BMJ  2005;331 (9 July), doi:10.1136/bmj.331.7508.0-g

Editor's choice

Where are the leaders?

Got the wrist band, got the "Make Poverty History" T shirt, and glad to have been in Edinburgh among what Colin Douglas calls "the marching innocents" (p 117). At the time of writing it's not clear what, if anything, will come out of the G8 summit, so naive optimism is still, it seems to me, a legitimate option.

The same won't do for academic medicine. Long taken for granted as medicine's indispensable research and teaching arm, academic medicine is now the focus of international concern, a sick patient with an uncertain prognosis. The diagnosis is becoming clear, thanks to the work of a global campaign to revitalise academic medicine launched by the BMJ and partners in 2003, which reports back this week (p 101). Academic medicine lacks vision and leadership. It is failing to engage with the real issues of health care and failing to attract the best young recruits.

It's hard to think about academic medicine in the abstract. Who are these academics and what do they do? A simple definition is that they are people who do at least two of three things related to medicine: research, teaching, and clinical practice. Over the years, as Jocalyn Clark explains, they have helped us to think, discover, evaluate, learn, and improve. Without them, we would not have recognised the link between smoking and lung cancer or the need for early treatment after myocardial infarction. Without them, we are unlikely to find cures for cancer or vaccines for HIV and malaria. A future without strong global academic medicine is hard to imagine.

But that is what's in store, according to the campaign, unless something radical is done. The question is, what and by whom? To help find an answer, the campaign working group has developed a series of scenarios that illustrate alternative futures. They provide an opportunity to steer a new course towards greater engagement with the public, greater global equity, incentives for innovation, mentoring and support for young academics, flexible career paths, robust institutions with secure long term funding, leadership, and vision for academic medicine around the world.

The five scenarios are not mutually exclusive. Nor are they entirely futuristic. As Sally Davies points out in her commentary (p 105), elements from the scenarios are already discernable. Zulma Ortiz (p 106) thinks we already have the worst possible combination from each scenario but acknowledges that the seeds of change are also here. Karen Sliwa-Hahnle gives a formidable account of how to succeed in today's climate (careerfocus.bmjjournals.com). Tiago Villanueva calls for practical hands-on education for medical students (p 105), something that Benson and colleagues report is acceptable to patients in general practice (p 89). Amye Leong (p 107) speaks for patients and all of us in saying, "When academic medicine thrives, we all win."

These entertaining scenarios are at root deeply serious, reflecting a crisis at the heart of academic medicine. The debate presents a clear challenge to the people currently in leadership positions in academic medicine. Step up to the plate and engage with the issues. Or step down.

Fiona Godlee, editor

(fgodlee{at}bmj.com)


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Relevant Articles

Five futures for academic medicine: the ICRAM scenarios
Jocalyn Clark for the International Campaign to Revitalise Academic Medicine
BMJ 2005 331: 101-104. [Extract] [Full Text] [PDF]

Universities have a vital role
Sally C Davies
BMJ 2005 331: 105. [Extract] [Full Text] [PDF]

The future for medical education
Tiago Villanueva
BMJ 2005 331: 105-106. [Extract] [Full Text] [PDF]

How far is the future?
Zulma Ortiz
BMJ 2005 331: 106-107. [Extract] [Full Text] [PDF]

Challenging the patience of patients
Amye L Leong
BMJ 2005 331: 107. [Extract] [Full Text] [PDF]

Death and taxes
Colin Douglas
BMJ 2005 331: 117. [Extract] [Full Text]

Impact on patients of expanded, general practice based, student teaching: observational and qualitative study
John Benson, Thelma Quince, Arthur Hibble, Thomas Fanshawe, and Jon Emery
BMJ 2005 331: 89. [Abstract] [Full Text] [PDF]

Rapid Responses:

Read all Rapid Responses

Closed society
John Stone
bmj.com, 8 Jul 2005 [Full text]
Stifling conformity
Malcolm E Kendrick
bmj.com, 8 Jul 2005 [Full text]
The wine presses of academia produce young wines that don't cellar well..
Roger K.A. Allen
bmj.com, 9 Jul 2005 [Full text]
Superficial analysis
Richard A Rosin
bmj.com, 12 Jul 2005 [Full text]
The leaders are lost in the system.
Haitham Idriss
bmj.com, 13 Jul 2005 [Full text]
Straight jackets prevent straight thinking and straight talking
Roger K.A. Allen
bmj.com, 13 Jul 2005 [Full text]
Where are the readers?
Anne Savage
bmj.com, 14 Jul 2005 [Full text]
Superficial analysis - yes, but things have deteriorated since the late 19th century
John Stone
bmj.com, 14 Jul 2005 [Full text]
Rear guards with mute mouths make mediocre medicine
Roger K.A. Allen
bmj.com, 15 Jul 2005 [Full text]
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