Search

Leadership development is vital to the future of medicine. Some leadership development may take place through the formal curriculum of the medical school, yet extracurricular activities, such as student government and affiliated student organizations, can provide additional, highly valuable leadership development opportunities. These organizations and their missions can serve as catalysts for students to work with one another, with the faculty and administration of the medical school, with the community, and with local, regional, and national organizations. The authors have organized this discussion of the leadership development potential of student organizations around six important principles of leadership: ownership, experience, efficacy, sense of community, service learning, and peer-to-peer mentoring. They provide practical examples of these leadership principles from one institution. They do not presume that the school is unique, but they do believe their practical examples help to illuminate the potential of extracurricular programs for enhancing the leadership capabilities of future physicians. In addition, the authors use their examples to demonstrate how the medical school, its surrounding community, and the profession of medicine can benefit from promoting leadership through student organizations.

This article provides historical background on Henry S. Pritchett, first president of the Carnegie Foundation for the Advancement of Teaching (CFAT), analysis of his introduction to Abraham Flexner's 1910 report on medical education, and discussion of the major role that Pritchett played in conceiving the study on which the Flexner Report is based and his advocacy of the report's findings. The authors examine Pritchett's career as a scientist, scholar, and administrator. A textual analysis of the introduction to the Flexner Report demonstrates Pritchett's unique contributions to the report and how they complement Flexner's perspectives and conclusions. Finally, the authors discuss the significance of Pritchett's introduction, his rhetorical choices, and Pritchett's and CFAT's subsequent advocacy activities to improve medical education.

The story of Abraham Flexner's role in the founding of the Institute for Advanced Study in Princeton, New Jersey, offers important insights into Flexner himself and valuable lessons for contemporary leaders in academic medicine. The authors review this remarkable achievement along with Flexner's other accomplishments in the 49 years he lived after the 1910 publication of his report on medical schools in the United States and Canada. Lessons include his approach to philanthropy, his determination and networking, his belief in the synergism between the natural sciences and the humanities, and his regard for learning as a lifelong process. Flexner's record was not unblemished, however, and the cases in which he faltered also offer important lessons for today's academic leaders.

The authors celebrate the 30th anniversary of Lewis Thomas's provocative essay, "How to Fix the Premedical Curriculum," by reexamining its three central themes: the influence of medical schools on undergraduate education, the selection of students for admission to medical school, and a radical proposed reform of premedical education. At issue are fundamental questions concerning the relationship between the liberal arts and medical education--questions that are no less vital today than when Thomas first posed them: What is the purpose of undergraduate education? How closely aligned are the undergraduate and graduate phases of medical education? What do future physicians need to know that is not taught in medical school? Thomas reminds us that the undergraduate curriculum is no less vital to the future of medicine than medical school itself, and that premature specialization does not serve the best interests of future physicians or patients. Instead of treating premedical education as a mere prelude to medical school, we should encourage undergraduates to take full advantage of their college years as an opportunity to develop as human beings.

Academic medical centers (AMCs) devote countless hours to studying the diagnosis and treatment of disease, yet little or no time to determining the factors that enhance or detract from physicians' professional fulfillment. This is unfortunate because physicians' degree of professional engagement, the quality of care they provide, and their tendency to burn out all depend on the fulfillment they find in work.Indeed, if AMCs are to thrive, it is vital to understand and promote the professional fulfillment of physicians. This article reviews the sources of professional fulfillment among physicians and outlines ways to enhance it within physicians' organizations.

For a variety of reasons, new radiological imaging techniques are supplanting traditional cadaver dissection in the teaching of human anatomy. The authors briefly review the historical forces behind this transition, and then explore the advantages and drawbacks of each approach. Cadaver dissection offers an active, hands-on exploration of human structure, provides deep insights into the meaning of human embodiment and mortality, and represents a profound rite of passage into the medical profession. Radiological imaging permits in vivo visualization, offers physiologic as well as anatomic insights, and represents the context in which contemporary practicing physicians most frequently encounter their patients' otherwise hidden internal anatomy. Despite its important strengths, radiology cannot simply substitute for cadaver dissection, and the best models for teaching gross anatomy will incorporate both cadaver dissection and radiological imaging.

The outcomes assessment movement has the potential to significantly enhance the practice of medicine by enabling physicians to identify and implement what works. It represents a rich wellspring of material for investigation and is already proving to be an important source of research support. As such, it also represents a boon to academic medicine, whose activities in patient care, research, and education it may enrich. Yet outcomes research may also prove itself a threat to academic medicine insofar as the "outcomes" of the academic medical center are not adequately represented in its deliberations and recommendations. Ultimately, the results of the outcomes movement will be defined--both now and in the generation to come--by medicine's guiding vision. It behooves those who care about academic medicine to recall that this vision itself is a highly prized outcome.

Medical students' concerns that their education is not preparing them to be the doctors they could be can be traced in part to inadequacies in the basic concepts of health and disease they are taught, which prevent them from learning how to most effectively meet the challenges and exigencies of patient care. The author proposes an alternative theoretical perspective on the biological foundations of medicine by describing two divergent models of health and disease. The first, reductive isolation, represents the dominant theoretical approach to health and disease in contemporary medical education and practice. It emphasizes quantification and measurement and aims to peer beneath variability, subjectivity, and the infinite variety of patients' experiences to something universally definable, measurable, and objective. The second model, ascendant interrelation, takes as its starting point a special and prototypical property of the living organism, metabolism, in which the organism has an identity that transcends the material of which it is made, and in which such characteristics as form, wholeness, self-generation, and integration dominate. Medicine and the teaching of medicine must use both these models; the tools of reductive isolation are necessary but must be applied with a view to the larger and more complex reality of the patient as addressed by ascendant interrelation. Alone, reductive isolation does not offer an adequate perspective on the health of the whole human being, just as the well-functioning of the eye cannot be adequately explained without reference to seeing. In short, patients are more than their diseases; complex factors in their lives must not be overlooked as contributors to their illnesses or keys to healing.(ABSTRACT TRUNCATED AT 250 WORDS)