Culture and the Courage to Change - Member Profile - AAMC

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Culture and the Courage to Changeour core mission of education, we now understand that attainingcompetence as a physician requires an integrated learning continuum,not a discontinuous assortment of independent lectures and tests.The code words of this new culture of academic medicine are verydifferent. When I asked my colleagues to think of single words or phrasescapturing what our culture code needs to be, they offered descriptors likecollaborative, transparent, outcomes-focused, mutually accountable, teambased,service-oriented, and patient-centered. To put it in simplest terms,when most of us entered academic medicine, it was all about achievingyour “personal best.” Now it has become the quintessential “team effort.”If culture is made up of the complex web of values, assumptions, norms,behaviors, and rituals pervading an organization, a major change in culturecan be wrenching, to say the least. Increasingly, I believe that the root causeof much of the discontent heard in academic medicine is a direct expressionof the dislocation we are experiencing in trying to move from a culturefocused on autonomy, competition, and individual achievement to one thatvalues collaboration, shared accountability, and team performance.“...our culture code needs to be...collaborative,transparent, outcomes-focused, mutually accountable,team-based, service-oriented, and patient-centered.”Imagine the reaction of a faculty member who started his or her careerfocused intensely on personal achievement and building an impressivecurriculum vitae, but who now finds that the emphasis has shifted tobeing a collaborative component of a research network? What about theteachers who no longer feel that they each have a personal set of lecturesthat they independently “own?” Imagine being a department chairgoing from a world in which the individual departments and sectionsare independent boats expected to float on their own financial bottoms,to a world in which the finances of the entire center are open informationand managed as an integrated whole. How does it feel when8Association of American Medical Colleges
Culture and the Courage to Change“Just as it requires courage to leave one countryand emigrate to a new one, it is going to takecourage for all of us in academic medicine, asindividuals and as institutions, to embrace ournew culture.”core organizational values change from competition to collaboration,from autonomy to interdependence, from private focus to transparencyand sharing of information and resources, from personal control totrusting one another? For many of our colleagues in academicmedicine, it must feel bewildering, like the rules have changed in themiddle of the game. In that light, it becomes much easier to understandthe distress so many of our colleagues express. They entered a world ofacademic medicine built around one culture, and now are asked toembrace a very different culture. No wonder so many of us express adesire to return to the “good old days.”This is where we come to courage. Just as it requires courage to leaveone country and emigrate to a new one, it is going to take courage for allof us in academic medicine, as individuals and as institutions, toembrace our new culture.While any change of this magnitude can be expected to engender a realsense of loss, there are three facts in which we can take great comfort.First, this change in culture is not only possible, it is actually wellunderway at many of our institutions. Second, we should realize thepotential for enormous personal fulfillment in a new kind of culture.Last, and most important, we do not have to abandon every element ofthe traditional culture of academic medicine. In fact, we should fight toretain our commitment to overall excellence, even as we shift fromdoing this as individuals to doing so in a new collaborative context.Excellence is excellence, regardless of how we get there.9Association of American Medical Colleges
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Culture and the Courage to Change - Member Profile - AAMC

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