Very early in our career we developed an interest in the problem of teaching medicine to entering students and came to the conclusion that the education model which stresses understanding (rather than parroting) and learning for oneself is not a curiosum. We also came to the conclusion that reform in medical education demands, by and large, a scheme of action that takes into account two key concepts. One is that a shift in responsibility from the teacher as the expert to the student as active learner is necessary. Another is that an integrated core curriculum calls for a knowledge base that would eliminate the dangerous misconception that only experts are able to competently teach the manifold disciplines that constitute modern medicine. Thus, the availability of these modules ought to greatly simplify the task of the student, as well as that of the tutor or lecturer. This now brings us to the question: How should progress be monitored? In a nutshell, the tutor assigns topics, and the student, in turn, assimilates and masters the subject matter, then initiates and conducts a discourse in a small-group setting, and finally, writes an essay. This procedure is followed at least once weekly. Thus, continuous assessment by the tutor of student initiative and performance is made possible.
There can be no quarrel with this education model. In fact, its many virtues have been expounded in the Harvard report thus: "New Pathway students preferred a self-directed learning environment, tended to memorise less and conceptualise for their own educational success, were likely to choose more patient-centered specialties, were more satisfied, stimulated and challenged than their classmates" (the control group). To prevent misunderstanding, we would like to say at once that this model of education can be adapted to tutorial groups of 15 to 20 students. Further, there is a good deal to be said for the adoption of a mixed system of lectures and tutorials in the early stages of reform and transition from a large to small group is a meaningful change in outlook and spirit is the first desideratum. Without change in spirit reform will avail us little.