Deans and deaning in a changing world.

Much has been written about the threats to medical schools and teaching hospitals, but less attention has been given to what these changes mean to the individuals who lead these institutions. In the belief that the quality of leadership of academic medical centers, especially medical schools, will help determine the future of these institutions, the author assesses the situation of deans today. He first discusses the dramatic decrease in the tenures of deans over the last 20 years and reviews the evidence for some of the possible reasons that this has happened, such as possible changes in the personal characteristics of deans (not a factor), their salaries (not a factor), the inflated titles and increasing power of deans, and the greatly expanded sites of the operations that deans now govern (caused by the enormous increase in the health care establishment and corresponding increases in medical schools).

Medical education in the 1990s--and beyond: a view from the United States.

American medical education is under continued study, and reforms are being suggested to improve it. The current paper reviews the standard U.S.

It's report card time again.

The author, the outgoing president of the AAMC, presents report cards on how the academic medicine enterprise is faring today and how it may fare in the year 2000 by assigning grades to four spheres of activity: Manpower gets a D today, for the following reasons: (1) There are still far too many specialists and too few primary care physicians, and the problem may be worsening; (2) the proportion of underrepresented minorities is still too low in medical schools and the physician workforce, but there are encouraging signs that this problem may be lessening, thanks to schools' efforts to fulfill the mandate of the AAMC's Project 3000 by 2000; (3) student indebtedness is increasing, a situation that affects some students' choices of specialties. By the year 2000, the grade for manpower will rise to a C, since most Americans will have access to care, and there will be some--but not dramatic--improvement in the generalist-specialist balance. Effectiveness of medical school faculties gets a C today, mainly because although faculties have grown with no corresponding increase in students, there has been no significant increase in time or effort devoted to teaching.

The future of internal medicine.

Internal medicine may be in its twilight because it has failed to address the shortage of primary care physicians by training more general internists. Data from several sources indicate that progressively fewer persons are entering general internal medicine as opposed to its subspecialties. The reasons for this decline include adverse experiences in medical school, an unfavorable patient mix, declining incomes, and increasing hassles in caring for patients.

An American's view of Canadian medical education.

Undergraduate medical education in Canada and the United States is remarkably similar, except for the fact that Canadian medical schools are supported by their provincial governments. However, the systems diverge sharply at the postgraduate level. In Canada, the number and specialty mix of residents are negotiated by medical schools in response to educational and social needs; in the United States, these factors are largely determined by hospital service needs.

Commentary: primary care--medical students' unpopular choice.

Title VII funding to medical schools has not succeeded in correcting the shortage of primary care physicians. Although it is generally true that there is an inverse relationship between the amount of research funds awarded to a school and its success in producing primary care physicians, there are many exceptions. Neither Title VII, the amount of research funding, or Medicare's Direct Medical Education payments has had a substantial effect on the production of primary care physicians.

The doctor is in.

The growing trend toward an overproduction of specialists and an underproduction of generalists (i.e., family physicians, general internists, and general pediatricians) in the United States has prompted many in medicine and academic medicine to endorse the goal that 50% of the United States's physician graduates should be generalists.