SummaryIt has long been recognised that intensive efforts are needed to reform medical education in order to meet the future needs of populations worldwide. Pressure for changes to the organisation, content and delivery of both undergraduate and postgraduate medical education has greatly increased in the last two decades. The experience of innovative medical schools, the emergence of learner-centred teaching methods and the implications of healthcare reforms in North America and Britain are major factors influencing calls for change. The pace of change has accelerated to such an extent in recent years that progress towards widespread reform appears to be more attainable than ever before. This article provides an overview of the changing context of health-care, some patterns of existing medical education and some strategies for change. Health care has become a central public issue and is no longer seen as the prerogative of doctors or medical schools.'`3 Governments, the public and the medical profession recognise that medical education has not kept pace with the health-care needs of populations around the world. Problems in medical education have been clearly documented over many years and efforts are being made to find solutions.4-6These problems include new patterns of disease in developing and developed countries, inadequate health-care systems and a shortage of the right kind of doctors, ie, generalists as opposed to specialists.7 Aging populations, chronic disease, and rehabilitation medicine are making increasing demands on health services. Public health issues and social problems such as maternal and child health, AIDS, and alcohol and substance abuse, are presenting major challenges for health-care and for medical education.8-'0The health-care context In Britain, changes in management structures and funding arrangements have introduced a competitive market economy to the national health-care service. Rapid advances in medical knowledge and technical skills have widened therapeutic and research opportunities. Advances in information technology have increased opportunities for communicating information, sharing ideas and facilitating research." Government legislation and the Patients' Charter are clearing the way for the public to expect much more from the national health-care system. Increased emphasis on the role of the community in the care of the ill, in preventing disease and promoting health has placed a heavy burden on existing services. "-" As a result, relationships between those involved in health-care are changing, both towards each other and towards patients. If doctors are to function effectively in this new context, their education and training as medical students and professionals must undergo reform.
University medical schoolsThe responsibility for producing appropriately trained doctors lies with university medical schools. It is here that educational foundations are established, affecting patient care and community health in the future. The ways in which students are selected and the cont...