WHITCOMB, MICHAEL E. MD
During the past two decades, the number and size of the research and clinical programs conducted by medical school faculties increased at a remarkable rate. To support this growth, medical school deans and department chairs had to address a number of important challenges. Foremost among those was how the faculty should be organized so that its members could pursue most effectively the institution's research and patient care missions. Recognizing that coordinating contributions from faculty members drawn from multiple disciplines was increasingly required for the conduct of biomedical research and the delivery of complex patient care services, medical schools responded to this challenge by establishing myriad multidisciplinary centers and institutes dedicated to the conduct of specific research or patient care programs.
More recently, deans have begun to consider how the medical school faculty should be organized to conduct the institution's medical education mission. In recent years, there has been a progressive trend to replace the discipline-specific, departmentally controlled courses that traditionally occupied the first two years of the medical school curriculum with courses in which content relevant to a specific topic is drawn from various disciplines and presented in an integrated fashion. And now there is a growing awareness that the latter years of the curriculum also need to be redesigned to provide clinical experiences that will allow content drawn from multiple disciplines to be integrated throughout those years more readily than now occurs during departmentally controlled clerkships.
Just as serious questions have been raised as to whether or not the traditional departmental structure of the medical school is the optimal way to organize the faculty for the conduct of research and patient care programs, deans now are being forced to consider whether or not the departmental structure should continue to serve as the basis for organizing and conducting the medical students' education program. At issue, here, is how the members of the faculty most involved in the education of medical students—a very small number of the faculty in any department—should be organized to ensure the quality of medical students' education.
Although there is not general agreement on how this can best be accomplished from an organizational perspective, there is widespread agreement that those members of the faculty who are most committed to, and involved in, the education of medical students must be supported and rewarded, both professionally and financially, and that the central administration of the school must play a key role in seeing that this happens. The creation of a distinct, school-wide, organizational entity—for example, a center, institute, or academy—is an approach that is being adopted by some schools that have very large faculties. Other schools, particularly those that have small faculties, are attempting to achieve the same objectives using strategies that affect policies governing how departments support and reward faculty educators. Regardless of which organizational model is employed, schools must adopt policies that ensure that those members of the faculty most involved in the education of medical students are supported and rewarded appropriately for their efforts.
In addition to being attentive to their existing cadre of medical educators, schools also must develop programs that will allow members of the faculty who are interested in pursuing careers as medical educators to acquire the in-depth knowledge about education and teaching that is required to be an effective educator. This is critically important if a school hopes to maintain the quality of its educational program over time. In this month's issue of Academic Medicine, Gruppen and colleagues, and Steinert and colleagues, describe programs designed to produce educational leaders; these programs have been established at the University of Michigan and McGill University, respectively. Both of the programs are a year in duration and provide a wide scope of educational experiences. While the programs have many similarities, there are also substantive differences. One element of the McGill program that is noteworthy is the requirement that the enrolled scholars take two courses offered by non–medical-school, university departments (departments of education, epidemiology, or management) during the course of the program.
Finally, not only must a school develop approaches for supporting its cadre of dedicated medical educators and for developing new educational leaders, it also must provide formal opportunities for all members of the faculty, including volunteer faculty, to improve their teaching skills. Most medical schools now depend on large numbers of volunteers—practicing physicians—to serve as clinical preceptors for students assigned to community-based, clinical learning experiences. Because the members of the volunteer faculty tend to be dispersed geographically at some distance from the medical school location, providing faculty development opportunities for them is a particular challenge. The paper by Langlois and Thach in this issue describes an innovative approach for accomplishing this.
A medical school's most important asset is its faculty. To maintain the quality of medical students' education, schools must invest in programmatic activities that are intended to optimize the performances of individual faculty members who are involved in the educational program, regardless of whether they are educators or teachers. Given the complexity of the challenges being faced by modern academic medical centers, this commitment has never been as strategically important as it is today. Several of the papers that appear in this month's issue provide important insights into how schools might meet this commitment. Success in this effort is necessary if the quality of the medical students' education is to be maintained in the future. This is a challenge that medical schools must not fail to meet.