Table 1.

Summary of scenarios

	Academic Inc	Reformation	In the public eye	Global academic partnership	Fully engaged
Description	Academic medicine flourishes in the private sector	All teach, learn, research, and improve	Success comes from delighting patients, the public, and media	Academic medicine for global health equity	Academic medicine engages energetically with all stakeholders
Main features	Medical research, training, and service are commercial business activities	Academic medicine disappears	Extreme consumerism	Global cooperative networks devoted to redressing health inequalities and 10:90 gap	Strong connections among patients, policy makers, practitioners, and the public
		Research and education integrated with health care	Patients govern academic medicine
			Continual use of media
Medical education	Private medical schools	Teamwork	Conducted by expert patients	Centred around improving global health	Medical training is energised and community based
	Major investment in information technology	Learning by doing	Responsiveness to patients is key value	Partnerships between medical schools in developed and developing countries	Students help drive the agenda
	Some niche schools (care of elderly people, rural medicine, etc)	Competency based assessment
Research	Privatised, takes place in an array of different companies	Research and quality improvement are simultaneous	Patients determine priorities, through game shows or citizens' juries	Public health and basic science equally valued	Conducted by groups of diversely skilled individuals, including stakeholders
	Responsive to the needs of customers	Translational research favoured
Decision making and governance	Corporate governance	Leadership provided by societies of practitioners and patients	Bottom up: patients in charge	Global governance made up of institutional networks, policy makers, politicians, and the public	Dynamic organisations of all stakeholders to guide academic medicine
Disadvantages	Efficiency and effectiveness trump equity	Lacks stability because requires shared values	Advances in science and technology subject to fads and fashion	Idealistic	Academic medicine may be perceived as “dumbed down”
	Two tier system—brain drain and 10:90 gap preserved	Decision making could be slow	Job insecurity among practitioners	Requires enormous political will and global cooperation	May lose elite status, originality, and independent thinking
	Innovation may suffer	Individuals sometimes could not shine	Little regulation of health information