Enduring Difficulties in Medical Education and Training: Is There a “Cure”?

Michael Basch was a clinician and theoretician extraordinaire. His greatest legacy, however, was his teaching. He touched enormous numbers of residents and students both through his lucid books on psychotherapy and his exceptional teaching in the clinics and lecture halls. In the years to come psychoanalysts will continue to read his creative manuscripts on affect theory and the integration of cognitive neuroscience into the psychoanalytic understanding of the human psyche, yet Mike will be remembered by thousands of medical students and residents for his genuine and passionate commitment to teaching. With this in mind, we have chosen to write about medical education as a testimony to Michael Basch, a true master teacher.

A dramatic social transformation of American medicine is well under way as manifested by increasing governmental regulation of the profession, federal workforce initiatives to counter an alleged surplus of specialist physicians, and the rise of corporate medicine. New health care policies and delivery models and cost containment efforts have changed medical practice and altered the process of medical education (Greenlick, 1995). Throughout the last 50 years the academic health science center has been the driving force behind the advancement of American medicine (Ginzberg, 1984). Today, economics intrude on traditional values and well-nigh dominate the guiding principles of education, research, and service even within academic medicine (Berns, 1996). Although most attention has recently been focused on these economic influences, long-standing educational problems continue to influence the learning experience of most medical