Intended for healthcare professionals

Editor's Choice

The four pillars of global academic medicine

BMJ 2004; 329 doi: (Published 30 September 2004) Cite this as: BMJ 2004;329:0-g
  1. Kamran Abbasi, acting editor (kabbasi{at}

    Have you ever slept during a lecture? A quarter of university students have, although the figure might be higher for medical students—who learn a great deal from role models, such as professors snoozing in grand rounds. Academia must be in crisis when, according to a survey in the Independent newspaper, more students have sent a text message during a lecture (63%) than asked a question (49%).

    If you manage to stay awake more than you sleep you may be aware that medical education has a hidden curriculum, which, say Heidi Lempp and Clive Seale (p 770), achieves the “enculturation”—a new word to me—of students as they mutate into doctors. A hidden curriculum is essentially a set of influences, often unarticulated or unexplored, falling outside formal teaching. In medical education this amounts to six learning processes: loss of idealism, adoption of a “ritualised” professional identity, emotional neutralisation, change of ethical integrity, acceptance of hierarchy, and learning less formal aspects of “good doctoring.” Ring any bells?

    While there is a positive effect of role models, conclude Lempp and Seale, students are exposed to a competitive atmosphere that tolerates haphazard tuition and teaching by humiliation—which is enculturation of the bad sort.

    Yet, teaching is only one component of academic medicine, as this week's theme issue brings out clearly—nor is academic medicine confined to medical schools and teaching hospitals in the rich world. Nelson Sewankambo, dean of an African medical school, spells out how academic medicine can contribute to global health; in the process he provides readers with a valuable service by explaining what academic medicine is (p 752).

    Firstly, academic medicine is about answering important questions through relevant research. Secondly, the evidence generated by that research has to be implemented and the “know-do gap” closed. Thirdly, academic medicine must ensure that medical students and doctors are adequately trained. Finally, the quality of healthcare delivery must be optimised, partly through improved access to health information. All of which helps to explain why academic medicine means different things to different people.

    When editors from the Lancet and the BMJ met in a dimly lit Greek restaurant to plan the academic medicine campaign there was some uncertainty over its global resonance. We needn't have worried. Jocalyn Clark and Peter Tugwell explain how the campaign has attracted an overwhelming international response, and this issue sets the campaign in a truly global context (p 751)—but it is a global context grounded in the reality of patient care. “Academic medicine must show that,” says Sewankambo, “in its pursuit of the different aspects of scholarship, its relevance to society's needs is still of paramount importance.”


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