Symposia

Driving Change in Academic Medicine

Darrell Kirch, M.D., president and CEO, Association of American Medical Colleges provided perspective on the need for change in academic medicine.

Dr. Kirch emphasized the importance of focusing medical and health care education reform on the training of all professionals who work in the delivery of health care. Individuals who practice in any portion of care delivery are a vital part of the team approach to medicine and need to have a voice in the evolution of training.

Dr. Kirch noted that many buzzwords are associated with health care reform. One of these words is "change." He focused on two degrees of change:

• Incremental, which is usually considered good in academic settings, and
• Revolutionary, which encompasses broad change

Dr. Kirch proposed the need for a middle ground in education: transformational change. This involves sweeping, fundamental change that recognizes the tremendous good in the current system — especially the dedicated people.

A primary barrier to change, he noted, is true culture shift in medical and health care education. Dr. Kirch cited the 1910 Flexner Report as the last true culture shift in medical and health care education. Flexner emphasized an academic culture which has medical research at its core. While this is a valid foundation, Dr. Kirsh said that this focus has led to competition among individuals in research and practice.

A New Culture
Dr. Kirch discussed that today's patient expects teamwork in medicine. The current health care practice — which emphasizes individualism — is unsustainable, and there is broad recognition that teaching and learning have to be different. Health care professionals need to use information rather than retain information.

Dr. Kirch concluded his presentation by outlining five items for medical and health care education reform:

• First, health care systems and educational systems need to be partners. This involves training organizations that are accountable for developing value in the health care system.
• Second, the medical and health care training system needs to put aside culture and focus on training that meets the needs of patients.
• Third, medical and health care education schools must be increasingly transparent with financial and tuition information.
• Fourth, medical education must develop future leaders, building a bottom-up approach that focuses on teamwork and consensus.
• Fifth, the health care system must examine the factors that drive medical and health care education training. This must include the concept of justice in the health care system. Dr. Kirch emphasized that the current health care system is unjust or fundamentally unfair, which is not a political issue but a core ethical issue.