CAS Spring 2008 - New Orleans AAMC Fall 2008 - San Antonio
Greetings from your CAS representatives
In this update, we are reporting on two meetings: the Spring CAS meeting held in New Orleans, and the Fall AAMC meeting in San Antonio. It was a busy Fall meeting with record attendance ( over 4,200) with the theme of “Creating a Better Tomorrow”. Advances in Medical Education, concern about conflict of interest, vitality of Academic Health Centers, and quality health care for all continue to be at forefront of the agenda of the Fall meeting. Much of the Spring CAS meeting was devoted to understanding and addressing the challenges of a redesigned USMLE testing process. Highlights of the meetings are available on the AAMC website at www.aamc.org.
President Darrell Kirch in his Presidential address posed “The Tough Questions” facing Academic Health Centers, Medical Education and the Health Care System:
How do we achieve freedom from conflicts of interest?
How do we address the disparity of resources among our institutions and the economic inequality among medical specialties?
How do we find true balance in our missions of education, research, and patient care?
How do we achieve flexibility and responsiveness in preparing a new generation of doctors?
How do we lead improvements to health care quality?
Dr. Kirch challenged the leaders of the nation's medical schools and teaching hospitals to bring change to academic medicine by confronting these five "tough questions" related to medical education, research, and patient care. He urged academic medical centers to “… take responsibility for answering the tough questions we have been avoiding in academic medicine." On the question of balance of mission, Dr. Kirch questioned why we tolerate imbalance or misalignment between clinical and academic mission and suggested “it is time for us to develop a new business model for medical schools that does not rely on keeping more and more clinicians on a treadmill”.
A “Focus Session” addressed working conditions in Academic Medical Centers asking “Is Your AMC a Great Place to Work?”. Increased demands on academic medical faculty have raised awareness about faculty satisfaction and vitality, in part because of the demonstrated empirical link between job satisfaction and retention. Overall, 10% of faculty leave academics for good, 40% leave for another institution. Suggestions for possible solutions to improve retention included advocacy of Chairs, improving morale through Dean’s actions, stronger mentoring, more creative compensation approaches (tuition waivers for families, availability of free or lowcost child care), appropriate revisions of P&T guidelines, and creating and recognizing collaborations and partnerships, evidence-based recognition of excellence. Recent studies show significant differences between men and women in satisfaction with opportunities for promotion of faculty. The data are available at http://www.aamc.org/data/aib/aibissues/aibvol8_no7.pdf. A recent publication in Academic Medicine 80:980-89, 2005 discusses this issue and a new AAMC initiative is being planned to raise awareness of this issues. Watch for more on this initiative titled “Faculty Forward: Alliance for Advancing the Academic Medicine Workplace”. In related news, the AAMC has issued an "Analysis in Brief" on "Differences in U.S. Medical School Faculty Job Satisfaction by Gender." The briefing concludes that "the overall dissatisfaction in some areas of faculty promotion, pay, and compensation, and the significant differences in levels of job satisfaction between men and women warrant continued work in both institutional policy and practice to create equitable environments that maximize the satisfaction and vitality of all faculty." <http://www.aamc.org/data/aib/start.htm>
At the Robert G. Petersdorf Lecture, Dr. Alan I. Leshner, CEO, American Association for the Advancement of Science discussed “Science and Society”. He emphasized that for the scientific field to advance, it must have support from society at large. As such, it is critically important that researchers communicate the benefits of scientific progress. Leshner introduced the term "glocal," or bringing a global issue to a local level so that lay people can better understand how this scientific topic can help them individually. He suggests that the public are generally interested in and supportive of science but struggle where science and values are in conflict, such as stem cell research, evolution vs intelligent design, new genetics, and the nature of the mind and soul. Leshner endorsed an assertive strategy of public education and engagement by scientists, scientific societies and academic centers. He urged scientists and physicians to be involved in community and neighborhood groups, doctor’s offices, and local schools. He suggested train researchers how to talk to the public and how to reach out students in more effective ways. A website is available at http://communicatingscience.aaas.org.
The dilemma of Conflict of Interest was discussed in several sessions. Repeated themes were that: 1) both the public and congress are skeptical about conflict in Academic Medicine related to health care and research; 2) there is scientific evidence that even the smallest inducements may impact rational decisions by well-intentioned professionals; and 3) Academic Medical Centers need to show leadership and provide the standard. While interactions and partnerships with industry are vital for clinical and research missions, at the same time, public expectations that the integrity of our missions is not compromised by these relationships have never been higher. Leaders from three institutions, Stanford University, University of Pennsylvania, and University of Pittsburgh, described the implementation of policies to manage COI. General categories included banning of small gifts, prescription drugs, scholarships and food; no direct funding of CME; full disclosure of equity in drug and devise companies; and establishment of infrastructure to monitor and enforce compliance.
Both the Fall and Spring meetings provided updates on the pending restructuring of the USMLE competency exams. The new exams will consist of two “gateways”, one to determine competence to work under supervision and a second to conduct unsupervised practice with an unrestricted license. The primary purpose of the exam is to support and inform decision processes of state licensure boards. Three area that continue to receive attention and were described as “principles” of the exam were competencies in Information Technology, continued focus on Clinical Skills, and working on cost benefit ratio of the exam system. The proposed changes are entering the final phases adaption, with discuss and potential approval of the NBME Board and Delegates scheduled for March and April of 2009, respectively. Predictions (speculation) by the President of NBME, Donald E. Melnik, suggested changes in exam content in 2-4 years (such as IT, systems-based practice, and a shift to integration of basic and clinical science), revised sequencing of the testing process in 3-6 years, and implementation of the two-gateway model in 5-7 years.
Other front burner issues include increasing student debt, eroding support for teaching hospitals and physicians, strategies for sustaining NIH funding, and creating diversity in the physician training programs.
The three year process of restructuring AAMC Governance is nearing completion. The Assembly of the AAMC meet in San Antonio. Two issues were presented for vote by the Assembly: 1) a new set of by-laws to implement recommendation of the Governance Working Group, and 2) election of at-large members of the Board of Directors. The recommendations of the GWG and the by-laws have been accepted previously by the Executive Council. The Assembly approved both the by- laws and the at-large members. A Major change in the Governance structure are the replacement of the Executive Council by a Board of Directors with broader inclusion of representation from the various “Groups” that have evolved since the previous review.