Increasing the quality and capacity of education: the challenge for the 21st century


John Norcini PhD, Foundation for Advancement of International Medical Education and Research, 3624 Market Street, 4th Floor, Philadelphia, Pennsylvania 19083, USA. Tel: 00 1 215 823 2170; Fax: 00 1 215 386 2321; E-mail:


Medical Education 2011: 45: 81–86

Context  Abraham Flexner’s 1910 report to the Carnegie Foundation was a successful attempt to improve the quality of health care by reforming the education of health care providers. It was accompanied by a significant reduction in the number of medical schools and an increase in the quality of those schools that remained. Although the report’s focus on quality was laudable and appropriate to the times, we now face a significant shortage and maldistribution of health care workers, particularly in countries with the highest burden of disease. Hence, we see the challenges for the 21st century to involve increasing both capacity and quality.

Discussion  In our view, these two goals can be achieved through three research-driven educational reforms. Firstly, many educational methodologies are retained based on tradition and new methods are adopted based on fashion. Educational research must become the basis for educational practice. Secondly, educational methodology is often focused on improving quality and does not consider resource utilisation, which reduces its relevance and utility. Educational research must focus on quality and efficiency. Thirdly, one form of educational quality control is provided by accreditation processes. Some of these processes are so prescriptive that they are a barrier to improvement and for none is there evidence of effectiveness. Accreditation processes should be based on data about what is effective and efficient.

Conclusions  Just as Flexner argued for a scientific basis in the practice of medicine, we argue for a scientific basis in the practice of education. In our view, this is the way to meet the challenges of the 21st century.