AAMC President and CEO David J. Skorton, MD, today implored medical schools and teaching hospitals to lead the way forward to a healthier nation by confronting the long-term harm from the onslaughts of COVID-19, racial injustice, and social strife.
“The triple impact of a global pandemic, a severe economic downturn, and the unrelenting assault of systemic racism have made it impossible to ignore the truth: Our nation’s approach to health needs some serious rethinking,” Skorton told more than 4,600 medical professionals and scientists during the Leadership Plenary of Learn Serve Lead 2020: The Virtual Experience, the annual meeting of the AAMC.
“Now is the time to harness our collective energy, ingenuity, and innovation,” Skorton said. “Now is our time to act.”
Amplifying the call for fundamental change, Joseph Kerschner, MD, chair of the AAMC Board of Directors and dean of the School of Medicine at the Medical College of Wisconsin, also urged his colleagues during the plenary to reconceive how they support medical students and young doctors by listening to their perspectives, particularly around well-being, debt, and racial diversity.
“If we are going to participate in meaningful change, we need to take the time to listen and to reflect,” Kerschner said.
Skorton offers approach for action
Noting the “spectacular response” by the academic medicine community to repeated waves of the COVID-19 pandemic — including innovations in clinical care, research, and medical education carried out at once-unthinkable speeds — Skorton declared that “academic medicine has what it takes to lead the nation forward — because the path to healing our nation is by improving health for everyone living in America.”
“The pandemic has revealed a nation that, more than ever, needs what academic medicine can offer,” Skorton said.
He then posed a challenge: “How do we capture this innovative spirit and make even more significant changes to the other seemingly intractable problems that diminish health and well-being?”
Building on the theme of his plenary address last year that “the status quo is unacceptable,” Skorton declared that the need has grown even more urgent for academic medicine to confront the public health effects of conflicts and stressors that dominate American society.
Those stressors include political and social fragmentation — driven by the recent divisive elections — racism, and health inequities, he said.
“Sadly, we’re still not doing nearly enough to address racism and health inequities,” Skorton said. Noting that systemic racism affects social determinants of health, he stated that “it’s even more urgent today that we make steady and significant progress on what last year I called ‘diversity, equity, and inclusion’ — although today, I add the word ‘anti-racism.’”
Confronting these issues, Skorton noted, will require medical schools and university hospitals to go beyond their traditional three missions — medical education, clinical care, and research — to add a fourth component: community collaborations.
“We must do even more to make patients, families, and communities our utmost priority,” Skorton said. “That means not just delivering care, but engaging in two-way, ongoing dialogues” and working in partnership to address their needs.
He laid out three paths forward to address today’s challenges:
- “Stay focused on our most important constituents” — patients and their families. That means learning from and partnering with everyone in the communities that medical professionals serve.
- “Look in the mirror and see your own areas for improvement, as well as your institution’s.” That requires being accountable for making changes and tracking progress, specifically in addressing racism and gender inequities, mental health, substance use, and cost and access to care.
- “Contribute to the public discourse. Speak the truth about science and the importance of health equity at every opportunity.” That involves writing blogs and op-eds, engaging in social media conversations, and appearing in mainstream media outlets.
The AAMC has increasingly employed these strategies this year, Skorton said, noting that the association has been “speaking out more publicly, assertively, and broadly” on societal issues through news conferences and statements, media interviews, and op-eds.
In addition, the AAMC has produced resources to help academic medical institutions develop solutions, such as The Way Forward on COVID-19: A Road Map to Reset the Nation’s Approach to the Pandemic and the AAMC Framework for Addressing and Eliminating Racism at the AAMC, in Academic Medicine, and Beyond.
To demonstrate the association’s commitment to become an anti-racist organization, Skorton announced that the AAMC has renamed the Abraham Flexner Award for Distinguished Service in Medical Education, because although Flexner’s research recommended valuable changes in medical education, it also promulgated “racist and sexist ideas” that impeded the training of Black and African American physicians.
Skorton concluded by returning to his oft-repeated words: “Let’s do this together. This is our moment. Now is our time to act.”
Kerschner shows ways to listen
AAMC Board Chair Kerschner began his address by urging academic leaders to deepen their understanding of the needs and perspectives of their learners. Kerschner reflected on his own development in finding new ways to listen to students and act on what they shared.
“If you think you know the issues faced by our learners, but you haven’t specifically taken the time to talk and listen to learners — then you have some work to do,” Kerschner said. “If you know what the issues are and have discussed these issues with learners but haven’t actively engaged with them in forming solutions, then you really must ask yourself, ‘Why not?’”
Kerschner outlined three areas for academic leaders to pay particular attention to:
Learner well-being. Kerschner observed that despite improvements, “the overall levels of depression and distress for physicians … remains enormously high.” He urged hospitals and medical schools to “change our cultures” by increasing access to mental health resources, creating more flexibility for students and residents to complete their requirements at different paces, and continuously impressing upon students and residents the importance of self-care.
“Until we enable our culture to truly see those who are suffering, and remove negative connotations attached to this suffering and what is needed to support our colleagues, we will continue to risk our own and our colleagues’ mental health and wellness,” Kerschner said.
Student debt and transition to residency. Noting that the stress of student loan debt and the transition to residency affect the well-being of students and young doctors, Kerschner called for a national strategy to reduce the burden, particularly on low-income students. Increasing financial supports for those students would expand diversity among medical school classes, he said.
“How many students from less advantaged socioeconomic backgrounds are discouraged from even considering the field of medicine because … they learn of the overwhelming cost and debt that is required?” Kerschner asked.
Student diversity. The lack of racial diversity in medical schools is not only unjust but also harms patient care, Kerschner said.
“We know that racial concordance between patients and providers can contribute to better patient communication, satisfaction and trust — and that these attributes and others can provide at least a part of the solution to the lack of equity in health outcomes.”
He said medical schools must do more to ensure that their practices and policies combat racism, such as instituting anti-bias training for all faculty, staff, and learners.
Like Skorton, Kerschner challenged his fellow leaders in academic medicine to lead:
“For those of you in positions of influence, what have you done today, this week or this month to ensure greater diversity in your medical school’s student body? Will you, today, ask the question, ‘What is your institution’s anti-racist plan?’”
