Health Policy and Education 3 (1983) 317- 328 Elsevier Science Publishers B.V., Amsterdam - Printed in The Netherlands 317 DEVELOPMENTS IN MEDICAL EDUCATION: ISSUES AND RESPONSES KENNETH R. COX and ARIE ROTEM Centre for M edical Education Research and Development, The University of New South W ales, P.O. Box 1. Kensington 2033, Australia ABSTRACT The increase in scientific knowledge has led inexorably to the fragmentation of medicine and medical education. Doctors are trained to work and teach w ithin their discipline. Managing the process of planning, implementing and evaluating teaching among the disciplines requires knowledge and skills in organization and management. The tasks are at the levels of the individual teachers, the department and the faculty, and of the committees they generate. The challenge for the individual teacher and of the organization is to coordinate their cooperative activities in the interest of the students and the promotion of health. Since no individual teacher is responsible for the whole or- ganization, the central responsibility for this centripetal management lies with the Dean. Medical education is continuously changing in its approaches and or- ganization. The nature of the changes and the reasons underlying them are often not clear, even to those participating in the process. Nevertheless, there seems to be sufficient agreement in relation to the significant influence of three factors. First a rapid increase in scientific knowledge has led to a high level of specialization in educational content and in medical practice. Second, various interested groups are dissatisfied with aspects of the medical course and its outputs. Third, developments in education in general are being increasingly incorporated into medical education. These factors, and the problems they create for medical education, in- volve coordination within and among organizations. Few are amenable to solution by individuals acting on their own initiative. The nature of these factors and their influence on medical education are the subject of this article. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA The Consequences of the Growth in Knowledge It is not possible for the human mind to keep up with the exponential growth of scientific knowledge we have experienced in recent decades. To adapt, we reduce the breadth of what we cover, and concentrate on a selec- tive area which is more manageable. This necessary specialization or frag- mentation is a principal factor for disintegration in medical practice and the medical curriculum. 01652281/83/$03.00 0 1983 Elsevier Science Publishers B.V.