AAMC Reporter: July 2008

A Word from the President: "Our New Governance — Aligning the Whole, the Sum, and the Parts"

Last month, the AAMC took another important step in our ongoing journey from "good" to "great." On June 19, our Executive Council approved the final report of the Governance Working Group (GWG), a 16-member group of AAMC leaders and constituents charged with developing our new governance structure. Their assignment these last 13 months—analyzing a diverse and rich collection of councils, organizations and professional development groups and how these components relate to, and in some cases compete with, one another—was no easy task. The GWG is to be commended for its hard work.

Most importantly, the GWG designed a structure that brings us closer to being an AAMC that is aligned as a "whole," while at the same time ensuring that the voices of its component "parts" are heard. While you will be learning more about this redesign in the coming months, I believe it is important to discuss two key aspects of the GWG's remarkable effort: the transparent and participatory nature of the process leading up to the Executive Council's approval last month, and two new resources that will help us meet our strategic priorities in the coming years.

The GWG began its work in June 2007 under the expert guidance of Dr. Richard Krugman as chair. Efforts to engage as many voices as possible (and to do so more than once) were extensive. As a key first step, members of our administrative boards and representatives from the professional development groups were asked to participate in a town hall meeting and also small discussion groups (which generated some very interesting conversations). Over the summer, these discussions were augmented by meetings with our membership (professional development group steering committees and council and organization administrative boards were consulted). By the fall of 2007, the basics for our new structure began to take shape. The fundamentals were presented to the council and organization administrative boards at our September governance meetings, and to the councils and several professional development groups at the 2007 AAMC Annual Meeting. Several months later, a basic model emerged and was agreed upon by AAMC leadership at the December officers' retreat. Finally, in preparation for the Executive Council meeting last month, the report was further vetted at this year's spring meetings.

From this highly participatory process came a set of six recommendations, including the concept of a 17-member board of directors to replace our current system of a 30-member Executive Council and 10-member Executive Committee. Membership of this board will include the AAMC chair, chair-elect, immediate past chair, and president ex officio; the chair and chair-elect of each of our three member councils; and seven at-large members (including a student, a resident, and a public member).

Additionally, in keeping with our fundamental principle of the centrality of medical education, the board will include at least five members who are, or have been, deans of medical schools. As you can see, these membership requirements are atypical of a "traditional" board structure. The GWG strongly felt (and AAMC leadership agreed) that the board's charge to provide "fiduciary oversight, strategic oversight, and generative thinking" on behalf of the association required a mix of skill sets not necessarily achieved by representational membership from councils and organizations alone. By providing for at-large members, the new board structure allows the flexibility to engage individuals whose skills sets are complementary to those of our leadership and constituency. (In fact, a presidential memorandum soliciting recommendations for these at-large seats will be sent to our constituency later this month.)

The second key resource developed by the GWG is a leadership forum that provides a robust channel for communications between AAMC governance and our varied affinity groups (see box for membership). These affinity groups will continue to parallel our academic medical centers and in keeping with our strategic priority to ensure diversity, will soon include a new Group on Diversity and Inclusion (which has been approved in principle).

It is important to note that the leadership forum is not a formal part of the governance structure (i.e., is not a "legislative" entity, but instead creates a process). In this respect, I view the forum as being emblematic of the work that led to its creation: transparent, participatory, and dynamic. It is my sincere hope this process becomes a means to ensure ongoing, deep, and cross-cutting discussion of critical issues such as conflicts of interest, physician workforce, student tuition and debt, and other matters that are vitally important to our missions.

Governance itself is a dynamic process, and while we are proud of the work we have accomplished this last year, we also realize that no structure is "perfect." We therefore have provided for a formal review in a minimum of five years. Though that may seem like a long time from now, it is never too early to consider questions such as the following:

• Does the new structure provide a greater sense of continuity?
• Is it viewed as being representative of the whole?
• Have we achieved a balance of skills and expertise?
• Do our professional development groups feel more energized and integrated?
• And, critically important, are we getting the best people in the right seats?

As we move to the next, and final, steps of the process (preparing and presenting for action by Executive Council and our assembly the necessary bylaws changes), I would like to extend my heartfelt thanks to our current governance, AAMC leadership, and all constituents who participated in the governance redesign. I also would like to extend my deep appreciation to Dick Krugman for his extraordinary leadership. The sum and whole of these efforts will make the AAMC far more than a collection of its component parts and leave us well-positioned for the future.

Darrell G. Kirch, M.D., AAMC President and CEO

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