Medical Education Toward the 21st Century

To the Editor.—  The article "A Crisis in Medical Education"¹ raises critical issues. Clinical education must compete with the demands of peer review organizations, diagnosis-related groups, and other cost constraints.The hospital patient population and the length of hospital stay are changing, yet the goals of preparing future physicians for excellence in practice and compassion in the caring of patients remain the same. New approaches to the medical curriculum are needed. As patient care is shifted from in-hospital ward care to alternative care, we should consider teaching students in other clinical settings as well.At Mount Sinai Medical School, there is a pilot program in teaching medical students in the setting of the attending physicians' private offices. A day center in the hospital, where patients will receive diagnostic studies during the day and then be discharged, is being evaluated. The role of students in these alternative facilities should be