RESUMEN
Medicine is no hard and thorny science like mathematics and metaphysics, so I soon made great progress [Avicenna =Ibn Sina, A.; 980-1037 A.D]. The social importance of the medical function and the limited number of people with the training to perform as physicians are not the only criteria explaining their professional dominance. A particularly important factor is the organization of the medical profession itself. Two basic characteristics are sociologically relevant in explaining professionalism: prolonged training in a body of specialized and abstract knowledge and an orientation toward providing a service [Rizk, 2000]. Moreover, once a professional group becomes established, it begins to further consolidate its power by formalizing social relationships that govern the interaction of the professionals with their clients, colleagues and other official agencies outside the profession. Recognition on the part of these bodies and the wider society of the profession's claim to competence as well as the profession's ability to control its own membership is necessary if professional decisions are not to be reviewed by outside authorities. Doctors, however, now work in a context in which the old verities about medicine and medical practice can no longer be taken for granted [Rizk, 2007]. The awareness of societal changes and the need to prepare health professionals to work in new roles are evident in the plethora of meetings and publications directed to [Medicine in the 21[st] Century]. Hence, the medicine and doctors are in a serious need of leadership if they are to adapt successfully to a different future. The doctor's role is evolving continuously in a process of negotiation between the medical profession and the society it serves [Rizk, 2000]. At different points in the history of the profession, the relative power of the profession and of society has varied. In the recent past, scientific and technological advances, the consequent growth of the tertiary care teaching hospital and specialist expertise have tended to place much of the power to define a doctor's role in the hands of the profession which was best able to understand the scientific aspects of that role. Some recent changes given [Tab. 1] have, however, influenced the way in which the health care and the doctor's role are viewed. The net effect of these changes is that the balance of power in the negotiation of doctors' role is changing to give a more equal share to the society and the profession. This negotiation of role has the implications for medical education. Medical education performs a service for society in training doctors to meet the need for medical care in society. It is necessary, therefore, for medical educational institutions to be able to recognize and interpret those needs and design appropriate educational programs. In many countries the social context of medicine has changed since the majority of medical teachers were students. Increased biomedical knowledge and technological development offers seemingly limitless potential for medical intervention aimed at the cure or life support. Simultaneously, the recognition that much disease has its origins in .lifestyle and preventable environmental factors has evolved. Governments must allocate finite health resources where they can, potentially, do the most good [Rizk and El Safty, 2006]. Other health professionals and patients themselves have an expanded role to play in meeting the emerging needs for illness prevention and maintenance of healthy populations. Most clinical education takes place within teaching hospitals where patient and doctor expectations and negotiations are at a different level from those in primary care setting. In light of these and other changes, expectations of the doctor's role have also changed. The majority of medical students are therefore unprepared for the nature of the expectations and demands they encounter later in their professional work. To fulfill this new role, future doctors will need skills not just in the clinical areas with which they are currently concerned but also in the ethical, social, political and economic aspects of medicine. Furthermore, the impact of sophisticated and often competing anthropologic and societal variables such as the ethnicity, race, culture, religion, spirituality, geopolitical orientation, indigenous psychology, personality and gender identity on individual's realization of health role, experience of health and illness and utilization of health services is not appreciated in the medical curricula. Medical education must thus provide learning experiences which reflect the reality of medical practice in an era of increasing technological possibilities but limited economic resources [Rizk, 2007]. Medical students must also have the opportunity to consider the ethical and practical aspects of decision-making which incorporates cost-effectiveness as one parameter [Rizk, 2008]