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AAMC Reporter: June 2006
A Word from the President:
"Make No Small Plans"
For the past 12 years, I've had the extraordinary privilege as president of your association to raise several issues that I felt were especially important for medical schools and teaching hospitals to address; especially important because of my conviction that a robust academic medical community — one that continually seeks to reach its full potential — is crucial for maintaining and improving the health and well-being of the society we are pledged to serve.
Academic medicine is, after all:
- The cradle from which future physicians emerge with the foundational knowledge, skills, and attitudes needed to fulfill medicine's social contract
- The wellspring of discoveries for advancing medical science and for improving human health
- The laboratory for evaluating the safety and effectiveness of new technologies and new models of care
- The haven for the sickest and neediest of our
fellow human beings
- The steward of the medical profession's noble
values, and hence,
- The very conscience of American medicine.
As this is my last presidential column, I want to take the opportunity to imagine what progress we might make over the next 12 years by surmounting some key obstacles still preventing us from realizing our full potential.
Twelve years from now, I hope we can look back and say:
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We've finished building medicine's bridge to
diversity. We have helped nurture the academic aspirations of youngsters from all racial and ethnic backgrounds. We've encouraged many more well-prepared minority students to apply to medical school. We've improved our admissions processes to better identify
the qualities of mind and spirit that predict success as
a physician. We've taken full advantage of the diversity of our learning environments to achieve a high level of cultural sensitivity among all students. And we've taken the lead in eliminating racial and ethnic disparities in health and health care.
- We've accepted the challenge of transforming our outmoded and obsolete health care system into one that is well-designed to meet contemporary needs and expectations. We've demonstrated in academic medical centers across the country how the health of communities and the quality of health care for individuals can be improved by:
- collaborating closely with the full spectrum of institutions and individuals involved in delivering care to a defined population
- coordinating chronic illness care using well-integrated teams of health care professionals
- fully implementing modern information technologies
- attending to system-level shortcomings in order to maximize patient safety and simplify the processes of care
- establishing creative partnerships with private and public insurers and with employers to craft financing mechanisms that eliminate disincentives to improve performance and that reward desired outcomes
- vesting responsibility and accountability for cost and quality with integrated systems rather than with "autonomous" individuals and institutions.
We've put the "E" firmly back in GME. Residents are recognized by all to be primarily learners, not workers. Residency curricula are driven primarily by the educational needs of the residents. Learning objectives are defined prospectively and reflect what practitioners in
a given field must be able to do to serve the actual needs of their patients. Residents achieve educational milestones by demonstrating their competency to perform essential tasks.
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We've secured passage of legislation that establishes an "all-payer" fund for financing graduate medical education. Policy-makers have come to realize through our advocacy efforts that medical education is
a public good and that ensuring a steady supply of
well-trained physicians from all socioeconomic strata
is a social and economic benefit that justifies broad public support.
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We've created a system of continuing medical education that is individualized and driven by measurement of a physician's actual performance in his or her practice. Academic medical centers have reasserted the medical profession's responsibility for the entire continuum of medical education; CME has been weaned from financial dependency on industry.
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We've greatly expanded medical school and GME capacity to meet the growing need for medical services. The physician workforce continues to be composed predominantly of LCME graduates. We have developed a system for ensuring that foreign medical schools still engaged in educating significant numbers of U.S. citizens meet acceptable standards for both basic science and clinical components of their curricula.
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We've established clear and appropriate guidelines
for managing individual and institutional conflicts of interest in all of our activities — research, education, and patient care. These guidelines have been adopted by all stakeholders and are uniformly observed. As a result, our critical partnership with the pharmaceutical and medical device industries once again enjoys the full trust of the public.
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We've secured a predictable and appropriate level
of federal support for medical research. Through
our effective and coordinated advocacy efforts, new
congressional champions for NIH have emerged, and the value of incremental investments in medical research is once again widely appreciated.
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We've reversed the previously inexorable upward trend in medical student debt. We've done so through a combination of reducing the cost of education, freezing tuition, and promoting vigorous alumni (and other) fundraising earmarked for scholarships.
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We've managed to convert our learning environments from crucibles of cynicism to cradles of
professionalism. We've done so by clearly articulating what constitutes acceptable professional behavior on the part of faculty, staff, residents, and students and by including assessment of professionalism (with appropriate feedback) in everyone's routine performance evaluations. And we've done so by not tolerating anyone's unprofessional behavior and by celebrating those who exemplify the qualities — e.g., honesty, integrity, compassion, respect — that we prize and wish to instill in all of our learners.
I recognize that these imagined outcomes may prove difficult to accomplish fully in the next 12 years. But I also recognize that aspiration is the engine of achievement. As Daniel Burnham, the driving force behind the Chicago World's Fair, is credited with saying: "Make no
small plans; they lack the magic to stir men's blood."
I urge you to make no small plans. Why not aspire to transform each of these imagined outcomes into a triumphant reality? In so doing, academic medicine will come ever closer to achieving its full potential. Isn't
that what we're supposed to be about?
Jordan J. Cohen, M.D.
AAMC President
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