First, medical schools are being driven by external pressures to better respond to societal needs. Medical schools are increasingly decentralizing their educational process to help produce physicians with the values and skills needed to meet the diverse needs of Canadian society. Second, internally, the changing nature of medical knowledge and skill sets has led to differences in the educational process with more formal standards and educational goals. Within this second change is a difference in the trainees moving through the educational system - today's future doctors represent a different value set and demographic profile than their predecessors.

These changes pose both a challenge and an opportunity for ATHs. ATHs are well positioned to be leaders and facilitators of these changes. Doing so would help strengthen the system, and would ultimately help ATHs fulfil their complex and often competing mandates. Unfortunately, there are also incentives for ATHs to fight these trends. The response of ATHs to their evolving relationship with medical schools and universities will have a large influence on the future shape and function of the AHSC.

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