Medical Schools, the Social Contract and Population Medicine

McMaster Revisited

Published In: Journal of Manipulative and Physiological Therapeutics, v. 18, no. 8, 1995, p. 554-558

Posted on RAND.org on December 31, 1994

by Ian D. Coulter, Michael Wilkes

Offers provocative comments on the challenges faced by medical and chiropractic schools in meeting two goals: a return to the social contract that traditionally characterized academic medicine and the community, and a return to population-based medicine as a mechanism for fulfilling this contract. These two goals are discussed in terms of the experience of McMaster University (Ontario, Canada). The lessons learned from the McMaster experience are especially useful to the practice of medicine in the United States as physicians continue to enter into systems of managed care. McMaster was created in an environment receptive to regionalization and the practice of population-based medicine. These external forces do not exist in the United States, and thus U.S. medical schools face a different challenge from that of McMaster--i.e., to transform education while having no option of altering the health care delivery system. The question for U.S. medical education is whether the paradigm by which medicine is taught can be changed, given the more difficult external environment.

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