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Undergraduate medical education in Sweden has moved from nationally regulated, subject-based courses to programmes integrated either around organ systems or physiological and patho-physiological processes, or organised around basic medical science in conjunction with clinical specialities, with individual profiles at the seven medical schools. The national regulations are restricted to overall academic and professional outcomes. The 51/2 year long university undergraduate curriculum is followed by a mandatory 18 months internship, delivered by the County Councils. While quality control and accreditation for the university curriculum is provided by the Swedish National Agency for Higher Education, no such formal control exists for the internship; undergraduate medical education is therefore in conflict with EU directives from 2005. The Government is expected to move towards 6 years long university undergraduate programmes, leading to licence, which will facilitate international mobility of both Swedish and foreign medical students and doctors. Ongoing academic development of undergraduate education is strengthened by the Bologna process. It includes outcome (competence)-based curricula, university Masters level complying with international standards, progression of competence throughout the curriculum, student directed learning, active participation and roles in practical clinical education and a national assessment model to assure professional competence. In the near future, the dimensioning of Swedish undergraduate education is likely to be decided more by international demands and aspects of quality than by national demands for doctors.

Undergraduate medical education in Sweden has moved from nationally regulated, subject-based courses to programmes integrated either around organ systems or physiological and patho-physiological processes, or organised around basic medical science in conjunction with clinical specialities, with individual profiles at the seven medical schools. The national regulations are restricted to overall academic and professional outcomes. The 5½ year long university undergraduate curriculum is followed by a mandatory 18 months internship, delivered by the County Councils. While quality control and accreditation for the university curriculum is provided by the Swedish National Agency for Higher Education, no such formal control exists for the internship; undergraduate medical education is therefore in conflict with EU directives from 2005. The Government is expected to move towards 6 years long university undergraduate programmes, leading to licence, which will facilitate international mobility of both Swedish and foreign medical students and doctors. Ongoing academic development of undergraduate education is strengthened by the Bologna process. It includes outcome (competence)-based curricula, university Masters level complying with international standards, progression of competence throughout the curriculum, student directed learning, active participation and roles in practical clinical education and a national assessment model to assure professional competence. In the near future, the dimensioning of Swedish undergraduate education is likely to be decided more by international demands and aspects of quality than by national demands for doctors.

AbstractTwentieth Century medical education has stressed the basic sciences to the neglect of the humanities. The intent of this commentary is to explore the humanities' role and contribution to the professional formation of the physician. A major change on the United States' medical school admission exam starting in 2015 is a move away from its current focus on natural sciences and begins to incorporate a wider breath of liberal studies and social sciences. The ideal 21st Century physician is a more well rounded person who can interact on a deeper level with patients and not by a narrow spectrum of intellectual interests. The 21st Century curriculum has a unique opportunity to reflect and build upon professional values and attributes informed by the humanities, particularly as the latter relate to the role of the physician in society. It is important to be creative in constructing opportunities for humanities learning experiences and resources within the scope and structure of the curriculum. It is necessary to think in more innovative ways as to the experiential learning environment that targets professional formation, and for a more broadly and humanly educated physician.

Mandatory continuing education for physicians and other health professionals raises numerous problems. Issues that were considered academic when continuing education was voluntary now take on major practical and political significance. There is the risk that future legislation will mandate activities and methodologies which have not been proven. Research and development in continuing education must be accelerated so that decisions can be based on proper data. Centers of research and development should be established to encourage research and provide a sound foundation for the future of continuing education.

A significant portion of the deaths in the United States could have been prevented or postponed using known interventions. One reason this did not occur is because medical science and medical education are disease, not health, oriented. Since physicians are at the center of the health care delivery system, their disease orientation pervades the industry. Historically, there have been calls for physicians to focus more on disease prevention; however, medical education does not teach disease prevention/health promotion. There are several reasons for this: 1) medical school faculty conceptual discordance between "certainty" of curative disease vs. the "probability" of risk factor reduction; 2) gaps in the knowledge of effective interventions; 3) the concept that health promotion/disease prevention are outside the province of physicians; 4) the significant role of biomedical research grants on medical school funding; 5) the close association of medical education and the acute care hospital; and 6) the use of rote memory/lecture based teaching methods of traditional medicine vs. the problem-based learning necessary to teach disease prevention/health promotion. Some medical schools have begun to use problem based learning and to introduce health promotion concepts. Widespread and long-lasting change requires support of the leadership in medical schools and the preventive medicine/public health community, and grant funding from state and federal sources to support research on medical education research and change.

As health care changes under the pressures of restraint and constraint our vision of the future of medical education should be based on the medical school's responsibility to the community. The medical school is "an academy in the community": as an academy, it fosters the highest standards in education and research; as an institution in the community, it seeks to improve public health and alleviate suffering. The author argues that to better achieve these goals medical schools need to become more responsible and responsive to the population they serve. Medical schools have been slow to accept fully the social contract by which, in return for their service to society, they enjoy special rights and benefits. This contract requires that medical educators listen to the public, talk honestly and constructively with government representatives and assess the needs and expectations of the community.

The Western medical profession's knowledge concerning the development of Soviet medicine during the preceding two decades 1s ~ost meager. This situation may be attributed to scvct;al factors. First, there was a paucity of pertinent material available for study during this period due to the r~tri~tions imposed upon the exchange of sc1ent1fic data between Russia and \\'cstcm Nations. In addition, as a result o( the exigencies of war and politics, the . inter· change of competent and interested obse.Vers was reduced to an insignificant number. Furthermore, the lack of Western scientific personnel familiar with the Russian language limited the significance of the few Russian scientific journals which were available. And finally, the deficiencies of Russian medicine evident during the initial years of Soviet rule may have minimized the value of any further exchange.