Science and medical education: is it time to revisit Flexner?

CONTEXT: An important issue facing medical education concerns whether integrating the bioscientific basis of medical practice and research with other subject matter in so-called 'self-directed learning approaches' will ensure that medical graduates meet the needs of the 21st century. DISCUSSION: Although it may be possible to continue to integrate the more traditional medical sciences such as anatomy and physiology throughout the student curriculum, given the rapid development, continuous change and increasing breadth of the other biological sciences that underpin medical research and practice, and in view of the increasingly narrow specialisation of many clinical departments, it may become increasingly difficult to maintain courses in which the medical sciences and clinical practice are partially or totally integrated. CONCLUSIONS: The 100th anniversary of the Flexner Report is an appropriate time to revisit some of the principles that it contains and, in particular, to discuss whether well-intentioned efforts to humanise students' medical school experiences and to make students more responsive to the needs of patients threaten a core value that is as relevant as it was in Flexner's day: namely, competence in contemporary biomedical science.