The article proposes a change in medical paradigm from that of curative practice to one emphasizing primary health care (PHC). Discussed are origins and dilemmas of PHC; conflicting PHC values and practices; organizational changes and PHC; health care reform examples from Latin America; and implications for medical education. (DB)

Discusses four trends in the U.S. health care system that affect how women's health care is delivered: (1) the restructuring of primary care; (2) initiatives in quality assessment; (3) changes in patterns of health insurance coverage; and (4) threats to the health care safety net. Indicates that medical educators must link training to these…

Discusses implications of changes in the financing of medical care and the organization of health care delivery for the traditional medical school-university partnership. Suggests both tenure-track and clinician-educator medical faculty should be provided the time and financial support to meet requirements for scholarship. (DB)

Discussion of human motivation contrasts controlled and autonomous motivation, noting that autonomous motivation (self-determination) involves behaving with a sense of volition, agency, and choice. Suggests that medical students who learn in autonomy-supportive teaching and patient-centered environments, which have been associated with more…

This study documents the rapid increase in the number of relationships between academic health centers and continuing-care retirement communities (CCRC) in the latter half of the 1980s. An example of such an arrangement is presented as well as the issues involved and levels of involvement with CCRC. (GLR)

Rural health care can thrive if innovative tactics are used. Four principles can influence health care services: (1) an integrative approach is needed; (2) recognition that competition is a dominant mode; (3) cultural and professional ethnocentricity are counterproductive; and (4) the possibilities are limitless. (Author/MSE)

The economic, social, and educational forces that have led to current health care reform proposals are outlined, the main proposals made to respond to these forces are noted, and ways in which academic medicine can change effectively to meet the reforms are examined. Risks to academic medicine are also considered. (Author/MSE)

Factors affecting the optimal size of an integrated health care delivery system in an academic medical center are discussed, including: the institution's structure for survival; technology, innovation, and health care costs; and specific characteristics of the institution's education, research, and patient care missions. Several alternative…

The use of student health centers at California higher education institutions as medical student training sites in 1988 is documented. Directors of the 28 residency programs using student health centers for their residents reported satisfaction with the association, and health center directors with residents on rotation also reported overall…

Examined the health care needs, practices, insurance status, and concerns of 112 medical students, finding that one-third had informally requested prescriptions or diagnostic tests from medical school faculty and housestaff, and that women more often reported difficulty obtaining health care than men. The majority of students preferred to avoid…

A creditable response to society's needs and expectations can be best undertaken by establishing a national agenda in academic medicine that places a high priority on health services research and the scientific analysis of the entire health care system. The expansion of the cadre of health service researchers is needed. (Author/MLW)

Issues in balancing health services and costs in a changing society, where groups have differential access to health care, are discussed, including need for a universal health care system, growing cost of health care for the elderly, prolongation of life among older adults, and the claims of children on services. (MSE)

Seven common myths about rural America are debunked, and three characteristics of the rural environment (diversity, sparse population, and interdependency with broader social and economic forces) are examined in relation to health care delivery and medical education. Health care contributions to rural economic needs are discussed. (Author/MSE)

A discussion of the role of academic health centers in health care reform efforts looks at the following issues: balancing academic objectivity and social advocacy; managing sometimes divergent interests of centers, faculty, and society; and the challenge to develop infrastructure support for reform. Academic health centers' participation in…

Successful rural health delivery factors include group practice, retention of the same health providers for three years, community-oriented focus, integration of non-M.D. providers, and commitment to education within the practice. Academic medical centers with and without area health education centers should expand to serve rural communities…