Culture and the Courage to Change - Member Profile - AAMC

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Culture and the Courage to ChangeBut we also need to be honest about how the culture of academicmedicine has led to some very specific behaviors and structures thatmay no longer serve us as well as they did a decade or so ago, especiallygiven the future we face.“The descriptors I heard included words likeindividualistic, autonomous, scholarly, expertcentered,competitive, focused, high-achieving,and hierarchical.”In education, generations of medical educators have focused on theindividual accumulation of factual knowledge. But is this the best wayto create lifelong learners who have the skills to acquire and use dynamicallychanging and exponentially expanding information?On the research side, we have a history of training researchers to achievethe status of independent investigators, with the R01 standing asvalidation of their independence and expertise. But in a world ofincreasing research complexity, in which science is more and more interdisciplinaryand highly networked, just how well does this model ofautonomous investigators work?In our clinical practices, despite the fact that they have become hugehealth care delivery systems, we often persist in functioning like soloexpert specialists within them. But how can a loose collection ofspecialized experts ever achieve the clinical and operational coordinationneeded to create a seamless system delivering patient-centered care?We have lived in a culture in which our medical schools, laboratories,teaching hospitals, and faculty clinical practice plans often evolved asstructures designed first and foremost to support our autonomouspursuits. Perhaps most tellingly, we have held tenaciously to the grandtradition of rewarding the demonstration of combined independenceand expertise with that treasured status of tenure, the top rung of ourhierarchical professional ladder. And despite whatever struggles we6Association of American Medical Colleges
Culture and the Courage to Changeexperienced as individual faculty members, we affirmed this culture codeby taking enormous pride in our personal status as independent experts.If this culture of autonomy and individual achievement worked so wellfor us, just what is causing the negative reactions—ranging from justunder-the-surface unease to downright disillusionment—that Iencounter so often when I talk with our faculty colleagues?My theory is that we find ourselves in the middle of a major cultureclash. As we have grown our institutions—despite constraints in statesupport, NIH funding, and clinical reimbursement—we understandablyhave focused on strategies for generating new revenue while preservingour current structures and culture. But I would argue that, in doing so,we have failed to see how our changing environment is demanding thatwe adapt to a new, much different culture for academic medicine. Thereality is that, increasingly, the world around us is focused less on theachievements of individual experts, and more on collaboration betweenindividuals and groups to solve complex problems. The dilemma foracademic medicine may very well be that, while higher education andhealth care have held fast to their traditional individualistic culture, theworld has fundamentally changed.“The reality is that, increasingly, the world aroundus is focused less on the achievements of individualexperts, and more on collaboration betweenindividuals and groups to solve complex problems.”The evidence for this change is all around. In research, consider the NIHClinical and Translational Science Awards and other programs with anemphasis on teams of highly networked scientists and the open sharingof information. In clinical care, whether the setting is the intensive careunit or a newly configured “medical home” delivering primary care, thedriving concept is that patients want and need their ongoing care providedby a coordinated team, not a series of disconnected consultants. And in7Association of American Medical Colleges
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Culture and the Courage to Change - Member Profile - AAMC

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