AAMC Reporter: March 2008

Viewpoint: "A Grand Challenge"

Steven L. Kanter, M.D., editor in chief, Academic Medicine; Vice dean, University of Pittsburgh School of Medicine

What if all of us with a stake in academic medicine worked together to create a list of the most important issues facing medical schools and teaching hospitals? What if we had a set of clear, concise, and compelling descriptions of current challenges to help guide our efforts in academic medicine? An effort to develop such a list is currently underway and I invite you to participate by visiting www.aamc.org/academicmedicine to contribute your response to the question, "What are the grand challenges in academic medicine today?"

As I noted in my first editorial, published in the January 2008 issue of Academic Medicine, "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."

Thus, the task before us is to develop a list of the most important challenges across the full spectrum of concerns in academic medicine, i.e., education and training, health and science policy, research practice, and patient care in medical schools and teaching hospitals.

Developing a list of grand challenges has the potential to provide a starting point for prioritizing the work of academic medicine and for creating a compelling rationale for essential political and financial support. Such a list could demonstrate the value of investing in problems that are potentially solvable within a foreseeable time period, accelerate work toward developing solutions to those problems, and call attention to important, but underfunded, problems. Such a list would have the potential to energize the academic medicine community; encourage faculty, residents, and students to think more broadly about the problems we face on a daily basis; add clarity and transparency to our thinking; highlight benefits to society; and attract young people to a career in academic medicine who are intrigued by complex, yet solvable, problems with the potential to improve the human condition.

Other disciplines have pursued the development of grand challenges as a means to stimulate innovative thinking and to accelerate progress. In 1900, the German mathematician David Hilbert, in an address to the International Congress of Mathematicians in Paris, outlined 23 major problems in mathematics. This set of problems influenced the work of mathematicians for the ensuing 100 years, and the process of solving those problems has led to the identification of important new challenges. More recently, the Gates Foundation used a grand challenges initiative to launch its efforts "to help researchers achieve the scientific breakthroughs needed to prevent, treat, and cure the diseases of the developing world."

This is an especially important time in the history of academic medicine to develop a set of grand challenges because it is a period of rapid change in medical schools and teaching hospitals. The pace of scientific discovery has yielded more information in the last decade than in all of history prior to that, the time for these basic findings to move "from bench to bedside" is shorter than ever before, technological advances are creating novel avenues for biomedical research, and the application of these "hi-tech" innovations to health care (e.g., robotic surgery, functional MRI) is leading to new and better therapies. However, these dramatic advances and unprecedented opportunities in patient care, research, and education are coupled with increased costs, decreased reimbursement, imperiled funding, and new regulatory requirements. In addition, new trends—such as academia-industry relationships and the development of other entrepreneurial endeavors—create a variety of new possibilities as well as new questions. The implications of these changes make it critically important to articulate the issues we face as problems that are solvable within a foreseeable time period.

Developing a list of grand challenges in academic medicine, which is publicly available, has specific and important benefits for the journal, Academic Medicine. This list could help guide the direction of the journal and could help authors, reviewers, and readers consider individual articles in the context of overarching, broad-based problems.

And so a list of grand challenges is important to us. After all, how can we advance the field of academic medicine and set the direction of the journal Academic Medicine if we cannot articulate the core set of grand challenges that face us today? A set of challenges, crafted well, has the potential to advance thinking, catalyze progress, and help us define the next set of challenges. I strongly encourage you to examine the growing list of "Grand Challenges" at www.aamc.org/academicmedicine, and to contribute your ideas about the most significant problems facing medical schools and teaching hospitals today. Also, I urge you to work with your professional societies and associations to contribute challenges that represent the interests of those groups. I will work with the editorial board and professional staff of Academic Medicine to synthesize and summarize contributed challenges and to update the list on this Web site. It is only through our collective efforts to engage in broad-based and creative thinking about the substantive ideas in every aspect of academic medicine that we will achieve the clarity we need to move forward.

Editor's Note: Kanter became the editor-in-chief of Academic Medicine Jan. 1. To read his Editor's Notepad, go to www.aamc.org/academicmedicine

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