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Letters to the Editor

Involvement of Academic Health Centers Abroad

Williams, R Sanders MD

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doi: 10.1097/ACM.0b013e31818c74e3

The globalization of academic medicine is occurring at a rapid pace, and will take on dimensions both foreseen and unforeseeable. Merritt et al.1 have summarized nicely the diversity of actions being taken currently by several U.S. academic health centers (AHCs) to accommodate the changes wrought by globalization and to expand their reach and impact abroad via the traditional core missions of AHCs: education, research and patient care. Merritt et al.’s basic arguments about the risks and rewards of overseas ventures ring true with the experience my Duke colleagues and I have gained in Singapore.2 To develop an overseas operation to the standard of the parent AHC requires a clear commitment of top-tier faculty, management, and staff from the parent AHC, some of whom take residence abroad, and an exquisite clarity of expectations among all stakeholders.

I take some issue with the authors’ division of the different types and intensities of foreign operations by U.S. AHCs into four “development stages,” since a requirement for organic maturation of one to another is not apparent. Development stages, in my opinion, should more appropriately refer to the sequence of actions that (1) build the necessary relationships (2); establish a clear mutual understanding of goals, processes, governance and resources (3); identify the founding team members (both the individuals from the parent AHC and their overseas counterparts) (4); implement the required startup actions; and (5) advance, enlarge, and bring to maturity the components of a plan. As an advocate for globalization of my own AHC, I certainly hope that Merritt’s statement that “global involvement could, in the coming decades, serve as a new metric for leadership and influence in health care, education and research” will prove prophetic.

R. Sanders Williams, MD

Senior vice chancellor for academic affairs, Duke University, and founding dean, Duke-NUS Graduate Medical School, Singapore, Duke University Medical Center, Box 3809, Durham, NC 27710; ([email protected]).


1 Merritt M, Railey C, Levin S, Crone R. Involvement abroad of U.S. academic health centers and major teaching hospitals: The developing landscape. Acad Med. 2008;83:541–549.
2 Williams RS, Casey P, Kamei R, et al. A global partnership in medical education between Duke University and the National University of Singapore. Acad Med. 2008;83:122–127.
© 2008 Association of American Medical Colleges