Kanter, Steven L. MD
In these demanding times, how should those of us who work at academic health centers continue to advance the medical education mission?
It is tempting to skim past the how and respond that we must advance the education mission. After all, as a matter of definition, we must. If a medical school does not pursue an education mission, it cannot call itself a school. And, of course, we must if we are to educate the next generation of physicians and biomedical scientists to confront future health care challenges.
While these responses are fundamental and necessary, I don’t think they provide a sufficient and satisfying answer to the question. We need a broader and deeper approach. And we must address the how. We must think in more comprehensive, in-depth, and sophisticated ways about how we advance the education mission now and how we will continue to advance it as the academic health center (AHC) environment evolves.
To this end, I propose the following five-part framework to ground such thinking and to advance the education mission: governance strategies, academic strategies, financial strategies, programmatic strategies, and leadership strategies.
Governance strategies address the relationship among various entities of the AHC and can help maintain a healthy equilibrium among an AHC’s core missions. An example is an affiliation agreement between a medical school and a health system. Such an agreement may include financial support of the academic mission, may specify that the school’s students will complete required clerkships only at health system hospitals, and may stipulate that the health system will accept medical students only from that school. Of course, affiliation agreements may address other aspects of the relationship between a school and clinical affiliate, such as intellectual property issues, performance evaluation of unit heads, and flow of research funding.
Within a school, governance strategies may address the structure and organization of the MD-degree program, including decanal and committee responsibilities and reporting lines.
Academic strategies may include promotion guidelines that foster the career development of clinician–educators, explicit teaching requirements for those with non-regular (e.g., “volunteer” or “affiliated”) faculty appointments, teaching as a separate section of the annual faculty performance review, and school-level or unit-level education awards.
One particularly important academic strategy is clear communication, by the dean and/or by policy, of the meaning of holding a faculty title. For example, one approach is to specify that an individual who accepts a faculty title in a school also accepts a responsibility to teach that school’s students. This makes clear that a basic requirement for teaching is “built in” to the faculty appointment.
Financial strategies may include funding (e.g., partial salary support, supplemental pay) for key curriculum leaders and others with significant organizational and oversight responsibilities for major parts of the education program. Another financial strategy involves the use of a relative value scale for tracking education activities and crediting them to individuals, departments, divisions, or other units. While this strategy places a data-reporting burden on faculty and an administrative burden (for data collection, analysis, and verification) on a curriculum office, a relative value system for tracking education activities can communicate that teaching is one of the dean’s priorities, provide an objective understanding of how much time faculty spend teaching, and offer a rational basis for allocating funds.
Programmatic strategies can reflect the degree to which education is a priority for school leadership and may include opportunities for faculty members to improve their knowledge and skills in medical education, for students to learn in new and innovative ways, and for the school to integrate its research and education missions. For example, one programmatic strategy would be to hold an annual roundtable event that brings together curriculum committee members, course and clerkship directors, student representatives, deans, and other key informants to assess successes and challenges of the prior year and set plans for the coming year. Such an event reflects the importance of the education mission within the culture of the school.
Other programmatic strategies may include developing degree-granting programs in health sciences education, forming collaborations with clinical research programs to take advantage of coursework and services (e.g., statistical consultation, assistance with experimental design) that apply to both medical education and clinical research, and implementing curricular innovations that engage faculty and students (e.g., learning the “medical version” of a foreign language or taking a short elective on medical journalism). Over the last several years, a number of medical schools have developed academies of medical educators. This is a valuable programmatic strategy that further embeds the importance of education in the culture of a school and provides a way to recognize and reward a school’s most outstanding educators.
Leadership strategies are key. Senior administrators—especially the dean and department chairs—must make clear to faculty, residents, and students that it is important to them to advance the education mission. This can be reflected in both their words and actions. If the dean teaches in the medical student curriculum—even if that means giving one lecture or facilitating a small-group session in one course—it sends a strong message to faculty and students and it gives the dean a first-hand sense of current students and their concerns. Department chairs can meet individually with medical students for career advising and conduct “chair’s rounds” with residents.
Other leadership strategies include working with internal media offices and public relations staff to ensure that accomplishments in medical education are reported and highlighted along with research discoveries and clinical breakthroughs.
While particular strategies may evolve over time, and changes in the health care system may necessitate new initiatives in education, the five strategies outlined above can serve as a guide to facilitate a comprehensive approach to advancing the education mission and to help AHCs achieve equipoise among all three of their core missions of research, education, and patient care.
Steven L. Kanter, MD