Commentary: When Much Is Promised, Much Is-and Should Be-Expected

There is much to be excited about in Riesenberg and colleagues' report-if all they promise can be delivered. But their endorsement of nonphysician medical educators' (NPMEs') remedial role in educating health professionals is excessive, even as they point out that NPMEs are only one solution to the problems facing such training, and even as they raise provocative ideas (having NPMEs function as role models for physicians in training) about the realignment of responsibilities for educating future physicians. Moreover, it is not clear how the core transformational skills for NPMEs identified in their report are tied to the broad array of educational experiences they outline. Furthermore, the venues for teaching NPMEs about education, particularly graduate schools of education, are, with some exceptions, not viewed as exemplars of educational excellence within the general university community.Flooding classrooms, clinics, and hospital wards with NPMEs, however well trained and inexpensive, is not the way to best educate the next generation of health professionals. Medical practice and medical education constitute a complex system, and medicine's culture is tribal, and intolerant of generalists and outsiders (including "educationalists"). The real issue is not NPMEs' acquisition of theory, research methods, or teaching skills so much as it is whether NPMEs possess the disciplinary independence and identity necessary to make the kinds of contributions needed within a culture that can be so seductive, dominating, and dismissive of outsiders.