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A Word From the President: The Excellence Around Us

AAMC Reporter: November 2011

AAMC President and CEO, Darrell G. Kirch, M.D. Who among us has not checked to see where our institution falls in the various rankings lists? A recent summit hosted by one of our member institutions about the popular U.S. News and World Report rankings showed agreement among medical school deans, even those representing highly ranked institutions, that these “best-of” lists distract us from the important work of carrying out our individual missions.

As I noted in my address at the AAMC Annual Meeting earlier this month in Denver, five years of visits to AAMC member institutions have convinced me that we are breaking free of the trap of judging ourselves and our peers on metrics arbitrarily defined by others. From our longest-established and best-known institutions, to our newest medical schools, I see our members creating and demonstrating a new excellence in medical education, research, and patient care.

For example, at nearly every campus I visit, I see medical schools redesigning and rethinking the medical school admissions process so that we not only admit the brightest applicants, but also the ones who have the potential to be the best physicians. Across the country, medical schools are finding better ways to identify the best through innovative new approaches, such as the “Multiple Mini-Interview” (MMI), which allows us to probe dimensions ranging from an applicant’s response to novel situations to their reaction to an ethical conflict. Currently, 28 of our member schools in the United States and Canada use the MMI in their student selection process.

To support this new approach to assessing future doctors, an AAMC-appointed committee of medical education experts has worked for three years to shape the next version of the MCAT® exam that embodies a new approach to the scientific and analytic competencies for a physician in the 21st century, from molecular biology to the social and behavioral sciences. The new MCAT exam, and other supportive tools being developed by the AAMC, including a restructured AMCAS application and a new format for letters of recommendation that focus on the pre-professional attributes most important in future physicians, will bring us much closer to a truly holistic approach that identifies the “best and brightest” physicians of the future.

As one who spent a significant portion of his career at the National Institutes of Health, I am deeply committed to its role as a catalyst of historic scientific advances. That being said, I also know that the excellence of a research institution is not primarily a function of its size, but rather of its quality, as reflected in the success of specific individuals and teams in the peer review process and the impact of their work. Similarly, while medical education requires sound scientific foundations and a milieu that embraces the value of research, excellence in medical education is not a direct function of the total size of the research institute next door.

In the world of the new excellence, the results of our research and education efforts increasingly will be judged by their ultimate relevance to the overall improvement of health. That is why it is gratifying to see new collaborations emerging that explicitly seek to achieve that goal. One example is the HOMERUN initiative in which the AAMC is working with hospitalists from 15 health care systems to help them form an implementation research network, capable of measuring what works for whom, when, and then evaluating interventions to improve hospital care.

Turning to our patient care mission, rankings that examine patient volume or the number of services available at an institution confer no guarantee that the quality of care is the best. Nor is a ranking based on reputation a quality guarantee. Clinical quality cannot be presumed. It has to be demonstrated, especially in the current economic environment where academic medicine is rightly being asked to justify the public support it receives. To improve clinical quality and patient safety, more than 250 AAMC members are participating in the Best Practices for Better Care (BPBC) initiative. Unlike other quality and safety initiatives, BPBC not only includes a clear commitment to improve performance on a number of core clinical quality and safety measures, it also involves an equal commitment to align our research and educational enterprises with those efforts. Only academic medical centers have the ability simultaneously to work on improving clinical quality, while also scientifically studying our efforts and teaching evidence-based best practices to the next generation of clinicians.

The metrics upon which today’s ranking systems are based tell us nothing about whether medical schools are producing good physicians. Nor do rankings tell us whether we are keeping patients well and out of the hospital, or if our research enterprise is operating at its full potential and contributing to the health of communities. For academic medicine, the new excellence is not about size growth or public relations. It is about locally defined commitments to fulfilling an institution’s specific mission and to demonstrating real outcomes from those commitments. So, the next time a rankings list hits the newsstands, let us judge our success not by these numbers, but by how well our education, research, and patient care improves health and how well we serve the communities at our front doors.

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