The campaign to revitalize academic medicine kicks off. We need a deep and broad international debate to begin

Abstract

The British Medical Journal (BMJ) and a range of partners, including other journals published by the BMJ Publishing Group, Lancet, Canadian Medical Association Journal, Dutch Journal of Medicine, Medical Journal of Australia, Croatian Medical Journal, the Academy of Medical Sciences, and many others have initiated a project to bring people together to debate whether the existing structure of academic medicine is still fundamentally sound and, if not, to propose alternatives to it.1 I have taken on the challenge of coordinating this project, and I extend an invitation to readers all over the world to join me in this exciting enterprise. To achieve the project's broad goals (Table 1) we begin from the position that "more of the same" is not enough. We need to be free to propose radical changes to the fundamental nature of academic medicine (is the balance between bench and applied research all wrong?); its name (should it become "academic healthcare" or should we drop "academic"?); its home base (are hospitals the wrong place to train doctors?); its relation to service (why are they so often far apart?); its methods of training and certification (should medical education be lecture based and far shorter?); and its responsibilities (should it be held accountable for inequities in health care at the global level?). Our approach will be inclusive and is designed to ensure a broad input of opinions. Rather than allowing the process to be taken over by a few experts with vested interests, we will build consensus by inviting an exhaustive range of global stakeholders to contribute their views. We are especially interested in the views of the "customers"of academic medicine patients, politicians, practitioners, and the public. Anyone can contribute his or her views right now, today, as a rapid response to this article at bmj.com. In addition, our new project webpage is under development (www.bmj.com/academic medicine), and this will contain regular campaign updates, news, and collected resources. The proposed structure is as follows. The pivotal group will be an international working party whose composition will include knowledge and competency across the dimensions of global health and basic to applied healthcare research, representing the range of constituents (medical students, postgraduates, junior faculty, established academics-especially women). Supported by 4 advisory groups (Table 2) and made up of approximately 8 individuals, the working party will begin by answering four questions. Firstly, what are the roles of academic medicine? Secondly, how well is academic medicine carrying out these roles? Responses to the earlier BMJ editorial launching this initiative have already nominated a wide array of (but no clear consensus regarding) perceived failures, including failing to serve the public good, lack of a global perspective, an unnecessary dichotomy between education and research, various shortcomings in medical education, and inadequate numbers of and career paths for well-trained medical academics.2 Thirdly, why is academic medicine failing to fulfill its roles? Reasons might include inadequate leadership, a failure to translate basic discoveries into benefits for patients, inappropriate incentives to take up or maintain an academic career (especially among women), deficient mentoring for aspiring academics, lack of appreciation of the benefits of academic medicine by elected representatives, and poor integration with other health services. Many of the reasons will be economic the salaries and resources needed for research and teaching make academic medicine unattractive currently but we need to examine ethical and moral explanations as well. Finally, for each failure, what ought to be carried out regarding it? Given current economic constraints in countries with high and low income, special attention will go to strategies that call for no additional funding. We will, however, welcome strategies that call for the reallocation of current funding. At the policy level, we welcome strategies for how academic medicine can contribute to national and global health. These strategies will be combined and formulated into concrete proposals for action. We need your support and input. To nominate a member of the working party, join an advisory group, or register your experiences and views, send a rapid response to bmj.com or contact our project manager, Jocalyn Clark, at jclark{at}bmj.com. References 1.Academic medicine: resuscitation in progress. CMAJ 2004; 170: 309. 2.Clark J, Smith R. BMJ publishing group to launch an international campaign to promote academic medicine. BMJ 2003; 327: 1001-1002.