In my June editorial,1 I indicated that we (the editorial board, staff, and I) had decided to shift the focus of the journal somewhat by publishing a greater number of articles—both Articles and Research Reports—addressing the serious challenges facing the academic medicine community. To give potential authors some idea of the kinds of articles we would like to publish more of in the future, we decided to create a theme issue in which each article addresses some aspect of a key challenge confronting the leadership of academic medicine. And to stimulate discussion about the journal's new direction, we decided it would be timely to publish that issue just prior to the AAMC's annual meeting. Thus, the issue of the journal you now have in your hands. As you scan the table of contents, I think you will be impressed by the scope of the topics addressed in the collection of articles we have been able to pull together. I also believe that after you read them, you will agree that each contains valuable information of interest to the academic medicine community.
Since the announcement of the journal's new direction in June, a number of the journal's readers have asked me to identify what I believe to be the most important challenges facing academic medicine. I'm sharing my views in this editorial primarily because I hope that my comments will serve as a general “Call for Papers” addressing the kinds of issues that I outline. But I want to emphasize that potential authors should not be discouraged from submitting manuscripts to us because a topic they wish to address is not relevant to one of those I mention below. Space constraints prevent me from including all of the challenging issues that deserve attention. Having said that, here are the three issues that concern me most.
As I indicated in my July editorial,2 first on my list is the need to redesign in very fundamental ways the clinical education of medical students, and of residents in some disciplines. I put this issue at the top of my list because the medical profession has an absolute responsibility to ensure that the next generation of physicians is educated in ways that will prepare them to provide high-quality medical care to their patients. In my opinion—an opinion shared by many—the academic medicine community is not meeting this responsibility at the present time.
To do so, a number of important questions must be addressed. For example, what must be done in the financing of clinical education to make it possible to implement the changes that are needed? How should the roles of clinical faculty be redefined to optimize the clinical education of students and residents in the inpatient environments of teaching hospitals? Who will serve as the teachers of students and residents rotating through community-based practice settings, and how will those individuals relate to medical schools and/or residency programs? The list of questions could go on—and all would be excellent topics for articles in the journal.
Increasing the supply of physicians is another critically important challenge facing the academic medicine community. Once again, there are a number of serious questions that must be addressed if that challenge is to be met successfully. For example, what strategies might be employed to increase the supply of physicians, and how might those strategies be implemented? Will medical schools need to increase their enrollments to a much greater degree than they appear willing to do at present, and if so, how will that be accomplished? Will the country need more medical schools, and if so, what models might be adopted for meeting that need? What policies should be formulated to address concerns regarding the growing number of graduates of non-U.S. medical schools entering the country? Should the Liaison Committee on Medical Education begin to review and/or accredit the schools from which those individuals are graduating? And where will the increased number of medical school graduates receive residency training, and how will the costs of educating an increased number of residents be covered?
Finally, the academic medicine community must adopt management approaches that ensure that the kinds of conflict-of-interest situations that have plagued it in recent years do not occur in the future. This is a formidable challenge for those holding leadership roles in medical schools and teaching hospitals. The challenge relates to a great extent to the difficulty of gaining access to all of the information needed to monitor the behaviors of faculty members and to the diffuse nature of the systems of accountability that exist in most large academic health centers. Be that as it may, the institutions have an absolute responsibility to ensure that the interests of patients are being protected in both the clinical and research arenas, that those paying for clinical services are getting exactly what they agreed to pay for, and that standards and policies governing scholarship are being adhered to by faculty without exception. The importance of meeting this challenge cannot be overestimated, since even occasional failures can undermine the credibility of the entire academic enterprise.
Now, as I noted above, space constraints limit the number of major challenges I can comment on in this editorial. Suffice it to say, the academic medicine community is facing a number of formidable ones. I doubt that there has been a time in recent history when the challenges have been so great. It is for that very reason that we believe that the journal should provide an opportunity for anyone who has tackled an issue relevant to one of those challenges to publish a case study that will serve to share his or her experience with others in the academic medicine community. We also believe that the journal should provide opportunities for those who have studied some aspect of those issues to publish the results of their analyses. By disseminating important information and ideas in this way, the journal can make an important contribution to the academic medicine community's efforts to address the challenges it must if it is to fulfill its missions successfully.
Michael E. Whitcomb, MD
1 Whitcomb ME. A new goal for the journal. Acad Med. 2005;80:517–26.
2 Whitcomb ME. Redesigning clinical education: a major challenge for academic health centers. Acad Med. 2005;80:615–16.