In an article in the BMJin 1993, the assistant editor confidently claimed that ‘after years of stagnation medical education in Britain is changing’. Although it appeared that the pace of reform had accelerated in the 1990s, many of the changes had been debated since the 1960s. A gradual shift from vocational training to the concept of a basic medical education as preparation for future practice had left the structure of the curriculum undecided. How to integrate the curriculum and amalgamate London’s medical schools with multi-faculty institutions became the new goals. If the 1968 Todd report outlined a broad consensus on how medical education should be remodelled, the means by which the university-based training it envisaged was to be achieved proved elusive. By the 1990s, the focus had altered again. In the National Health Service (NHS), fresh criteria came to shape care, with greater stress on evidence-based and community medicine. New forms of treatment and diagnostic technology altered the nature of hospital care. New diseases such as AIDS emerged; old ones became resistant to antibiotics. Advances in genetic medicine, organ replacement, endocrinology and radioimmunoassay launched different avenues of research and fresh ways of approaching ill-health. While the number of cases treated increased, length of stay fell, making it difficult for students to see patients. These changes required educationists to rethink how medical students gained clinical experience. Although the need to include medical education in a multi-faculty environment remained important, the extension of community- oriented learning was constructed as the way forward and reflected a shift in the NHS and a growing critique of hospital-based medicine. Greater stress was placed on the value of primary care to training, and teaching hospitals were encouraged to extend links with community services. When Tomorrow’s Doctors was published by the General Medical Council (GMC) in 1993 it marked the consolidation of educational debates that had their roots in the 1950s.

The late 1950s witnessed a blossoming of interest in medical education. Often discussions went round in circles: fashions in learning and teaching came and went, and were frequently misunderstood or overestimated. As more disciplines were added, new ways of learning were suggested to cope with an overloaded curriculum.