Universities without walls: evolving paradigms in medical education

Medical education is entering a phase of renewed change driven by developments in information availability and technology. Over the past half century medical education has remained largely isolated from the changes that have swept through most other businesses: enterprise-wide computerisation, client centred thinking, and a service philosophy.

The clients of the medical education process, who, worldwide, generally pay for themselves (though in some countries they are state funded) are guaranteed little for their money, often not even a modern, efficient, or entirely relevant educational programme. Many leave medical school financially poorer and often little enriched cognitively: they are generally weighed down under a vast burden of obsolescent information, the important elements of which could be found by an intelligent member of the lay public faster and in an updated form directly from the world wide web. They are also changed culturally, not necessarily for the better. Their time spent studying in the academic ivory towers, from which most graduate, separates them from their community roots and also reinforces the divide between primary and secondary care and does little to emphasise the essential humanity and caring intrinsic to this vocation.1