Australian academic leaders answer the call of a new medical mission

The traditional mission of academic medical centers has been to promote health care excellence through three interrelated areas: medical education, research, and clinical care. In even the most advanced health care systems, however, the best efforts of educators, scientists, and clinicians have not done away with disparities in the accessibility or the quality of health care. Therefore from the clinical care aspect of the traditional mission has been carved a fourth domain focused on public health, what may be referred to as the social mission of the academic medical center.

Currently, medical educators and academic leaders in Australia are debating the role that the nation’s universities will play as part of academic medical systems as this fourth domain continues to evolve. It is a debate that is likely to have a tremendous impact on the skills and experience demanded of tomorrow’s medical school deans.

In February, Tom Aretz, MD and Elizabeth Armstrong, PhD joined a group of leaders in Australia for a five-day program on leadership in academic medicine. The course was organized in collaboration with the Committee of Deans of Australian Medical Schools (CDAMS), whose mission is to work with Australia’s 15 medical schools, as well as schools in the Australasian region, to develop approaches to issues and projects of regional relevance. CDAMS approached HMI about offering a customized leadership program after receiving positive feedback from a number of Australian faculty members who attended the programs of the Harvard Macy Institute in Boston.

Among the Committee’s major goals is the strategic development of future deans and other key staff to respond to the changing demands of Australian medical education and health care. With this in mind, forty-three leaders of academic medicine from across Australia, New Zealand, and the Pacific gathered in the scenic Blue Mountains outside of Sydney. Their interests ranged from medical education and research to clinical affairs.

Drawing on research and experience from not only medical education, but the business arena as well (and incorporating educational modules that had been previously developed for the programs of the Harvard Macy Institute and customized leadership programs), Aretz and Armstrong helped the participants approach the questions surrounding Australian medical education through the broad themes of organizational development, management and leadership, and teamwork and negotiation, with the final day focused on advancing from strategy to implementation.

From left to right, the program faculty: Patrick McNeil, Fiona Lake, Bruce Dowton, Tom Aretz, and Elizabeth Armstrong.

S. Bruce Dowton, MD, the former Dean of the Medical Faculty of the University of South Wales in Sydney and the outgoing Chair of CDAMS, said that the program was very successful, and that “a strong feeling of collegiality emerged among the participants by the end of the program.” This could be at least partly attributed to the way the course was organized. Dowton said that several participants commented upon “the ample opportunity for small group interaction, as an integral part of the programmatic design, to reflect upon the problems they are facing in their own medical school environments.”

These small group sessions included daily study sections in which literature pertinent to the day’s theme was reviewed; the second daily small group session was a project group. Participants had been asked to submit a project they are working on in their home institution to allow them to advance some aspects of the project during these meetings using the other participants as “consultants.” The final session asked the participants to apply the concepts of the week to their projects and create an action plan, which they shared with the other members of the group.

Many of the participants felt that the principles explored in the course would have a definite impact on the way they approached challenges in their home institutions. One participant noted that the course provided “insights into knowledge, skills, and attributes of experienced leaders, thereby sign-posting some areas for development in myself to cope with these roles,” while another said the course introduced “stronger theoretical underpinnings for my own development in leadership, especially in organizational change.”

At the program’s conclusion, several participants commented on how the course applies business principles to the issue of academic medicine. Though surprising to some, this multidisciplinary approach has been one of the main reasons for the popularity of the Harvard Macy Institute’s courses. “By the middle of the program, most of the participants found themselves thoroughly engaged in exploring a literature from the business and other professional sectors beyond that usually encountered by medical academics and physicians,” said Dowton. “This was seen as one of the most challenging but intellectually invigorating aspects of the program.”

The Blue Mountains setting contributed to the collegial atmosphere of the program, as participants felt encouraged to meet and discuss issues outside the formal program structure.

Said one participant, “The course grew on me. On day one and two it was not clear how it would all integrate, but by day four the elements came together into an organized whole that really triggered ideas and insights.”

In addition to Aretz and Armstrong, the program faculty also included Professor Patrick McNeil, a rheumatologist and dean of medical education at the University of New South Wales, and Professor Fiona Lake, a pulmonary physician and educator from the University of Western Australia in Perth. Both have participated in the Harvard Macy Institute’s leadership program held in Boston.