A Critique of External Forces in Medical Education

There will seldom be disagreement that what is taking place will be resented by persons or agencies whose presumed interests are served by continuing circumstances without change. A story is told about a man who lived in a village outside Paris. During the revolution he met a friend fresh from the city and asked what was happening. "It's awful," was the reply; "they're cutting off heads by the thousand." "Good heavens! Surely not heads," he cried. "Why, I'm a hatter!" Those of us who are involved daily in medical education can be expected to exclaim against a revolution which, if it does not actually diminish internal control of medical schools, at least requires that a whole array of powerful extramural forces be taken into account when making decisions. Our unifying theme might be this: "I'd rather do it my¬ self." There are good reasons to believe that we never have done it ourselves and that we shouldn't attempt to do it now. Much is written about the dramatic change which occurred in medical education more than 50 years ago, transferring its control from proprietary influenees into the university. Actually the transfer