Urban Medical Centers by Eli Ginzberg

Author:Eli Ginzberg [Ginzberg, Eli]
Language: eng
Format: epub
Tags: Social Science, General, Sociology
ISBN: 9781000009491
Google: carMDwAAQBAJ
Publisher: Routledge
Published: 2020-01-28T05:00:02+00:00

7

Reinventing Education in Medical Schools

Stuart Bondurant

Although the discussion thus far has focused on financing and organizational factors as the driving forces for change in medical education, there are, in fact, a whole series of other pressures that may be more fundamental and ultimately have more profound effects. Kenneth Shine and Richard Nesson have referred to the growing mismatch for over a decade between the products of our academic medical centers and societal needs. This phenomenon is not unique to New York or to the northeast. It is apparent throughout the country, and to those of us who have been immersed in medical education and committed to its future it has been a matter of deep concern. Medical schools are not the sole culprits in this respect; it is a pervasive issue throughout academia. There are now serious questions as to the effectiveness with which our universities are meeting the real needs of the society that higher education is intended to serve.

Much the same can be said of our hospitals, whose present functions are a mere shadow of what hospitals did in the past. I believe the entities that we now call hospitals might legitimately be designated "technology application centers" because that is essentially their work—they apply technologies. Hospitals originally were sources of social support and their mission extended well beyond the realm of medical procedures. In thinking about this transformation, it may be useful to recognize the extent to which the functions of health care institutions have been determined by constraints of bricks and mortar, not necessarily by systemic organizational factors.

We must also rethink the question of the association of research with education and with clinical practice. The days of the smoke drum are long gone and the research that is now performed is, in general, more removed from the bedside than it used to be. Stated simply, the model of the academic health center that we have revered, that has been so precious and socially useful over the years, is not necessarily the model that we should attempt to perpetuate. Much of the current biomedical research might be performed better in other kinds of institutions, as is the norm in many other countries.

Similarly, the association of teaching and clinical practice is an interesting phenomenon. Looked at from the vantage of a university administrator, medicine is unique among the professions in the extent to which practice is an essential part of teaching. This association may, however, be due for reexamination. Much of the tension inherent in the issues that we have been discussing derives from the association of the teaching function and the service function. Although I am not among those who are ready to abandon this paradigm, we need to examine what we mean, both conceptually and operationally, when we assert that the two functions must be articulated in new and very different ways. Currently, there is talk, for example, about "virtual" universities, and in a similar vein one can conceive of a "virtual" medical school. Many techniques that

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