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Crisis in Medical Education?

      Medical education at the undergraduate and graduate levels is at a crossroads. The number and quality of students choosing a career in medicine are declining. One deterrent seems to be the perception of medicine as a profession that is unable to fulfill the personal, psychosocial, and economic needs of the individual. The seriousness of these issues and some suggested responses are the subject of a series of editorials on medical education, which will begin in this issue of the Proceedings.
      Because medical practice is changing—for example, the shifting emphasis from inpatient to outpatient care—postgraduate medical training must change accordingly. More importantly, efforts must be invested in attracting the most qualified candidates to the field of medicine. Alterations in curriculum and clinical training need to keep pace with medical practice, but these changes alone will be insufficient to stop the “brain drain” from medicine.
      The concept of medicine as a worthwhile career goal needs to be fostered early, perhaps even at the elementary school level. Students well educated in mathematics and science are more likely than others to pursue a career in medicine. Thus, strong programs in these areas should be available in elementary schools and high schools. Furthermore, emphasis on the image of physicians having to complete a lengthy educational process and to update their medical knowledge continually, work long hours with night calls and little time for family and friends, interact with governmental agencies and third-party payers, and make personal and professional sacrifices that are considered extreme can dampen the interest in and the enthusiasm for careers in medicine. Instead, the focus should be on the role of the physician as a compassionate healer, a trusted leader, and a friend. Far-reaching plans are urgently needed to improve recruitment to medicine as a career.
      Those in the medical profession may have unduly ignored the competition for candidates from other careers that offer personal, professional, and financial satisfaction with fewer frustrations. The guardians of medical education must establish the appropriate priorities and the necessary liaisons to engender interest in the field of medicine and to attract talented candidates for the important responsibility of health-care delivery.
      This series of editorials on medical education seems particularly appropriate, in light of the 75th anniversary of the Mayo Graduate School of Medicine this year. We welcome the comments of our readers about these editorials, the issues they raise, and other issues that face medical education in the 21st century.