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A Word from the President A Centennial Conversation Abraham Flexner Meets Jim Collins

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

This month, we begin a year-long celebration of the landmark report that transformed the general model of medical education, Medical Education in the United States and Canada, the famous Flexner Report. When you consider the profound changes in education, research, and health care over the last 100 years, I think you will agree that Abraham Flexner provided academic medicine with a model that has served us well and allowed our institutions to thrive.

This notion of institutional staying power made me think about a visionary of today and one of our most popular annual meeting speakers Jim Collins. Known for his provocative presentation style, Collins first burst onto the national scene in 1994 with his book Built to Last: Successful Habits of Visionary Companies, which explored why highly successful companies at least 50 years old were able to thrive. Imagine if Collins could meet and talk with Flexner about the staying power of academic medicine.

The scene: The nation's capital on a grey January day. Flexner and Collins meet for dinner at the Old Ebbitt Grill, a Washington classic, not far from the White House. Flexner, having strolled over from the Hay-Adams Hotel, is already seated when Jim Collins, Bluetooth in ear and BlackBerry in hand, races in from his cab. They shake hands, place their order, and even before cocktails arrive, Collins leans forward and says:

JC: Abe, your report has certainly withstood the test of time. You're good you're very good. But given the challenges before medical education today, can you and your model for academic medicine stay "great"?

AF: As you yourself have noted, greatness is an inherently dynamic process, not an end point. That being said, I must tell you how impressed I've been with academic medicine's ability these past 100 years to confront what you would call "the brutal facts," and to continually reexamine itself. For example, look at the shift these past few decades toward linking education to core objectives, and also outcome-based assessment. Fascinating! Consider the work being done by institutions to ensure institutional integrity and better manage industry relationships. Impressive! And how about the way physicians are becoming more "patientcentric" rather than "expert-centric"? Truly inspiring! These are examples of how academic medicine will continue its journey from good to great.

JC: I'm glad you mentioned that term "expertcentric." Do you think you might have placed too much emphasis on the centrality of the university (and in particular the European paradigm)? Under the old academic model that stemmed largely from your report, everything was based on individual achievement. Some might even argue your report gave rise to a culture that is counterproductive to 21st century needs.

Today, we live in a world in which knowledge is virtually exploding and needs to be shared at light speed, research is much more complex and interdisciplinary, and patient care is becoming more team-based and collaborative.

AF: Let me say, Jim, that my recommendations led to the superb system of medical education we have today and to generations of physicians deeply committed to society's health care needs. I think you can safely say my report is also responsible for aligning physician education with the university culture of discovery that has produced some of medicine's greatest breakthroughs. I focused on the university because I wanted to ensure that both medical education and clinical practice reflected the tremendous scientific achievements taking place in my day, and in days to come.

JC: Fair enough. But to keep your edge today, you need nimble organizations and a new kind of leadership. I made those points in my book, Good to Great. Do you think academic medicine is recruiting deans, CEOs, chairs, faculty practice executives, and other leaders who are focused on their organization's long-term needs? Are they ready to take personally risky or unpopular stances to make the right decisions "happen" for their organizations? In other words, are they what I call "Level 5 leaders"?

AF: I know where you're going with this, Jim. You want to know whether I think academic medicine is still recruiting "command and control" figures poorly suited for the challenges ahead. I say, go visit our campuses! You'll see senior leadership not only working interdependently, but collaborating to ensure alignment within the structures of their institutions and across all three mission areas. You'll sense their deep passion "first and foremost for the cause" to quote your book and also see their extraordinary ability to encourage and engage staff.

JC: Well, Abe, I've enjoyed our dinner together, but have a flight to catch at Dulles. Just let me ask you one last question. Surely you've heard how some think medical education should undergo another extensive reexamination that another Flexner report is needed...

AF: Ha! I have heard that! Well, Jim, I did the best I could given what I faced in 1910. But I don't think a new report is needed. There actually is considerable agreement within academic medicine about future directions. Medical schools and teaching hospitals know what they need to do in education, research, and patient care and understand the importance of remaining true to their core values as they do it. They also know the country faces unprecedented challenges, and that academic medicine cannot rest on its laurels. In contrast to my time, when much of medical education's foundation needed to be swept away, today we have a solid foundation upon which to build and use as the basis for transformational change in the entire health care system. We need action, not another report!

JC: Thanks, Abe. So glad we finally had the chance to meet! Let's get together again in the next century to see which of those academic medical centers "built to last" since 1910 end up being truly "great" in 2110. Until then, be well!

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