Magill M K, Catinella A P, Haas L, Hughes C C
Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City 84132, USA.
Acad Med. 1998 Aug;73(8):871-5. doi: 10.1097/00001888-199808000-00012.
Academic health centers (AHCs) are experiencing turmoil in all three of their traditional missions of teaching, research, and patient care. The authors examine origins of universities and medical education to place in historical context the stresses affecting AHCs at the end of the 20th century. They describe the cultures of the university to suggest strategies for successful adaptation to these stresses. Clashes of values and norms of the cultures within universities and AHCs can hinder effective adaptation to external change. Administrators, researchers, teachers, and clinicians can have strongly conflicting perspectives. For example, business skill is of increasing importance to the survival of the clinical enterprise, but not typically valued by faculty members. University faculty have often considered accountability as antithetical to academic freedom, and, until recently, accountability was not strongly demanded of AHCs. The authors conclude that AHC faculty must transcend the outdated view that the roles of the scholar, scientist, and healer are in opposition to those of the leader and manager. If AHCs are to survive and prosper through their current cultural transition, their faculty must understand all these roles as part of their intellectual and organizational responsibility.
学术健康中心（AHCs）在教学、研究和患者护理这三项传统使命中都面临着动荡。作者审视了大学和医学教育的起源，以便将影响20世纪末AHCs的压力置于历史背景中。他们描述了大学的文化，以提出成功应对这些压力的策略。大学和AHCs内部文化的价值观和规范冲突可能会阻碍对外部变化的有效适应。管理人员、研究人员、教师和临床医生可能会有强烈冲突的观点。例如，商业技能对临床企业的生存越来越重要，但教师通常并不重视。大学教师常常认为问责制与学术自由相悖，而且直到最近，对AHCs也没有强烈要求问责制。作者得出结论，AHCs的教师必须超越那种认为学者、科学家和治疗者的角色与领导者和管理者的角色相对立的过时观点。如果AHCs要在当前的文化转型中生存和繁荣，其教师必须将所有这些角色理解为他们智力和组织责任的一部分。
