Reforming medical education: a review and synthesis of five critiques of medical practice.

For physicians to provide appropriate healthcare at a reasonable cost, health reform may not be enough. This essay discusses the scope of educational reform needed in the U.S. to train tomorrow's physicians to practice effectively in an increasingly complicated health care arena. We undertook a review and synthesis of five critiques of medical practice in the U.S.: of quality, evidence-based medicine, population medicine, health policy and heuristics. Our findings suggest that physicians are inadequately trained to function in the complex organizational and social systems that characterize modern practice. Successful health care reform in the U.S. will require physicians who are trained not only in bio-medicine, but also in the social sciences. Other developed countries, which have both greater government control of health care and a culture less oriented to individualism, may have less need for specific efforts to train physicians in the social sciences but could still benefit from considering an expanded curriculum. Effective educational reform must address the medical admissions process, academic and intellectual preparation, and professional and clinical training.