On a busy day a few years ago, I encountered one of our first-year medical students in the hallway. I did what I usually do: I stopped to ask her about her experience thus far at our school of medicine. “Of all the questions I have been asked, there is only one that has actually made sense,” she said to me unabashedly. I was somewhat taken aback by this confident pronouncement from a freshman medical student, since I knew that several of our highly accomplished faculty members were devoting considerable time to work with her on an individual basis. I wondered if her reply had something to do with her disability.
So I said, “Tell me a little more.” Once she was seated comfortably in my office, and after expressing how grateful she was for the support she received every day from our faculty and her fellow students, she explained that, of all the individuals who had interviewed her for medical school, only one had asked her about her challenge, not her impairment. This bright student with a warm smile had severely limited vision – so limited, in fact, that even though she knew me well she could not recognize my face when we passed within four feet of each other in the hallway. The faculty member had posed to her the simple query, “How do you get information?”
How do you get information? With these five simple words, the faculty member got right to the heart of what mattered most to the student: How does she access the data and concepts that she needs to think, to learn, and to become a doctor? As I reflected on this simple query, I saw that it was both elegant and effective because it penetrated the superficial constraints of the disability itself and laid bare the more important underlying challenge. As we all know, exposing fundamental challenges with elegant questions is key to advancing our work in research, education, and patient care. And, of course, such challenges, which get right to the heart of what matters most in academic medicine, are of keen interest to this journal.
As the new editor-in-chief of Academic Medicine, I plan to use each year’s January editorial to challenge the academic medicine community with a broad-based, thought-provoking, discussion-generating question that will help chart the course for the journal over the ensuing year. It is in this spirit that I invite all of you who have a stake in academic medicine to help shape the future direction and focus of the journal by responding to the question, What are the grand challenges in academic medicine today?*A “grand challenge” has been defined for a variety of disciplines in different ways but generally means the statement of a problem that is thought to be solvable within a foreseeable time period (e.g., a decade, a century, or something in between) through the application of significant increases in knowledge and/or major breakthroughs in technical capability. For our purposes, “grand challenges” should stimulate thought across the full spectrum of academic medicine: from fundamental precepts to far-reaching policy, from organ systems to sociocultural systems, from understanding our past to shaping our future.
The list of grand challenges that emerges will help to advance the core mission of Academic Medicine, which is to provide a scholarly treatment of pressing contemporary issues that affect medical schools and teaching hospitals. To make the list widely available, I will work with our editorial board and professional staff to synthesize and summarize submitted descriptions of grand challenges and post them on the Editor’s Notepad Web site, (www.aamc.org/academicmedicine). Over time, our list of challenges should reflect the collective wisdom of all who participate. It can help authors frame their work in terms of the most important questions we face today, help reviewers assess whether manuscripts advance our understanding of those challenges, and help readers interpret in a larger context what they learn from the journal’s articles.
The effort to define grand challenges also will help the journal continue to be a key source of valuable and timely information to every individual who holds or assumes a leadership role in a medical school or teaching hospital, from chairs of major committees to presidents and deans. In addition, I believe that Academic Medicine has a special obligation to provide content that can nurture and support the growth and development of those who may assume leadership roles in the future (e.g., junior faculty, chief residents, students). And while the journal will be essential reading for leaders and future leaders, I also believe that all faculty members at our medical schools and teaching hospitals can be more effective citizens of the academy, more effective advocates for academic medicine, and better clinicians, scientists, and teachers, if, as a result of reading the journal, they are more conversant with the pressing issues of the day.
In addition to the grand challenges initiative, I see the journal’s potential to advance thinking around key problems in academic medicine by developing new ways to tap into the experiences, perceptions, and expertise of current academic leaders. One mechanism we will explore is a “point – counterpoint” feature that will enable the presentation of thoughtful deliberation of the pros and cons of major dilemmas. I also see the potential to advance knowledge of the history of academic medicine in a way that enriches our understanding of current challenges. This can be done by publishing articles, both solicited and unsolicited, on important historical figures, events, trends, and decisions. Historical perspectives, enhanced by thoughtful analysis of their value to offer insight into today’s problems, will improve our community’s ability to generate effective solutions.
And, as a matter of course, we will continue to accept high-quality submissions that advance knowledge of the principles, policy, and practice of research, education, and patient care in the academic setting. We will continue to publish sets of articles—united by common, broad-based, cross-cutting themes—by soliciting key individuals to share emerging ideas, advance new notions, and examine current beliefs in new ways. We will work to achieve the right balance among unsolicited articles, solicited pieces about common themes, and special features. And we will strive to present all of the journal’s content in a way that can best crystallize thought and catalyze change.
The simple query I discussed above— How do you get information?—also begs the question of how Academic Medicine’s readers, authors, and reviewers get and use information. It will be essential that the journal reflect a sophisticated understanding of the means by which all of us—in our roles as faculty, residents, and students—currently acquire information so that it may provide content in substantive and meaningful ways. The contemporary “user” of the journal will require modern informatics and communications methods, including a “smart” presence for the journal on the World Wide Web. In addition to the capability to access full-text content via the Internet (which exists now), we will develop the means for readers/users to view interviews with authors of selected papers, expert discussions of selected themes, supplemental video recordings of appropriate projects, and other Web enhancements. Also, we are exploring several modern “push” and “pull” information strategies that will enrich and broaden the nature of the reader’s experience as he or she interacts with the journal’s content.
Such goals would not be in sight were it not for the significant accomplishments of my predecessor, Mike Whitcomb, who focused his efforts on guiding Academic Medicine to “strive to be the journal that those holding leadership positions in medical schools and teaching hospitals turn to first for information that will help them address the major challenges facing their institutions and academic medicine as a whole.”1 Mike not only established this vision for the journal but also brought about other important changes, including the more frequent use of theme collections, an upgrade of the “look and feel” of the print edition, and an effective transition to an electronic manuscript tracking process for all submissions.
In sum, I believe that the journal will continue to be successful—and to grow and develop as a trusted and necessary resource—if goals and ideas are shared effectively, if the journal’s content serves as a source of rational and empirical guidance for those with leadership responsibility, if we pursue forward-thinking strategies about how individuals acquire and use information, and, ultimately, if the journal’s articles and special features enrich the conversations that occur every day in the halls of our medical schools and teaching hospitals.
I am honored to be entrusted with the responsibilities of the position of editor-in-chief of Academic Medicine. I look forward to working with you, and to hearing your ideas about the grand challenges in academic medicine.
Steven L. Kanter, MD