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Time to HealAmerican medical education from the turn of the century to the era of managed care$
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Kenneth M. Ludmerer

Print publication date: 2005

Print ISBN-13: 9780195181364

Published to Oxford Scholarship Online: October 2011

DOI: 10.1093/acprof:oso/9780195181364.001.0001

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Academic Health Centers Under Stress: Internal Dilemmas

Academic Health Centers Under Stress: Internal Dilemmas

(p.288) 15 Academic Health Centers Under Stress: Internal Dilemmas
Time to Heal

Kenneth M. Ludmerer

Oxford University Press

Throughout its history, the American medical school, like the rest of the country's system of higher education, had been shaped by social, economic, and political developments in the larger society. Thus, it was hardly a surprise that many of the pressures experienced by academic health centers in the 1970s and 1980s arose from outside events. Yet, academic health centers encountered additional dilemmas that could not so clearly be related to external pressures. A number of traditional challenges to medical education grew more intense: the problem of teaching bedside medicine as biomedical research became increasingly molecular, the perpetual difficulty of achieving a suitable institutional balance between teaching and research, and the ongoing dilemmas of residency and fellowship training. These frustrating problems arose mainly from the evolution of medical knowledge and the institutional development of academic health centers rather than from the challenges imposed by a hostile external environment.

Keywords:   medical schools, academic health centers, medical education, bedside medicine, residency, fellowship training

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