Campaign to revitalise academic medicine: A road map needs to be drawn for the 21st century

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7452.1377-c (Published 03 June 2004) Cite this as: BMJ 2004;328:1377
  1. Jean D Gray, professor emeritus (jeangray{at}hfx.eastlink.ca)
  1. Dalhousie University, Halifax, NS, Canada B3M 2B3

    EDITOR—The international effort to revise and reform academic medicine is timely and appropriate.1

    In the past century the science of medicine has become a massive enterprise, fuelled by both government and industry money. But growth has also resulted in a separation of science from practitioners of the discipline. Most of today's major scientific health advances are created not by practising doctors but by people whose entire career is based in laboratories. Disciplinary boundaries in health care have become blurred so that many health professionals do well in roles previously thought to be medical roles. Several major reports have resulted in transformation in the processes of medical education so that curricula are now more student centred (problem based learning), more community based (to provide training in the milieu where practice will subsequently occur), and more inclusive of the social sciences than was the case in the past.

    The 21st century calls out for new reforms. Scientific medicine must not only incorporate the contributions of “basic” scientists and, where available, clinical investigators but also build teams of many skills to deal with contemporary health problems. Both students and practitioners of medicine must see the relevance of research to their own work and perhaps contribute.

    Globalisation requires that the fortunate medical schools in the developed world must partner with their colleagues in the developing world to ensure that educational standards and basic healthcare delivery are assured for all.

    Instead of lengthening the medical school and residency curriculums to encompass new developments, medical educators must accept responsibility for the continuum of health education, moving beyond the initial four years of medical school and encompassing the entire learning lifetime of practising clinicians. If health professionals work in teams then they should also learn in teams to change health care. Faculty members engaged in team activities are currently not rewarded but a reward system must arise out of the new approaches to research and education.


    • Conflict of interests None declared


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