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From the Editor

Innovation and Leadership Across the Five Missions of Academic Medicine

Roberts, Laura Weiss MD, MA1

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doi: 10.1097/ACM.0000000000004425
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Academic medicine exists to advance the health of people and populations. 1 As our work in academic medicine brings benefit to others now, we also carry a special responsibility in society to enable greater well-being into the future and throughout the world. This combined aim of direct and indirect contributions across generations and geography differentiates academic medicine from other health-related entities. Extraordinary resources are vested in academic medicine so that we may carry out the enduring obligation to improve health and well-being both near and far.

Academic medicine strives to fulfill its commitment to deliver benefit to others through innovation and leadership in (1) scientific discovery, (2) education, and (3) clinical care. And academic medicine increasingly seeks to honor its accountability to the public and earn the public’s trust through (4) collaboration with communities and partners, local to global, and (5) commitment to rigorous and forward-looking standards of equity, professionalism, and ethics, including unwavering, repeated demonstrations of respect for persons, justice, inclusion, and integrity.

In short, academic medicine does not have just 3 missions—it has 5. Academic medicine has evolved, building upon the traditional strengths of research, education, and clinical care to include collaboration with communities and key partners and the elevation of professionalism and ethical commitments as 2 additional and crucial academic missions. These 5-mission domains, if intentionally combined and furthered through innovation and leadership, can become a powerful and transformational methodology for advancing human health. Our tool for transformation, like our own hands, is palmate, not tripartite.

The palmate model of academic medicine serves to recognize the extraordinary service and contributions of those trainees, staff, and faculty who may not fit squarely into traditional academic roles. For this reason, the model is more inclusive than the tripartite model and more accurately reflects the range of activities and settings in which academic medicine is engaged. The palmate model endeavors to change the elitist and inaccessible view of academic medicine as an “ivory tower” and places academic medicine within its broader local and global context.

Understanding academic medicine as having the ability to transform human health through innovation and leadership across 5 synergistic missions is an affirmation of our purpose at an unprecedented and challenging time in our world. The palmate model reminds us of our role in engaging the full portfolio of academic medicine in the service of others. Engaging with this model, we help not only our own patients, learners, colleagues, and collaborators but also many people whom we will never meet. Indeed, the definitive measure of academic medicine’s value is the improvement of health and well-being for people and populations separated from us by geography or generations, far beyond our immediate reach.

Within academic medicine, the 5-mission model elevates crucial aspects of our work that are implicit and deserve greater attention. Examples include fostering creativity and nurturing leadership qualities among members of our field, strengthening diversity and undoing exclusionary institutional practices, and addressing health disparities. 2 Looking inward, this model reinforces our need to undertake academic initiatives of consequence, for example, efforts that support professionalism and health professionals’ well-being and that better align the moral compasses of health systems and institutions with the values of the health care workforce. By elevating equity, professionalism, and ethics, the model strengthens a culture of trustworthiness and accountability in academic medicine. Trustworthiness and accountability derive in part from our ability to self-observe and respond in a manner that is faithful to the ideals of medicine. Being more intentional about this mission domain motivates our field to address societal challenges with health implications (e.g., discrimination, racism, health disparities, and neglect of underserved populations). Looking outward, the model affirms our responsibility to orient scientific, educational, and clinical work with the needs of our communities.

Connections across the missions are lived by those in academic medicine each day. Medical students learn in neighborhood clinics and later return to such clinics as attending physicians. Clinicians partner with community leaders to address health disparities and strengthen standards of care for disadvantaged or vulnerable groups. Clinician–scientists partner with entrepreneurs to pursue high-potential ideas and to launch biotechnology start-ups. Specialist clinicians work shoulder-to-shoulder with primary care clinicians, implementing evidence-based interventions to address chronic illnesses or multidimensional health conditions. Local advocates work in cooperation with academic health systems to undertake new equity-oriented and community-serving initiatives. Researchers translate their findings to build and scale more effective health policies. Academic medicine today is replete with such examples. Although these activities may be underweighted at times in academic promotion decisions, they deliver on the promise of academic medicine to society at large.

The 5-mission model positions academic medicine as a forward-looking and responsive participant in an evolving global ecosystem. The relationship between academic medicine and this global ecosystem has many interdependencies and links that are relevant to the central task of our field to advance well-being in the face of growing health inequities and emerging threats to population and planetary health. Attention to all of the missions of academic medicine means that the focus of our work will naturally shift as the conditions of the world change.

Overall, the 5-mission palmate model highlights both the promise and the promise-keeping of academic medicine. The new model affirms the potential of great work in advancing frontiers in science, clinical care, and education and opens up opportunities for pioneering and creative inquiry. The new model is transformational in that it creates a new ethical basis for the field of academic medicine by elevating innovation and leadership; combining synergistically discovery, clinical care, and education with collaboration and professionalism; and bringing greater intention, inclusiveness, mutualism, equity, and accountability to our field. Finally, the new model is expressed in a world in which epidemics, pandemics, health disparities, injustice, and newly emerging risks to well-being shape societal needs and call for a response from academic medicine. The model gives us the means, Dear Reader, to answer that call resoundingly.

References

1. Roberts LW. Our journal, Academic Medicine. Acad Med. 2020;95:1–2.
2. Roberts LW. Leadership and gender inclusiveness in academic medicine. Acad Psychiatry. 2016;40:339–401.
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