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					Competition Meets
Collaboration: The
Transformation of
Academic Medicine

American Association of
Osteopathic Colleges of Medicine


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

June 29, 2007
•   An Historical Perspective
•   Reflections on the Nature of Change
•   Reaffirmation
•   Redesign
•   In Search of Transformation
•   The Way Forward
An Historical Perspective
An Historical Perspective
Factors Contributing to
A Sense of Crisis

•   Pressures on clinical revenues
•   The “hard landing” for NIH funding
•   The upward spiral of tuition and debt
•   “Privatization” of public institutions



        A time to recognize the transformational
               opportunity!
•   An Historical Perspective
•   Reflections on the Nature of Change
•   Reaffirmation
•   Redesign
•   In Search of Transformation
•   The Way Forward
Reflections on the Nature of Change
• Revolution
• Reaffirmation and Redesign
• Transformation
Adapted from: Collins and Porras, 1994
• An Historical Perspective
• Reflections on the Nature of Change
• Reaffirmation
• Redesign
• In Search of Transformation
• The Way Forward
Reaffirmation – Core Professional
Values for Every Physician


• Restating our values in oaths, charters,
  and compacts

• Aligning the formal and informal
  curriculum
Academic Medicine; June 1996
Reaffirmation – Core Competencies
for Every Physician

• Patient care that is compassionate, appropriate,
  and effective
• Medical knowledge
• Practice-based learning and improvement
• Interpersonal and communication skills
• Professionalism
• Systems-based practice
• An Historical Perspective
• Reflections on the Nature of Change
• Reaffirmation
• Redesign
• In Search of Transformation
• The Way Forward
Redesign – Creating a New
Culture in Academic Medicine


     “Culture eats strategy
       for lunch every day”


                - Andy Grove
                Former Chairman of Intel
Creating a Culture of Teamwork and
Collaboration
Creating a Culture of Reliability in
the Face of High Risk
Creating a Culture of Quality
Creating a Culture of Transparency
Creating a Culture of Trust
Creating a Culture Based on
“Evidence” Rather Than “Eminence”




   Issacs and Fitzgerald, BMJ 319: 1618, 1999
Creating a Culture in Which All Teach
and All Learn
The Old Academic Culture Versus
    The New Academic Culture
  Old Academic Culture    New Academic Culture


  • Autonomy              • Mutual goal-setting and
                          shared accountability
  • Independence          • Interdependence across
                          individuals and systems
                          • Group process and
  • Individuality
                          consensus
  • Narrow, focused
                          • Professional diversity and
  professional pathways
                          adaptation
  • Predictable career
                          • Creative pathways that
  trajectory
                          balance service and
                          scholarship
Redesign – Building New Models




           http://www.aamc.org/meded/iime/
A New Model of Teaching

From “one size fits all”…


  … to a “balanced portfolio” of teaching and
  learning methods.
A New Model – Capturing the Power
of Technology
A New Model – Simulation
A New Model – Standardized Patients and
Objective Clinical Skills Assessment
A New Model for the Faculty

From the increasingly elusive “triple
threat”…


       … to the “intensivist.”
A New Model for the Faculty – Emerging
“Academies” For Educators
A New Model for the Faculty –
Promotion and Tenure
A New Model for the Faculty –
Promotion and Tenure


We shouldn’t create tracks…


    …unless we create flexibility, reward
     productivity, and avoid inequities!
A New Model for the Organization


From the “ivory tower”…


       … to “high performance.”
A New Model for the Organization –
Aligning Revenues with Effort
                     Grants and
   Tuition and       Contracts      Physician and
  Appropriations                  Hospital Revenues




                   The Cauldron   Discretionary
                                      Fund




   Clinical Care                     Education

                     Research
A New Model for the Organization –
Teams
                                                                        High-
                                                                        performing
                                                                        Team
 PERFORMANCE IMPACT




                                                                 Real
                                                                 Team
                        Working
                        Group

                                                           Potential
                                                           Team
                                        Pseudo-
                                         Team

                                                            TEAM
                      Source: Katzenbach and Smith, 1993
                                                            EFFECTIVENESS
Adapted from: Collins and Porras, 1994
• An Historical Perspective
• Reflections on the Nature of Change
• Reaffirmation
• Redesign
• In Search of Transformation
• The Way Forward
New England Journal of Medicine; Sept. 28, 2006
Discontinuity in the Medical
Education Continuum


Premedical   Medical   Residency and   Practice
             School    Fellowships
In Search of Transformation – New
Models of Continuity for the Process


Premedical   Medical   Residency and   Practice
             School    Fellowships
   In Search of Transformation – New
   Models of Continuity for the People

  Premedical    Medical     Residency and   Practice   Life-long
                School      Fellowships                Learning


Two-Year Premedical       Medical Residency and   Practice Life-long
College                   School Fellowships               Learning


Non-Premed   Premedical Medical    Residency and Practice Life-long
Degree                  School     Fellowships            Learning



Pre-    Medical Residency and Practice Re-      Practice Life-long
medical School Fellowships             training          Learning
• An Historical Perspective
• Reflections on the Nature of Change
• Reaffirmation
• Redesign
• In Search of Transformation
• The Way Forward
The Way Forward
• Rejecting “ownership”
• Accepting “accountability”
• Alliances on a new level
      Association Matrix
                                  American Association of Colleges of Osteopathic Medicine

             American Osteopathic Association                          American Medical Association

     Federation of Association of Schools of the Health Professions      Federation of American Hospitals

                American Hospital Association
                                                         Federation of State Medical Boards
 American Council on Education
                                                                        University HealthSystems Consortium
Council of Medical Specialty Societies                      Association of Academic Health Centers


    Association of American Universities                                           Institute of Medicine


National Association of State Universities and Land Grant Colleges    American Association of Colleges of Nursing

Accreditation Council for Graduate Medical Education
                                             Education Commission for Foreign Medical Graduate
  National Association of Advisors for the Health Professions


            National Board of Medical Examiners
The Way Forward
•   Rejecting “ownership”
•   Accepting “accountability”
•   Alliances on a new level
•   Moving to a new form of leadership
The Way Forward
•   Rejecting “ownership”
•   Accepting “accountability”
•   Alliances on a new level
•   Moving to a new form of leadership
•   Reaffirming the missions of academic medicine
    as a public good
Reaffirming the Missions of
Academic Medicine as a
Public Good!

				
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