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Putting the School Back into Medical School


From the Editor

Members of the academic medicine community and many observers of academic medicine are well aware that the leadership and faculty of medical schools and teaching hospitals are facing a number of important challenges. To help our readers better understand the nature of those challenges, we decided a while back to publish, as often as possible, monthly “theme sets” of papers presenting different perspectives on one or another of the most important challenges. Regular readers of the journal and others seeking information about issues relevant to academic medicine have informed us that they have found this approach to be quite useful.

The papers in this month's theme set focus on the kinds of strategies that the leadership of medical schools should consider adopting to ensure that their students receive a high-quality education. Unlike papers published in the journal in recent months, which focused on issues related to the design and conduct of the individual educational experiences in the medical school curriculum, this month's deal primarily with issues related to the organization and management of the educational program per se. The various authors have shared their insights into the kinds of strategies that schools should consider adopting to enhance the quality of their students' education.

In the lead article, Watson makes the point that medical schools should begin by acknowledging the fundamental importance of the education mission. He points out correctly that the expansion that has occurred during the past two decades in the research and clinical enterprise activities conducted by medical schools has resulted in extraordinary growth in the size of medical school faculties. And he goes on to note that the increase in the number of faculty devoted primarily to the schools' research and patient care missions has created a situation in which the average faculty member now has only sporadic contact with medical students and that a relatively small percentage of the faculty are involved to any significant degree in the education program. Given this situation, it is understandable that deans and department chairs—the leadership of the medical school—appear to devote little personal attention to the education of medical students. This may be understandable, but it has had the effect of marginalizing a school's education mission. He reminds all of us of the unique responsibility of medical schools—“They and only they have the mission of selecting and educating the next generation of physicians responsible for the care of the public.”

In order to address this situation, Watson suggests that the time has come for medical schools to reconsider the role of departments in the management of the school's education program. He believes that the education mission would receive more focused attention if schools established an increasingly centralized approach to program management. Indeed, there is some evidence that schools are beginning to move in that direction. In the past few years, medical education centers, institutes, and academies have been established by a number of schools as they have sought ways to focus attention on education and to direct resources to those members of the faculty most involved in teaching medical students. In this regard, the academies established at the University of California, San Francisco, School of Medicine and at Harvard Medical School have been of particular interest to the members of the medical education community. In this month's journal, Cooke and colleagues and Thibault and colleagues describe the rationales for the establishment of the academies in those two institutions, the policies governing the appointment of faculty to the academies, and the activities conducted by academy members.

In addition to establishing organizational structures to support the education mission, it seems clear that medical schools should create policies to ensure adequate funding of the activities of the faculty involved in the education program. A number of papers describing various approaches for accomplishing this (mission-based management) have appeared in the journal during the past few years. Their authors make clear that the development of a metrics system acceptable to the faculty for measuring faculty productivity is key to the implementation of a mission-based management approach for allocating available resources. Authors of two papers in this issue focus on different approaches for measuring faculty productivity. Tarquinio and colleagues describe the method developed for the department of medicine at Vanderbilt, and Coleman and colleagues describe the one developed for the VA Connecticut Healthcare System. These authors emphasize the importance of developing metrics that address the unique circumstances existing within different kinds of organizational units.

Finally, medical schools must support the development of individuals who can provide the leadership required to manage and enhance the quality of their educational programs. Past issues of the journal have contained papers about leadership development programs established by various schools. In this issue, Armstrong and colleagues describe aspects of a national leadership development effort—the Harvard Macy Physician Educator Program. This initiative brings together education leaders from schools across the country to learn leadership and management skills together while working on projects specific to their home institutions. The experiences of those who have completed the program attest to its value.

Taken as a whole, the authors of this month's theme-set papers emphasize the complexity of the challenge medical schools face as they strive to enhance educational quality by improving the design, content, and conduct of their curricula. These are, in themselves, formidable undertakings in the current medical school environment. The authors suggest that enhancing the quality of the education program could be pursued more effectively if schools adopted a more centralized way of managing their education programs, rationalized their approaches to program funding, and committed resources to develop faculty leaders committed to their schools' education missions.

As medical school deans and faculties continue their efforts to respond to the issues discussed in this month's journal, it is important for them to bear in mind Watson's reminder that their students are “the next generation of physicians responsible for the care of the public.” We all know that the public would like medical school deans and faculties to take education issues seriously and to implement strategies that will enhance the education of their students. After all, one of those students may be caring for them at some time in the future.

© 2003 Association of American Medical Colleges