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Academic Medicine:
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Mission‐based Management and the Improvement of Medical Students' Education

WHITCOMB, MICHAEL E. MD

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Improving the quality of medical students' education is one of the most important challenges that medical schools confront on a regular basis. During the past decade, a number of medical schools responded to this challenge by making dramatic changes in the organization and structure of their curricula, and by adopting new educational methods for enhancing students' learning. In planning to implement those innovations, medical schools also began to rethink how the efforts and contributions that faculty make to the education of their students were being recognized and rewarded.

In the mid-1990s, papers describing various methods for quantifying the involvement of faculty in the education of medical students began to appear in the literature. The measurement systems (educational metrics) described in those papers suggested that medical schools could rationalize the management of all of their mission-related activities, not simply those devoted to education, by implementing systems for quantifying the contributions that members of the faculty made to each of the schools' missions during the course of an academic year. Given the financial stresses that schools were experiencing in the 1990s, the implementation of mission-based management principles seemed to be a logical strategy for medical schools to pursue in their efforts to balance and prioritize their various mission-related activities.

At present, only a few schools have successfully implemented comprehensive mission-based management practices that include the budgeting of non-restricted funds. However, a number of schools have recognized the value of applying those principles to the management of their education programs. In and of itself this is an important development. If, in the current environment, medical schools hope to be able to continuously improve the quality of their students' education, they must find ways to recognize and reward the efforts and contributions that faculty make to achieve that goal.

Three papers appear in this issue of Academic Medicine that provide important information about medical schools' efforts to implement mission-based management. In the lead paper, Mallon and Jones provide an overview of the experiences of 41 schools that had developed, or were developing, educational metric systems as of April 2001. The results of their survey work make it clear that schools face a major challenge in reaching an agreement with their faculties on the need to quantify the educational activities of individual faculty, and on the design of a metric system that will achieve that objective. Their work demonstrates that the negotiation that occurs in attempting to resolve these issues leads to considerable variability in the kinds of metric systems that are adopted, and the ways they are used.

Nevertheless, the importance of these initiatives cannot be overestimated. For several decades now, members of the academic medicine community have recognized that as the size of faculties has increased, participation in the education of medical students has become a marginal activity for a large percentage of the medical school faculty. In more recent years, faculty who have been involved in educational activities on a regular basis have, on occasion, found it more difficult to participate in those activities because their salaries are derived increasingly from self-generated funds. Given traditional medical school budgeting practices—allocation of funds to departments based largely on historical patterns—it is not possible for individual members of the faculty to show that their teaching efforts are income-generating, even though institutional funds supporting those efforts are passed to their home departments. Under these circumstances, it is not surprising that faculty would bypass opportunities to participate in educational activities in order to participate in research or patient care activities that they can identify directly to be generating income.

The authors of the two papers that follow describe the approaches adopted at their schools for collecting the information needed to implement a comprehensive mission-based management program that applies to all of the schools' mission-related activities. Since the two systems described in the papers are quite different, the case studies illustrate the kinds of compromises that will be reached in gaining agreement with the faculty on the need to implement mission-based management. The papers emphasize one of the important lessons emanating from the survey work reported by Mallon and Jones—there is no single, or best, approach for implementing mission-based management. Each medical school will have to adopt an approach that best serves its particular needs at the time.

Taken together, the three papers provide important insights into the challenges faced by medical schools that decide to adopt metric systems that can be used to recognize and reward faculty for their contributions to the education of medical students. Equally important, the papers show that progress is being made to achieve those objectives, albeit quite slowly! So what can be done to accelerate the pace of the change?

I believe that schools are more likely to be successful in getting faculty co-operation in the implementation of an educational metric system if the system is one component of a comprehensive set of strategies for emphasizing that the education of medical students remains the primary, and only unique, mission of the medical school, and is, thus, the primary responsibility of the faculty as a whole. One means of accomplishing this is to establish a highly visible organizational entity that will: (1) provide a mechanism for recognizing and rewarding those faculty who make important contributions to the education of medical students; (2) serve as a means for budgeting individual or departmental contributions to medical students' education; and (3) manage faculty development programs aimed at improving the teaching skills of interested faculty. A number of schools are developing, or have already developed, various kinds of entities—medical education centers or institutes, and special faculty societies or academies—to accomplish these goals.

If medical schools are to continue to be successful in improving the quality of the education of their students, they must adopt strategies that recognize and reward faculty for the efforts and contributions they make to the medical students' education program. Not only must these strategies acknowledge the special contributions made by a small number of faculty, but they also must make it clear to those faculty who serve primarily as clinical teachers that their participation in the education of students is valued and does generate income for them or their departments. The three papers that appear in this issue of the journal provide insights into the various kinds of metric systems that might be adopted to accomplish these objectives. Because of the importance of the information provided in the papers, they should be required reading for deans, department chairs, and others whose management decisions affect the quality of the education of medical students at their school.

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