I have been asked to apply for the position of Dean for the College of Community Health Sciences at UA Tuscaloosa. In fairness, as far as I know everyone who is reading this has also been asked to apply for this position as well. In fact, it may be the rare person who has not been asked to apply for this position, so I’m really not letting this request boost my ego too much.

I suspect that I have been asked to apply for the job in part because I am in Academic Family Medicine, as the campus has a mission to further the delivery of care in rural Alabama through training, research and care delivery and a Family Physician is the best positioned to accomplish this. I also suspect that my experience in medical school administration makes my application appealing. Lastly, it doesn’t hurt to have worked on several statewide projects with members of the search committee (well, it could have hurt me but it seems it didn’t). An interesting part of the application process was the requirement that a statement of adminstrative and leadership philosophy be enclosed.

As a departmental chairman, I lead 7 physicians, 1 behavioral scientist, and 1 PharmD and support staff in the training of 18 residents and 70 students in clinical instruction. I make sure that the training programs are performing effectively, the faculty are progressing towards promotion, and the departmental programs are performing optimally given the available resources. When I am not engaged in teaching or in patient care I am a mid-level manager who job is to help others to do their job better. That is, I guess, my current philosophy.

If I were to apply for a Dean’s job, that philosophy would be challenged. Deans are in charge of the entire educational program, not just one department. My observation of medical education is that we do surprisingly well given the chaos the system is currently in. The path to academics as an MD almost always includes a residency in a clinical field and a clinical appointment, although the residency is typically more education and service than it is preparation for an academic career. An academic physician  is expected to be able to develop and maintain a clinical practice (thus challenging the adage “those who can, do, and those who can’t teach”) and often expected to use this clinical practice in delivering clinical instruction. There is limited instruction in teaching in all medical schools but pedagogical excellence is expected as measured by learner satisfaction.  Most medical schools require some sort of scholarly activity and although publications are not required try selling anything else to the Promotions and Tenure Committee of any university. Adding to the chaos is that most of the clinical education in allopathic (traditional) medical schools is still by the most junior clinicians (those in residency training). On top of that is the challenge of providing physicians for a reformed system that is not yet clearly defined.

I guess when all is said and done, my philosophy is we can do better. The LCME (the accrediting body for allopathic medical schools) has been trying to put some organization into this disorganized system. They have specifically been presuring schools to make sure that the education of medical students is based on a unified philosophy focused on the production of quality physicians as an outcome. They have included the need for faculty instruction in teaching in the accreditation standards

The faculty who teach at all instructional sites should be sufficiently knowledgeable in the subject matter to provide effective instruction and have a clear understanding of the objectives of the educational experience and the assessment methods used to determine achievement of those objectives. Opportunities to enhance teaching and assessment skills should be available for faculty at all instructional sites.

Including specific requirements for residents participating in instruction

residents who supervise or teach medical students and graduate students and postdoctoral fellows in the biomedical sciences who serve as teachers or teaching assistants must be familiar with the educational objectives of the course or clerkship (or, in Canada, clerkship rotation) and be prepared for their roles in teaching and assessment.

They now speak of the quality of the faculty

Effective teaching requires knowledge of the discipline and an understanding of curricular design and development, curricular evaluation, and methods of instruction. Faculty members involved in teaching, course planning, and curricular evaluation should possess or have ready access to expertise in teaching methods, curricular development, program evaluation, and medical student assessment.

and the need to further the profession

A faculty member in a medical education program should have a commitment to continuing scholarly productivity that is characteristic of an institution of higher learning.

Perhaps my philosophy should be that it is important to observe the rules that are already in place.