For the past few years, the journal's staff and I have sought to refocus the journal's content so that it primarily addresses issues related to the major challenges facing academic medicine's leaders.1 We decided to move in this direction because we believe, as do the editorial board, that the journal can render an important service by giving institutional leaders opportunities to share with others the approaches they have taken to address one or more of those challenges.
Unfortunately, given the world we now live in, a new challenge is emerging: all institutions, including those of academic medicine, are increasingly at risk of facing major disasters, both natural and man-made. Thus, the lessons embedded in the collection of articles that appear this month could be extremely important as a resource for academic medicine's leaders if they find their institutions faced with the impact of a major disaster of any kind.
This is also a very special collection for another reason: several of the articles provide insight into the extraordinary commitment that members of the academic medicine community have to the students and residents whom they are educating. Unfortunately, that is something we don't hear enough about. We read all too often about the difficulty medical schools have in getting members of the faculty to carve out time from their research and clinical care duties to teach their students. And while there is undoubtedly some truth to this, I believe that the problem is vastly overrated. During the past decade, I was privileged to visit the majority of medical schools across the country. I always came away from those visits impressed by the level of commitment that many members of the faculty have to the education and nurturing of their students. Indeed, if that were not the case, the extraordinary changes in curriculum design that have occurred in recent years could not have been accomplished.
Those who are skeptical about this assessment should read, and then reread, many of the articles appearing this month, especially those by Krane, DiCarlo, and Searle and their colleagues. They describe extraordinary responses to the Hurricane Katrina disaster by the leadership and faculties of the Tulane University School of Medicine, the Louisiana State University (LSU) School of Medicine, the Baylor College of Medicine, and three other Texas schools (the University of Texas Houston School of Medicine, the University of Texas Medical Branch at Galveston, and the Texas A&M Health Science Center College of Medicine in College Station).
And while the articles provide a great deal of information about the scope of the responses, I can tell you from personal experience that in some respects, they only scratch the surface. Along with several Association of American Medical Colleges colleagues, I was fortunate to visit Houston to meet with members of the leadership of both Tulane and Baylor during the time that Tulane was relocated in that city. We also were privileged to visit Baton Rouge to meet with members of the leadership of LSU during the time the school was relocated there. We all came away from those visits with a sense of awe about what those individuals and their faculties had been able to accomplish.
During the visits, we also had the opportunity to meet with students and residents to hear their stories. And in some respects, their accomplishments were equal to or surpassed the incredible accomplishments of the leadership and faculties. Imagine yourself as a young person studying to be a doctor, suddenly being cut off from your colleagues, the institution in which you are training, and your family. What do you do? Somehow, the students and residents in New Orleans, because of something deep within them—a commitment to their studies and to the institutions in which they were training—were able in an amazingly short period of time to move to another city, find a place to live, and immerse themselves once again in the study of medicine. And all of this in the face of incredible personal challenges! To be clear, they could not have achieved what they did without the unbelievable accomplishments of the leadership and faculties of their schools. Be that as it may, it doesn't diminish what they were able to achieve on their own. The article by Conlay et al provides just a glimpse into the extraordinary challenges faced by the residents in training at the affected institutions.
While the impact of Hurricane Katrina on Tulane, LSU, and the Baylor College of Medicine is the most dramatic of the events described by several articles in this issue, there are also important lessons contained in the article by DeMers and her colleagues, which describes the effect of the unprecedented 1997 flood on the University of North Dakota School of Medicine, and the article by Sexton and her colleagues, which recounts the total evacuation of the hospital of the University of Texas Medical Branch at Galveston in response to Hurricane Rita. Other articles in this issue are noteworthy because they contribute to a better understanding of the resources that can be mobilized when a disaster strikes. The articles by Sklar and Fordis and their colleagues are important in this regard. And the articles by Fowkes and Cherry and their colleagues provide important information about ways for educating and preparing health professionals to be better able to respond to local disasters.
The truly heroic efforts of the students, residents, faculties, and leadership of Tulane and LSU continue in some sense as they confront a series of challenges related to their efforts to relocate in New Orleans. We are all aware from television newscasts and newspaper articles of the many problems the city and its citizens still face, and we recognize that full recovery will take a long time, and may never be fully achieved. It is inevitable that the medical schools are being affected by the situation, particularly the continuing impact that the hurricane and flood had on the clinical facilities that served as educational sites for both students and residents. But what is remarkable is that the same commitment to the institutions that was evident at the time of the disaster is still evident as all involved work through the current set of challenges they face. There is still a great deal to be accomplished as the institutions strive to achieve stability, but I am confident that the spirit that has carried them this far will allow them to achieve the success they seek. We are all humbled by what they have accomplished!
Michael E. Whitcomb, MD