How shall we prepare the future healthcare professional

Ancient Greeks thought the future comes upon us ... from our backs as the past recedes away before our eyes ... the past dominating everything in our sight. -Postscript Zen and the Art of Motorcycle Maintenance Robert Pirsig IT IS TEMPTING to think we know how to prepare the future health professional, or if we are uncertain, it is tempting to project forward, based upon what has worked in the past. The lead authors in this issue invite us to consider another option. They ask us to think of a set of inexorable forces at work. These forces, trends, and capabilities-both current and emergent-offer us a sense of what healthcare in the context of tomorrow might be like. The authors reflect on the implications of that world for today's preparation of the health professionals who are likely to work in that world. Accepting the authors' invitation may require reconsideration of the categories and assumptions we currently use to help us get through our overstuffed days. Consider their suggestions-the pause might be refreshing. Freeman Dyson suggests that future scientific practitioners will need to be prepared to work with ideas and tools (Dyson 1999). To be prepared to work with ideas means to be able to understand concepts and theories. To be ready to work with tools means to be able to use methods and techniques. Future health professionals will also require at least one more basic preparation: they must be able to do what they do in relationships that offer other people benefit. Mary Stefl describes the "new rules" for the twenty-first century health system developed by the Quality of Care in America Committee of the Institute of Medicine. In some important ways, those new rules are like the inexorable forces described by Peter Schwartz in The Art of the Long View (iggi). Schwartz suggests that, in thinking about the future that is being created, we consider the driving forces in society, technology, economics, politics, and the environment. Within each category, predetermined elements work their way forward into the future; these elements present themselves irrespective of how we may wish to structure the future. The speed of change is immaterial: such predetermined realities can be observed in slowly changing phenomena, in constrained situations, and in inevitable collisions. We may wish to ignore some of these realities, but Pirsig's insight that "our sight [is] preoccupied with the categories of the past" challenges our complacency. Are the new rules really new or are they better considered as inexorable forces already at work? David Leach and David Stevens invite our attention to Dee Hock's admonition: "preserve substance, modify form" as they suggest a strategy for the preparation of the future physician, but their message applies to the preparation of all future health professionals. They suggest that the substance of medicine (healthcare) is relationship-humans relating to other humans-but that the current healthcare system sabotages relationship. Leach and Stevens assert that we have lost control of time and that it dictates who we are. In answer, they suggest we currently spend our time on form, rather than substance. I propose that the forms of time-categories and segments that we impose on time-may be the culprit. Time remains the same as it has been. Leach and Stevens recognize that the io M's new rules invite deepening human relationships and reinforce the substance of medicine and healthcare. They offer eight corollaries to the roll's new rules for learning in the twenty-first century health system. At the core of their argument is the idea that good patient care involves relationship and that good care is necessary for good learning. We are asked to consider the dilemma of the accreditor: if the substance of medicine (or healthcare professions) is more important than form, and institutions are mental forms, how do you accredit a relationship? …