SOME GENERAL COMMENTS

I appreciate this opportunity of commenting on papers of as high a degree of interest as are presented in this monograph. As I try to discern on the one hand, some consensus of opinion, and on the other hand, a possible conflict of ideas, I am keenly aware of the absence of greatly divergent lines of thought. This entire monograph, as a matter of fact, has been noteworthy for its unanimity in its expression of a sense of urgency in putting new forces to work in medical education, and in properly planning for these new forces. The basic theme that runs through all of these discussions concerns itself with broadening the base of medicine and medical education: any variations from that theme seem due more to difference in the professional backgrounds of the speakers than to B lack of agreement on the basic issues. While Dr. Evans refers to a “crisis in medical education”, that crisis, thankfully, is not of the “sputnik” variety which so radically upset educational thinking in this. country. We can all hope, barring some spectacular Soviet medical breakthrough, that the progressive ideas being discussed here can be put to work in shaping medical educational programs. We can look forward to a time when the laboratory, hospital and clinic will be put into their proper perspective in relation to the environment as a .whole. We have been told previously that teaching effectiveness depends on the creation of those institutional characteristics which favorably influence learning and professional development; in other words, a community for learning. The emphasis is on learning rather than teaching. Mr. Blucher illustrated vividly the complexities of the interaction between the medical center “community” and the total surrounding community. He shows us how difficult it is to define precisely what that community is now, and how much more difficult it is to determine its future. Dr. Evans then reminded us that medicine’s focus has shifted from the empirical, disease-oriented practice of the past, to scientific medicine that concerns itself with health as well as illness in the continuum of the human life process where the ambulant patient and the environment become the primary targets. But Mr. Juster is understandably critical of the ability of planners and architects to express these concepts and to provide a flexible housing for these evolving teaching concepts. We begin to wonder what went wrong. If we can all talk a good game, why can’t we play a good game? Is it still true, as Le Corbusier said in 1923, that “there is one profession, and one only, namely architecture, in which progress is not considered necessary, where laziness is enthroned, and in which the reference is always to yesterday. . . ?” No doubt there was justification for this very negative point of view in 1923, but in the intervening years the teaching and practice of architecture has, like its counterpart in medicine, come a long way out of its narrow confines. Both medicine and architecture are very old professions and both suffer from the precepts of the past. The more recently evolved professions like engineering have made quicker progress because they have not had to climb over such 8 great array of obsolete baggage. But the time has come in the socio-economic sphere when it is increasingly difficult for the medical profession to cover its mistakes with