The Medical School and the University

Honor for Dr. Vernon Lippard is richly merited but perhaps poorly served by an essay on relationships between medical education and universities. Doctor Lippard could do the job so much better himself. In fact, more than a decade ago he did it with his presidential address before the Association of American Medical Colleges.' Doctor Lippard's thesis, presented under the title, "The Medical School Janus of the University," suggested that "the American medical school is committed to a role which requires it to face simultaneously toward the university and the community." Development of this thesis emphasized the university aspect and examined carefully its hazes and obstructions. Doctor Lippard wrote: "As medical education matures, the trend will be toward either proprietary or university orientation, and the day has arrived when the compass should be set in one direction or the other." Note substitution of "proprietary orientation" for "community." A decade ago that switch was so easily accepted as to pass almost unnoticed; a dominant medical force in the community was indeed proprietary. Today the community manifests other forces of greater strength. One of them is a public that demands medical care that is comprehensive, continuous, and readily available. With many voices, the public asserts that universities and their medical schools are important mechanisms for providing new models and perhaps even new mechanisms for more extensive delivery of health care. The medical school still looks toward the community, and may in fact have placed there a hand or even a foot. That involvement is the subject of another essay in this series. What has happened in the view toward the university? Universities have changed; medical schools have changed perhaps too little; some of the old obstacles to clear vision are still present; but increasingly, in spite of variable administrative linkages, medical schools and other divisions of the university regard the world from similar vantage points. A persistent distinguishing feature of the medical educator is preoccupation with his academic identity. He alone among educators seems to stand publicly exposed, asking "Who am I?" He has received many answers and