For decades, educators, historians, and social commentators accorded major responsibility for the reform of medical education in the United States to the Flexner Report of 1910. More recently, historians have begun to challenge the impact of the Report and the desirability of the changes attributed to it. This volume takes the themes articulated in the Report and traces their development. With each theme being discussed by a specialist in the subject area, the book provides a comprehensive review of medical education in the twentieth century. These themes, many of which have not been discussed in other books, include the basic sciences, the clinical curriculum, women in medicine, black medical education, and sectarian medical education. In addition, the volume includes chapters on the evolution of the health care delivery system, trends in financing medical education, the use of outpatient settings for clinical education, the current status of the medical curriculum and needed changes, and health manpower needs. The work concludes with a chapter discussing the current proposals for change and how they relate to the problems and reforms of the Flexner era. The work will be of interest to medical school administrators, policy makers, and faculty members as well as to practicing physicians.

"Innovation Processes in Medical Education" is the first empirical study to investigate the barriers to successful educational change. Using a qualitative case study approach, it examines the factors that have either supported or impeded change in four medical schools: Case Western Reserve, University of Illinois, McMaster University, and Michigan State University. Following an overview of the historical forces that led to the current structure of the medical school curriculum; the authors discuss their research methodology and data, and analyze their attempts at innovation in each of the four cases, examining the relative merits of each effort. A matrix is developed that will help medical school innovators establish implementation strategies by showing them how to arrive at optimal strategies based on the specific context in which they work.

The financing of graduate medical education is likely to change significantly in the near future as third party payers are already pressuring hospitals to discontinue paying for graduate medical education through patient care. The Medicare System of Prospective Payment Implications for Medical Education and Practice isolates significant implications of prospective payment systems, and deals with each one in detail. Besides providing a theoretical base, it identifies various alternatives and provides guidelines for dealing with them.