Edited sentence: Academic health centers bear a large responsibility for the dominant trend towards specialization in direct opposition to the primary care needs of society.As the practice of medicine changes, the educational needs of physicians have changed.MD graduates of academic health centers face heavy competitive pressure from foreign and Caribbean trained medical graduates both for 3rd year rotations and residency training slots.Many schools have moved towards simulation devices that can teach many aspects of medical practice.Streaming recorded lectures are now available at many schools, including Johns Hopkins, Weill Cornell Medical College, Robert Wood Johnson Medical School, Baylor College of Medicine, and even medical schools abroad such as Ross University School of Medicine.Technology provides for several alternatives to the historic lecture based model.The 100 year old model of medical education based on the Flexner Report needs updating.The web creates the opportunity for unprecedented participation via the wiki model, which has been used with variable success.Training physicians in the proper use of modern information resources has become a major goal