Powerful forces are intensifying change in health care delivery: population-based thinking about health care, especially emphasis on prevention; the reemergence of the biopsychosocial mode of thinking in health care; the need to increase capacity for health services research; and the knowledge that reductions may be needed in the use of high-priced physicians, the number of acute-care hospital beds, and the duplication of expensive equipment. Academic health centers are being forced to adjust their educational offerings to these realities of the service sector. Yet, institutional obstacles stand in the way of needed education reform: fragmentation of the sense of community in health professions schools, turf-related forces that separate various health professions, inflexible institutional structures that prevent adequate responses to a changing environment, an increasingly acute shortage of money to support education, and the devalued status of teaching within our institutions. Universities must develop centers to determine regional and local workforce needs and subsequently establish regionally based educational networks of academic and community health centers. Further, academic centers must demonstrate a real commitment to multiprofessional, interdisciplinary team approaches to a patient- centered system. In parallel, the institution must create a student- centered value system.
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