Medical education has undergone considerable change in the 20th century, since Flexner emphasized the scientific foundation of Medicine. Growth of scientific knowledge led to the frgmentation of the c urriculum and medical educators looked for newer ways of organizing content. This resulted in the development of integrated curricula in the second half of this century. Medical schools began to establish educational units to train faculty and facilitate development. The growth of elective programs, early exposure to clinical experiences, problem-based learning and community-oriented medical education were other trends which became evident in the quarter of this century. Many factors, however, have impeded change in medical education, amongst them institutional complacency, inertia and the of loss of control. The department continues to hold a commanding position in the school and often departmental allegiance takes precedence over institutional goals. The bias towards research over teaching in the rewards system, as well as the rigidity of external bodies such as national boards, also discourage change, Yes these barriers can be overcome with dynamic and imaginative leadership. While predictions about the nature of medical education in the 21st century are risky, the spurt of activity in the last quarter of this century makes it likely that the future graduate will from the present in many respects. A greater attention to the social concomitants of illness, to preventive and promotive services, and to ambulatory and domiciliary care will make the student more aware of continuity of care, rather than only of episodic care in a tertiary hospital. The pendulum will continue to swing between generalist and specialist education and increasing attention will be paid to medical ethics and legal medicine. Technological advances will mandate familiarity with the newer tools of investigation, management, communication and learning. The student body of the future is likely to be more mature, on the average, while the proportion of non-medical faculty in medical school will increase. Countries of similar status will form alliances, but the gap between schools in developed and developing countries will widen unless selfish motives are curbed. Global action in necessary if desirable change is to spread. WHO, WFME and international bodies such as the Network of Community-Oriented Schools can play a pivotal role in changing the face of medical education in the 21st century.
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