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Riding the waves of change

Change — in health care, its systems and community need — is one of the few certainties in medicine. A past Dean of Harvard Medical School, Sydney Burwell, put it this way in the 1950s: “My students are dismayed when I say to them, ‘Half of what you are taught as medical students will in 10 years have been shown to be wrong. And the trouble is, none of your teachers know which half.’” (BMJ 1956; 2: 113-116). A broader question is: do we ride out change or ride with it?

Many contributions in this issue of the MJA highlight not only change but also the associated challenges, constructive debates needed and hard decisions to be made as medicine and health care evolve.

An obvious, pressing development is the steady increase in medical graduate numbers, which are now double what they were in 2006. This surge means that a 400-place shortfall in first postgraduate-year training positions is forecast within 4 years. These “waves” of future graduates face questions about when, where, how and even if they will complete their junior medical officer year to become fully registered practitioners. Kevat and Lander