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Print This Article Editorial The Future of Academic Medicine Ana Marušić Croatian Medical Journal Note: This editorial was prepared from the published articles Zagreb University School of Medicine, on ICRAM activities and the Power Point presentation on Zagreb, Croatia the five scenarios of futures of academic medicine in 2025, prepared by Dr Jocalyn Clark, British Medical Journal. The presentation of the scenarios was used by the author of this editorial for lectures on several occasions, including the Sym- Corresponding author: posium on “Gefährdung der univerisitären Medizin”, Neue Ana Marušić Universität Heidelberg, 22 July 2005; 10th “Grazer Konferenz” Salata 3 on “Curriculum Development as an Ongoing Process” in Vi- 10000 Zagreb enna, 11-13 May 2006; and the Symposium on “Ethics and Croatia Medicine: Today and Tomorrow” in Zagreb, 24 November e-mail: ana.marusic@agram.mef.hr 2006. Received: 05. 09. 2006 Key words: Education, Medical; Schools, Medical; Biomedical Accepted: 25. 09. 2006 Research; Evidence-Based Medicine; Bosnia-Herzegovina. Academic medicine is usually defined as a cal Sciences in the UK, published in 2002 triad of teaching, research and practice in its report “Clinical Academic Medicine in medicine (1, 2). More broadly, it can be de- Jeopardy: Recommendations for Change”; fined as the “capacity of the health-care sys- and the American Association of Medical tem to think, study, research, discover, eval- Colleges released in 2004 their analysis of uate, innovate, teach, learn, and improve” medical education system in the USA, en- (3). Although these attributes of academic titled “Educating Doctors to Provide High medicine make it crucial for the improve- Quality Medical Care: A Vision for Medical ment of health, there are many voices in the Education in the United States” (3). academic medical community that worry Editors of medical journals, which are about the future of academic medicine (3). an important part of academic medicine, Many national and professional bodies in have also become aware of the problems in medicine discussed this problem and es- academic medicine, and decided to promote pecially the many deterrents to pursuing a the discussion about the future of academic clinical academic career for young physi- medicine at the beginning of the new mil- cians. For example, the Academy of Medi- lennium. BMJ, Lancet, and 40 other jour- 1 Acta Medica Academica 2006;35:1-8 nals, including the Croatian Medical Journal the ICRAM Working Party used different (1, 4), in 2003 launched a global initiative methodology: a) systematic reviews of the to develop a new vision for the place of aca- research on different aspects of academic demic medicine in the global community. medicine, b) regional meetings with aca- The first result o this initiative was the for- demics from different areas to assess local mation of the ICRAM – the International specificities and needs, c) consultations with Campaign to Revitalize Academic Medicine all stakeholders in academic medicine, and (5, 6). The goal of this campaign was to offer d) discussing and developing vision and val- young medical academics an opportunity to ues of academic medicine in future. think about the future of academic medicine So far, four systematic reviews were con- in a novel way and globally. ducted by the ICRAM members (Sharon ICRAM is run by a working party of 20 Strauss from Canada, John Ioannidis from medical academics (Table 1), nominated by Greece, and I from Croatia) and their col- colleagues from their academic communi- laborators: 1) patient outcomes in academic ties. They represent 14 countries, half of vs. non-academic health institutions (16); 2) the members are women, and half of them role of mentoring in academic medicine (17); come from medium or low income coun- 3) career choices in academic medicine (18); tries. The ICRAM Working Party is chaired and 4) funding of clinical research (19). by the Leader of the Campaign, Prof. Peter To increase awareness of medical students Tugwell from the Centre for Global Health and young physicians about possible careers at the University of Ottawa, Canada; and the in academic medicine, Gretchen Purcell, Campaign Coordinator is Dr Jocalyn Clark, ICRAM Working Party member from the Assistant Editor at the BMJ. (Table 1.) USA, published a series of articles in the BMJ As the contribution to the ICRAM, the Career Focus (http://careerfocus.bmjjournals. Croatian Medical Journal published a series com/), presenting exceptional individuals of 23 essays on academic medicine, both who chose careers in academic medicine from the developed countries (7, 8) and and their advice to aspiring academics. developing and newly emerging countries Members of the ICRAM Working Party (9-14). These challenging and thought-pro- also convened advisory groups of different voking articles from experts coming from 20 stakeholders, as well as seven regional meet- different countries all over the world were ings, modeled after the regions of the World published as a separate book (15). Health Organization. ICRAM Goals and Activities Scenarios on the Future of Academic Medicine The goal of the ICRAM Working Party was to produce a series of evidence-based recom- Working on the visions and values of aca- mendations for reform in global academic demic medicine, revealed many differences medicine by developing a vision and values in opinions among the members of the of academic medicine, discuss strategies for Working Party (3). We could not agree on building capacity of academic medicine, in- the values of academic medicine: was it to cluding better career paths, and proposing compete (to earn more) or to provide public how academic medicine could improve its service. We also disagreed on the role of the relationships with other stakeholders – pa- private sector, especially the pharmaceutical tients, policy makers, funders, and health industry, and its importance for academic practitioners (5, 6). To reach these goals, medicine of today and tomorrow – would 2 Ana Marušić: Future of Academic Medicine Table 1 . Members of the International Campaign to Revitalize Academic Medicine, ICRAM (4) Peter Tugwell, University of Ottawa, Institute of Population Health, Ottawa, Canada Leader of the Campaign Jocalyn Clark, Assistant Editor, BMJ, London, UK Campaign Coordinator ICRAM Working Party Members: Tahmeed Ahmed Clinical Sciences Division, ICDDR, Dhaka, Bangladesh Shally Awasthi Department of Paediatrics, King George’s Medical University Lucknow, India Mark Clarfield Department of Geriatrics, Soroko Hospital, Ben Gurion University, Beersheva, Israel Lalit Dandona Centre for Public Health Research, Administrative Staff College, Hyderabad, India Amanda Howe School of Medicine, University of East Anglia, Norfolk, UK John Ioannidis Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece Edwin Jesudason Department of Child Health, University of Liverpool, Liverpool, UK Juan Manuel Lozano Department of Pediatrics and Clinical Epidemiology, Javeriana University, Bogota, Colombia Youping Li Chinese Cochrane Centre, West China Hospital, Chengdu, China Ana Marušić Department of Anatomy and Croatian Medical Journal, Zagreb University School of Medicine, Zagreb, Croatia Idris Mohammed Department of Immunology and Infectious Diseases, University of Maiduguri, Maiduguri, Nigeria Gretchen Purcell Department of Surgery, Pittsburgh Children’s Hospital, Pittsburgh, IL, USA Karen Sliwa-Hähnle CH Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa Sharon Straus Department of Medicine, Toronto General Hospital, Toronto, Canada Tessa Tan-Torres Edejer Department of Health Systems Financing, Expenditure and Resource Allocation, WHO, Geneva, Switzerland Tim Underwood Cancer Sciences Division, University of Southampton, Southampton, UK Robyn Ward Department of Medical Oncology, St Vicent’s Hospital, Darlinghurst, Australia Michael Wilkes School of Medicine, University of California Davis, Davis, CA, USA David Wilkinson Mayne Medical School, University of Queensland, Brisbane, Australia business interests threaten or save academic moil about the Future of South Africa (16), medicine? the vision of AIDS problem in 2025 by UN- In such a deadlock, we decided to use the AIDS (17), or the future of patient-centered methodology of scenario building, which care in 2015 by Picker Institute (18). is often used by commercial companies for When several ICRAM Working Party short-term decision making and long-term members met in London on the 7th to the strategic planning. In the process of scenario 9th February 2005 to work on the scenarios, building, alternative futures are developed I thought that we would do our job very as credible stories which are not predictive quickly – we would sit down and write how but are plausible. Building such scenarios we imagine the future. However, we soon helps to stretch thinking about the future, learned that scenario building is structured allows richer conversations, and addresses process, requiring team work and exploring conflicts, disagreements, dilemmas and di- different perspectives, including the consid- vergent opinions. erations of instabilities of the present and Scenario building has proven useful not the drivers for the future. Among the main only for planning business strategies but instabilities we identified in the present aca- also in different situations and settings, such demic medicine (3, 23), the most prominent as the Mont Fleur scenarios undertaken in were the unsustainability
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