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Medical practice and the new curricula.

Professions, like all closed systems, tend to self-replication. They change only when social forces threaten to take the initiative from them, and when, as is now the case, they are painfully reminded that professions themselves are ultimately instruments of specific social purpose. To speak, therefore, of the impact of curricular reform on practice is to belie a certain presumption common to educators and practitioners alike. New curricula arise primarily in response to unfilled social, political, and scientific needs. A new curriculum at first reshapes practice along more socially relevant lines. It then perpetuates the prevalent care system until new external pressures generate another wave of educational reforms. It is with this cycle in mind that I shall examine some of the probable effects of the current curricular revolution on our medical care system. It was Flexner's rather shocking revelations of the insensitivity of medical education to the relevance of the