Revitalizing Medical Education Leadership
As academic medical centers navigate growing complexity, expansion, and financial pressures, we believe they must reconsider long-held assumptions about educational leadership—particularly in Graduate Medical Education...
As academic medical centers navigate growing complexity, expansion, and financial pressures, we believe they must reconsider long-held assumptions about educational leadership—particularly in Graduate Medical Education (GME) as well as Undergraduate Medical Education (UME). A key mistake is to undervalue leadership roles such as GME and UME directors, designated institutional officials, and other essential positions and to underestimate the strategic influence they can exert. Another assumption to reconsider is that there is a robust pipeline of qualified and willing future leaders for these roles.
Challenging beliefs regarding UME and GME leadership is essential to secure the future vitality of medical schools and academic health systems. Indeed, it comes at a time when our field is seriously (and systematically) rethinking medical education as a whole, and when new medical education programs are cropping up in non-academic settings. The future looks very different in terms of skills, technologies, and funding for physician education. Thus, what better time than the present to reconsider leadership?
The broader picture, of course, relates to adequately preparing the next generation of clinicians. To ensure a thriving physician workforce going forward, we believe institutions must reexamine how they identify, support, and develop leaders in medical education and look to reinvigorate the roles with greater authority and wider responsibilities.
Limiting Assumptions
Allow us to briefly explore what we, in speaking with institutional representatives and recruiting these leaders as part of our daily work, see as persistent assumptions about medical education leadership which may be hindering the impact and success of UME and GME leadership. They include:
Underestimating roles. This is particularly true regarding the strategic influence GME and UME leaders can and should have. In our experience, these roles are often viewed as primarily administrative and “academic,” ignoring their potential strategic impact on, for example, institutional culture and clinical workforce development. These leaders influence far more than curriculum—they are integral to shaping the future of medical education and therefore the values and priorities of future physicians.
Over the past two decades, the role of Chief Academic Officer within academic medical centers and medical schools, which may have oversight over areas such as UME, GME, faculty affairs/faculty development, and sometimes interprofessional education, has emerged. This role may also be responsible for accreditation, implementing campus wide academic strategy, and for authorizing and developing educational affiliations. Developing and overseeing simulation centers, education technology, and educational facility planning may also be part of this ever-expanding portfolio.
We are beginning to see more institutions recognize this and broaden the scope of roles. One recent client, a community-based medical school, expanded the role of Associate Dean for Educational Affairs to Chief Academic Officer for the enterprise to give it higher visibility and authority over the learning environment at multiple clinical sites. It is this kind of expansion of the role that is warranted and will allow these leaders to wield greater influence as members of their institutional senior leadership teams.
Taking a narrow view of what defines candidates as qualified. Institutions frequently default to conventional career trajectories when seeking to hire medical education leaders, missing out on individuals from nontraditional backgrounds who often bring fresh perspectives and valuable skills. We have seen effective medical education leaders come from a background of university/higher education curricular leadership, for example. Further, institutions often prioritize content expertise and academic bona fides over an individual’s ability to lead or potential to do so. This often includes an unwillingness to consider candidates who hail from more of a clinical rather than academic background. It can also limit the ability of candidates from underrepresented groups to break into leadership.
Overlooking the need for pipeline development for tomorrow’s leaders. By underestimating what GME and UME leadership can be, medical schools diminish the roles in the eyes of would-be candidates and disincentivize them from pursuing academic leadership as a career path. On top of this, there exists a misplaced assumption that the pipeline for future GME and UME leaders is sufficient. In our experience, the candidate pools for these kinds of roles could be more robust. Oftentimes, we see talented and experienced faculty and emerging leaders who fail to consider higher positions. They may not know the pathway to advancement nor have mentors and role models who help them build competency and confidence and advocate for them when striving to achieve leadership roles.
Pigeonholing GME and UME leaders, thus limiting career advancement. Given the perception of these roles as primarily administrative and academic, many institutions assume that leaders in UME or GME are not suited for more advanced positions such as dean or chief medical officer. This overlooks the operational and visionary insight these leaders often possess, or could possess in time. Shortcomings in skills or experience that academic leaders may exhibit can often be overcome through intentional professional development, mentoring, and coaching.
The traditional ascendency of chairs of large clinical departments into dean roles results from a bias that medical education leaders may not have enough experience with clinical operations. Of course, different dean roles may require different experience, but in many cases medical education leaders have such a deep understanding of the core education, accreditation, faculty, and research realms that this can be overcome.
The Risks
Ignoring these challenges has consequences:
For the institution, it obviously diminishes the impact that GME and UME leaders can have, restraining leaders from envisioning and implementing much-needed change. For instance, when educational leaders are excluded from broader strategic discussions, opportunities for alignment between education and clinical operations are missed.
With little career development or attention to pipeline, it is more difficult to identify future academic leaders, requiring institutions to recruit leaders from outside rather than promoting from within. Bringing in leaders from other institutions can have advantages but it also comes with costs—for example, a loss of institutional knowledge or significant time needed for an outside hire to build relationships and exert influence to drive strategic initiatives.
For individuals who aspire to leadership in medical education, there are limited career pathways. Without clear advancement opportunities beyond roles like GME dean or DIO, talented individuals may seek growth elsewhere, weakening the leadership bench. And as mentioned, there are many faculty and junior administrators who may not realize that greater roles are possible or that they have the potential to one day fill them, and could benefit from a greater emphasis on leadership development.
Strategies for Reimagining Leadership in Medical Education
To build a stronger future, medical schools, AMCs, and academic health systems must take proactive measures to reinvigorate medical education leadership:
- Redefine the purpose of roles and their connection to the success of medical educational programs. As higher education evolves, leadership roles must also adapt. Updating the roles’ purpose keeps them relevant, focused on the most critical outcomes, and positioned to add lasting value. It also prevents stagnation and ensures leaders in these roles are driving progress in areas that matter most to the educational institution.
- Assess and update position requirements for UME and GME leadership roles. Any job description becomes outdated with time and needs reevaluating. Look carefully at the position requirements for these leaders, with an eye for the strategic influence they can have within an expanding academic health system that may look much different than it did five or 10 years ago. Pay special attention to the insights that academic leaders can and should have regarding resident training opportunities and other collaborations with the clinical enterprise, and how clinical input can have a positive influence upon educational curricula and leadership. In addition, consider opportunities that may exist for partnerships with other institutions or via industrywide consortia, committees, or other collaborations. Consider elevating these roles so that the educational mission gets top billing and a seat at the table with the clinical, research, and other missions.
- Invest in development for up-and-coming leaders. Create structured opportunities for program directors, department chairs, and emerging leaders to learn and grow, through formalized mentorship programs and support for professional development (such as leadership training through national organizations like AAMC and ACGME). Undertake succession planning to identify individuals within an institution’s ranks who have what it takes to advance and become the next generation of leadership.
- Broaden evaluation criteria for UME and GME leadership candidates. When considering individuals for higher roles, assess leadership potential in addition to academic credentials and accomplishments. Look more to requisite leadership competencies as predictors of job readiness. We don’t mean to suggest that one’s reputation and standing within the academic community isn’t important, only that it shouldn’t be the determining factor in leader recruitment and selection.
- Support career advancement for UME and GME leaders to take the next step. For GME leaders aspiring to roles such as dean or CMO (or even perhaps CEO one day), encourage involvement in operational areas like practice management and institutional committees. Demonstrating excellence in these domains strengthens skills and candidacy for broader leadership roles. And when high potential talent emerges, extend effort to advocate for those leaders and find additional opportunities or projects that can further refine their skills.
Conclusion
Academic health systems will be stronger when educational leaders have a seat at the table to ensure that organizational strategic decisions take into account all missions—academic as well as clinical. Creating a pipeline of education leaders who are ready to step into these executive roles will be essential to create this balance at the top of our institutions.
