He cited the vast monetary rewards for some areas of medicine as detrimental to the ideals of the field, and added that "government and public health ought to be the aim of medicine, rather than the enrichment of physicians."

While doctors differed on what factor they thought was most responsible for medical education's insufficient preparation of students for practice, most said they believed Bok's report identified the major areas of concern.

But while most agreed with Bok's claim that attitudes and practices in medical education are so ingrained that the Medical School faculty may resist change, officials disagreed about the central problems of poor teaching.

Meikle said he "took issue" with Bok's claim that faculty are unwilling to upgrade their teaching methods primarily because there is very little reward for teaching.

"I believe academic promotion must be based on a professor's productivity in worthy scholarship. And teaching should be part of the basic portfolio that someone brings into a college or medical school," Meikle said.

Avorn agreed, noting that one point Bok's report did not fully address was the promotion of teachers on the basis of research, a phenomenon he said predominated at Harvard schools, and particularly the Medical School.

"How can we have a system of promotion and appointment based solely on research output and expect good teaching?" he asked, adding that there is no necessary correlation between good research and effective teaching.

He added that he wrote a letter to Bok immediately after the release of the report expressing his concern with teacher valuation, but that Bok responded that he doubted very much would change in the near future.

Too Good

Although many doctors and administrators said they thought it was appropriate for Harvard to make a statement on such a significant issue, because other schools will follow Bok's lead, A vorn added that the University's stature may in fact be detrimental to any efforts at broad change here.

"I sometimes fear that the national impact [of the report] may be greater than that at the Med School," he said, adding "in some ways all this would be much easier if we weren't so successful, didn't have the great [research] track record we do."

Smaller schools, he added, have more room for change because they don't receive the enormous research grants that Harvard does, creating expectations for research output.

"Pragmatically, [change will be difficult because] the economic inertia and enormous success of HMS will carry the day. But only time will tell," he said