BMJ  2004;329:751-752 (2 October), doi:10.1136/bmj.329.7469.751

Editorial

Who cares about academic medicine?

This theme issue provides some answers

The reaction to the campaign launched by the BMJ and its partners several months ago^{1 2} suggests that academic medicine needs resuscitation.^{3 4} But is it worth saving?

The academic medicine campaign aims to develop a vision and set of recommendations for reforming academic medicine in the 21st century. Driven by an international working party, it gives high priority to incorporating the perspectives of the chief customers of academic medicine—patients, policy makers, and practitioners—through a series of stakeholder and regional consultations. The campaign also supplies an opportunity to question the global relevance, responsibilities, and scope of academic medicine: Who is it for? Why does it matter? How best to invest in its future? Articles in this theme issue (including two from the working party (pp 787, 789)) discuss these questions and identify the challenges facing the campaign.^{5 6}

Challenges

The first challenge is the impression of "been there, done that." The message that not enough money and not enough talent are flowing into academic medicine is hardly new and is common to many countries. Throwing more money at such problems is unlikely to produce meaningful or sustained change, so simple calls for increased funding may fall on deaf ears. As Fox has argued, before resources will flow it is important to re-establish the "story" that persuades policy makers—and the public they represent—of the critical contribution of academic medicine.⁷

That story is being woven by international tellers. One strength of the campaign is its international compass, seeking to highlight both the perceived problems and some best practices in successful reform around the world. In this issue Schmidt and Duncan discuss the case of Brazil, where a public health system has harnessed academic support to promote innovation and the translation of knowledge into effective health actions (p 753).⁸ Sewankambo, drawing on his experience in Uganda, links the contributions of academic medicine to strengthened health systems with the overall aim of improving population health (p 752).⁹ He argues that academic activities must have both local relevance and potential for North-South partnerships. Such partnerships between academic medical centres in developed and less developed countries will enable both to contribute to redressing global health problems and inequity.

But the global reach of the campaign leads to the second challenge. Thinking globally demands a needs based approach—that is, focusing on the relationship between academic medicine and the public, especially patients—because health systems differ so greatly from place to place. As one of our supporters, Michael Drake from the University of California, has argued, an attractive byproduct of such an approach is that it will illustrate the great distance that lies between academic medicine and the actual health needs of much of the world's population. But how do we encourage this approach in the architects and governors of academic medicine for the 21st century?

How to foster leaders

Thirdly, much talk has been given to enticing the best and brightest to embark on careers in academic medicine. The Association of American Medical Colleges has asserted that academic medicine needs "deans and chairs who conceptualize their work as values-based and collaborative and who will build the consensus and garner the resources necessary for medical schools to become better learning organizations." But Lamp and Seale's qualitative study within a medical school shows that competition rather than cooperation is the defining feature of medicine (p 770)¹⁰—hardly the training ground for globally conscious academics. And what of the leadership needed to forge better protection for the unique threats to the academic freedom of clinicians? Wright and Wedge discuss the competing and sometimes conflicting values held by academics with both university and hospital roles (p 795).¹¹

Fourthly, academic medicine must position itself as one aspect of the global health workforce crisis¹² but recognise that there are broader issues than merely improving career paths. Reichenbach and Brown argue that an explicit focus on gender equity (fairness and justice) rather than gender equality (equal numbers of women and men) is needed to revitalise academic medicine, strengthen the health workforce, and improve public health (p 792).¹³

The time is ripe to question the role and ability of academic medicine to respond to global health challenges. Undoubtedly academic support is needed to develop and identify the innovations that can be translated into health actions throughout the world. But inadequate incentives and insufficient leadership within academic medicine threaten the assumption of those global responsibilities. Does academic medicine care?

BMJ, London WC1H 9JR (jclark{at}bmj.com)

Institute of Population Health, University of Ottawa, Ottawa, ON, Canada K1N 6N5 (elacasse{at}uottawa.ca)

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Competing interests: See http://bmj.com/cgi/content/full/327/7422/1001 (for JC) and http://bmj.com/cgi/content/full/328/7440/597/DCI (for PT).

References

1. Clark J, Smith R. BMJ Publishing Group to launch an international campaign to promote academic medicine. BMJ 2003;327: 1001-2.[Free Full Text]
2. Tugwell P. The campaign to revitalise academic medicine kicks off. Lancet 2004;363: 836.
3. Academic medicine: resuscitation in progress. CMAJ 2004;170: 309.[Free Full Text]
4. Underwood T. Academic medicine: what's in it for me? studentBMJ 2004;12: 350.
5. International Working Party to Promote and Revitalise Academic Medicine. ICRAM: agenda setting. BMJ 2004;329: 787-9.[Free Full Text]
6. International Working Party to Promote and Revitalise Academic Medicine. Academic medicine: the evidence base. BMJ 2004;329: 789-92.[Free Full Text]
7. Fox DM. From piety to platitudes to pork: the changing politics of health workforce policy. J Health Politics Policy Law 1996;21: 825-44.
8. Schmidt MI, Duncan BD. Academic medicine as a resource for global health—the case of Brazil. BMJ 2004;329: 753-4.[Free Full Text]
9. Sewamkambo N. Academic medicine and global health responsibilities. BMJ 2004;329: 752-3.[Free Full Text]
10. Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching. BMJ 2004;329: 770-3.[Abstract/Free Full Text]
11. Wright JG, Wedge JH. Clinicians and patients' welfare: where does academic freedom fit in? BMJ 2004:329: 795-6.[Free Full Text]
12. Narasimhan V, Brown H, Pablos-Mendez A, Adams O, Dussault G, Elzinga G, et al. Responding to the global human resources crisis. Lancet 2004;363: 1469-72.[CrossRef][ISI][Medline]
13. Reichenbach L, Brown H. Gender and academic medicine: impacts on the health workforce. BMJ 2004:329: 792-5.[Free Full Text]

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