Undergraduate medical education--future directions.

Editorial Undergraduate medical education-future directions The responsibility to educate doctors was one of the earliest traditions of medicine. For instance the first section ofthe Hippocratic oath provides the first written framework forvaluing education inmedicine and laying upon doctors the duty to pass on their skills and learning.' It is only after this section that the oath turns to the more familiar duty of a doctor to patients. It is interesting therefore that in one of the earliest written codes of practice setting clear standards for those engaged in the profession of Medicine the responsibility for teaching was placed in pole position. Education has therefore been at the heart ofthe ethos ofmedicine since the earliest days of the Western tradition. Since the time of the Hippocratic School medical teaching has developed considerably, yet along distinct lines with a changing emphasis on two particular priorities, the need for a firm grounding in the scientific basis of the field and the practical skills necessary for diagnosis and the management of patients. The importance of the patient in education was summed up by William Osier as follows: "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." For many years, though, there have been additional mounting tensions generated largely because ofthe increasinglyrapid growth ofmedical knowledge and the need to rationalise how much ofthis plethora of information is transmitted to students. Even before the exponential increase in medical knowledge of the past forty years there were concerns about information overload, described prosaically as the "overburdening of young minds". The traditional approach to undergraduate medical training characterised by the explicit division ofcourses into biomedical science and clinical training also came under scrutiny as ideally these should interweave throughout medical training; it was also felt that that formal instruction in those characteristics of a doctor that should provide the basis for ideal patient care, such as skills in communication, should form an early part of the medical curriculum. In the UK this culminated in the publication ofa new vision of the aims, objectives and methods of undergraduate training by the General Medical Council (GMC), Tomorrows doctors in 1993 and subsequently modified in 2003.2 This laid down a clear statement of the expectations of the newly qualified medical graduate with a strong emphasis onpatient-centered education and people skills, vertical integration of learning. It also …