AAMC Reporter: November 2007

A Word from the President:
"Crossing the Cultural Divide in Academic Medicine"

Last week, at our 118th annual meeting, I had the great privilege and honor of delivering my second president's address, and reflecting upon my first year as AAMC president. For me, it has been an extraordinary year of meeting more of our members, and seeing firsthand the passion for medicine that still runs strong and deep within our community.

But as I traveled across the country, I also detected an undercurrent of deeply conflicted feelings about our lives in academic medicine and felt strongly that I should talk about them in my annual meeting address which I titled Culture and the Courage to Change. It is my belief that these deeply conflicted feelings stem from our being in the middle of a major culture shift—one that is moving us away from the traditional, individualistic culture we have known for decades, to one that is more collaborative and teams-based, and focused on outcomes, transparency, and patient-centered care.

Understandably, a shift of this magnitude is wrenching to say the least. But the good news is that many of our institutions are successfully making this transition, and the even better news is that we have many "culture-shifting" tools and resources to help along the way.

In order to use these tools effectively, we must be truly open to examining the norms, behaviors, assumptions, and other elements that comprise the current culture of academic medicine. Additionally, we must be honest that this culture has led to some very specific behaviors and structures that may no longer serve us as well as they did a decade ago. But with culture so interwoven into our every activity, how do we "see" what norms, behaviors, and assumptions should be changed?

While we do not have a "culture meter," we do have survey tools like the AAMC Graduation Questionnaire, which shows how graduating medical students experienced their medical education, and importantly, how they felt they were treated along the way. By taking these findings to heart, we can begin to articulate core tenets of mutual respect, such as those found between teachers and learners in "The Compact Between Resident Physicians and Their Teachers."

To build trust at the organizational level, we can look to programs such as Team Works!—a set of structured workshops and peer consultation in a "safe" environment for institutional teams to train in collaborative problem solving. Additionally, to assure the kind of environment where leaders can foster trust and where teamwork thrives, we can model programs like the AAMC GME Leadership Development Course, which prepares Designated Institutional Officials for their multifaceted role.

These same trends can be seen in the culture shift occurring in each of our core missions. In education, we are embracing the view that physician competence requires an integrated continuum where learners acquire and use dynamically changing information over a lifetime. At a conceptual level, the new document, "Good Medical Practice-USA," provides guidelines for and expectations of the physician community that can help improve physician competence. On a practical, everyday basis, we are training students, residents, and physicians in the art of using learning portfolios to self-reflect and improve performance.

With regard to teaching, greater attention is being paid to career development for tenured and nontenured faculty, and educational scholarship is receiving increased recognition. Tools such as MedEdPORTAL (the AAMC Web-based repository of peer-reviewed teaching materials) and a new report based on a recent consensus conference by the Group on Educational Affairs, "Advancing Educators and Education: Defining the Components and Evidence of Educational Scholarship," can be used to support this change.

When we consider our research mission, we find the world around us has changed from one primarily focused on the achievements of individual investigators to one where science is more and more interdisciplinary, highly networked, transparent, and where information is openly shared. A prime example is the Human Genome Project, where interconnected teams of scientists across the globe not only worked together in mapping the entire human genome, but developed an open database that today serves as a community research resource. Today, the Human Genome Project continues to operate under similar data-sharing policies. Within the academic community, many institutions are engaged in teamwork and information-sharing through the National Institutes of Health Clinical and Translational Science Awards program. This program, in which 24 academic health centers currently participate, offers a valuable model for addressing complex research problems.

In clinical care, the culture shift is being driven by patients' clear demand and need for ongoing care coordinated by a team of physicians and other health professionals. Academic medicine, in many instances, has led the way with initiatives such as the Academic Chronic Care Collaborative, where interdisciplinary teams at 22 teaching hospitals and medical schools coordinated care for patients with diabetes, asthma, and other chronic conditions. These initiatives provide important foundational lessons in patient-centered care.

As we make this culture shift in academic medicine, it is important to note that we do not have to abandon every element of our traditional culture. On the contrary, we should fight to retain our commitment to overall excellence in service to our patients. Excellence is excellence, regardless of the way we get there.

While the tools I have described are powerful instruments supporting change, their mastery depends on our courage to use them. By understanding the positive potential of culture change, we can more effectively harness the passion that brought all of us to academic medicine initially. And by working collaboratively to build a better future, we can help everyone in the academic enterprise feel genuinely valued and fulfilled along the way.

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

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