Academic medicine: who is it for?

The opening salvo of the webchat on academic medicine was whether a definition of academic medicine was needed.¹ No, it made the whole thing hopeless from the start. Yes, it helped to set a framework.

Thereon the main strands of the webchat were dominated by a negative view of the status quo: academic medicine is a giant industry perpetuating its own power and influence rather than serving the public. Medicine has become a source of profit for commerce and is now so intertwined with industry that the threads cannot be untied (although the BMJ campaign has made the links between academia and the pharmaceutical industry one of its research targets).

Vioxx and Seroxat were supposed to be triumphs of academic medicine. But, although the problems were recognised in academic circles, academics lack the power to communicate to wider society and effect change. Academic medicine has to change and start anew. To have any legitimacy it must address the problems of individuals in society—which it clearly is not doing. Another perceived problem was that government research allocations inevitably create priorities.

Ideas to identify areas for improvement tried to counter this negativity. Academic medicine should serve the interests of society as a whole, filling the gap between university education and everyday medical practice. It is primarily about people, teachers, students, and the public. Academics should be leaders in their field with special expertise; principles should be stated, relevant research conducted and published, and human resources rethought. Academics should define research priorities, proving to governments and society that academic doctors are a force to be reckoned with.

Teaching is a problem. Perhaps it should be left to those with a gift for it, and be taken out of the universities and into other work settings. This would help the interdisciplinarian approach to working that several participants desired (“academics on child health talking with schoolteachers”). International collaborations are to be encouraged, as is integrating students into the campaign from the outset.

The reason teaching is a problem may be the emphasis on publishing research in journals with high impact factors and on developing new methodologies, as determined by the UK government's research assessment exercise, for example. Creating new teaching materials would not improve a researcher's publications list and therefore not move him or her up the ladder, although it benefits both researcher and students.

Several participants agreed that new structures should be developed outside the mainstream, with new approaches to education, research, leadership, clinical care, publications, and all the things that currently constitute a successful career in academic medicine. The clarion call was be brave. Forget your reputation. Forget your status. Just act. Do it differently. Ignore authority. Reject conformity. Be you—the webchat's closing rally.