEXT  

Learner-Centered Medical Education
Ludmerer
NEJM 2004;351:1163-1164.
FULL TEXT  

Chronic Disease--The Need for a New Clinical Education
Holman
JAMA 2004;292:1057-1059.
FULL TEXT  

How important are role models in making good doctors?
Paice et al.
BMJ 2002;325:707-710.
FULL TEXT  

Family Practice in the United States: A Status Report
Graham et al.
JAMA 2002;288:1097-1101.
ABSTRACT | FULL TEXT  

E-Mail Communication Between Medical Students and Schoolchildren: A Model for Medical Education
Bernhardt et al.
Arch Pediatr Adolesc Med 2000;154:1258-1262.
ABSTRACT | FULL TEXT  

Time and Medical Education
Ludmerer
ANN INTERN MED 2000;132:25-28.
ABSTRACT | FULL TEXT  

Physicians for the 21St Century: Challenges Facing Medical Education in the United States
Patel
Eval Health Prof 1999;22:379-398.
ABSTRACT  

The Changing Health Care System: A Research Agenda for Medical Education
Xu et al.
Eval Health Prof 1999;22:152-168.
ABSTRACT  

The Social Medicine Reader
Bloom
JAMA 1998;279:1043-1044.
FULL TEXT  

Predominance of the Curative Model of Medical Care: A Residual Problem
Fox
JAMA 1997;278:761-763.
ABSTRACT  

Medical Student Education in Managed Care Settings: Beyond HMOs
Veloski et al.
JAMA 1996;276:667-671.
ABSTRACT