Perspectives: a medical school dean.

It has been said that every experiment in education is doomed to success. This is due presumably to unrecognized variables and to imprecise objectives and measurements of the outcome of education–in the case of medicine, physicians. Since our glimmers of insight into the neurobiology of learning are insufficient, we attempt to design and assess education by observation or measurement of surrogate derivative behaviors. Further, since the behavioral outputs are desired decades after the educational inputs and are subject to considerable uncertainty and change, no set of educational equations or prescriptions can be expected to provide a definitive comprehensive context for medical education. Nonetheless, we do have the power and the responsibility to control the form and content of medical education, and it is the highest responsibility of the medical educator to do so, Recognizing the limitations of educational analysis, Robert Ebert and Eli Ginzberg have given us a comprehensive and reasoned analysis of many of the secular trends considered likely to influence medical education and practice in the coming decades and offer a set of recommendations for reform. Their paper surely will stand as a thoughtful and comprehensive analysis of the problems and potentials of medical education in the United States as it adapts for the twenty-first century. I agree with the authors that change in current or anticipated health care practice is such as to call for substantial change, perhaps usefully termed reform, in medical education. I agree with much of the analysis and many of the recommendations. Specifically, I agree that in many medical schools there is need to reestablish devotion to teaching medical students, though I would be mindful that, as Albert Coates said, “Teaching is more stirring than stuffing,” and it is, after all, learning and not teaching that is the goal. I agree also with the recommendation that there be further selective