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What will the medical curriculum look In recent years we have reviewed and iours to the needs of local health servi-
like in the future? We have seen enor- learned from a large number of differ- ces and populations. The syllabus will
mous changes over recent years in the ing approaches to medical teaching in be more frequently reviewed to ensure
ways we teach and learn, especially with different parts of the world and would it is contemporary, and learning activ-
the increased use of small group and like to propose new strategies for future ities will be directly related to mean-
problem-based learning methods, more curriculum development. We have ingful clinical tasks and to career
teaching in the community and shorter, taken into account the growing impact development. Up-to-date teaching and
more structured postgraduate training of information technology, the emer- learning resources will be selected on
programmes. Many of these changes gence of problem-based learning as a the basis of evidence-based decisions.
draw heavily on the SPICES model of teaching method of choice by many Third, the medical curriculum of the
curriculum planning in which student- medical schools, the need for greater future will be interprofessional in
centred approaches, problem-based clinical experience amongst medical character. Programmes will espouse,
learning, integrated teaching, commu- students and for more protected learn- encourage, and re¯ect a culture of
nity-orientation, elective study periods ing time during postgraduate training. effective, multiprofessional learning and
and systematic approaches to curricu- The proposals are built on educational value interdisciplinary learning experi-
lum planning have been the building principles that are familiar to us all: ences, with an expectation that team-
blocks of modern curricula across the respect for the autonomy of the indi- work and collaboration in educational,
world.1 vidual while also recognising the power research and clinical contexts is based
Circumstances have altered sub- of group learning, the importance of on mutual respect and understanding.
stantially since the initial publication of critical re¯ection on practice, the direct Fourth, medical courses will be
the SPICES model. Medical teachers, relationship between assessment and shorter and the numbers involved will
managers and clinicians are facing dif- learning methods, and the fundamental be much smaller. This does not mean
ferent organisational and educational need to ensure that learning is context- that the total number of students or
challenges in the continuous drive to based, relevant and meaningful in the participants will decrease but that
achieve an effective balance between eyes of the learner. learning activities will take place in
teaching, research and clinical work. First, medical programmes will be smaller units, locally, wherever poss-
For example, student numbers are product-focused. By this we mean ible, and will combine modern tech-
increasing and there is a greater that curricula will increasingly empha- nology with independent and open
awareness that teaching and learning sise clinical practice and be practice- learning techniques. Outside North
should be evidence-based and re¯ect based wherever possible. This does not America, undergraduate medical cour-
changes occurring in clinical practice, mean a return to a wholly apprentice- ses will increasingly be reduced from six
health service management and clinical ship-based system. Rather, the princi- to four years by encouraging graduates
governance. In addition, the public pal focus will be on clinical work and and mature entrants to study medicine.
expect to be served by an accountable the acquisition of professional behav- Closer collaboration between teachers
medical profession in a cost-effective iours. Students will learn about basic in medical schools and in hospital
health service. Teaching hospitals science by applying it in the context of training will make the `continuous'
remain the cornerstone of clinical real clinical problems. They will learn curriculum more attainable by easing,
teaching in the later twentieth century, by doing, seeing and discussing mainly and ®nally dropping, some of the arti-
but increasingly treat patients experi- in structured, organised environments ®cial barriers presented by transitions
encing short-term and acute care epi- that are supported by modern technol- between the ®nal school year and uni-
sodes. Most other medical conditions ogy and by feedback from patients. versity, the preclinical and clinical years
are managed elsewhere in the commu- Programme planning will emphasise of initial medical education, and from
nity. These factors require the devel- learning outcomes congruent with undergraduate to postgraduate train-
opment of a revised set of principles to clinical practice rather than the use of ing.
guide medical education in the new educational processes or learning Fifth, modern medical education will
millennium. objectives. be based in multisite locations. The
Second, learning will become more narrow patient mix of teaching hospi-
relevant both to communities and to tals has resulted in students being
students. Learning programmes that increasingly educated in primary care
Correspondence: Professor J Bligh, Peninsula are planned around outcomes can link settings, and smaller hospitals and
Medical School, ITTC, Tamar Science clinical knowledge, skills and behav- units. The smaller units are unable to
Park, Davy Road, Plymouth PL6 8BX, UK