○대학의학에 주어진 단 하나의 미션

대학의학에 주어진 단 하나의 미션

A Single Mission for Academic Medicine

Improving Health

Paul G. Ramsey, MD

Edward D. Miller, MD

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Mission statements는 한 조직의 심장(heart and soul)과 같은 것이라고 할 수 있다. Mission은 기능을 중심으로 정의될 수도 있어서 근본적으로 추구하는 것이나 전략적 방향에 대한 선언이 될 수도 있다. Mission statement는 조직의 비전과 가치를 정의해주기도 하며, 어떤 활동이나 서비스를 수행하도록 하는 내적인 소명의식을 설명할 수도 있다. 어떤 경우든지 Mission statement가 답해야 하는 질문은 바로 이것이다. "한 기관 또는 조직이 성취하고자 하는 것이 무엇인가?"

Mission statements capture and express the heart and soul of an organization. Mission may be defined around function—a statement or declaration of fundamental purpose or strategic direction. A mission statement may offer the organization's definition of vision and values, or it may articulate an inner calling or vocation to pursue an activity or perform a service. In all cases, mission statements ultimately attempt to answer one question: What does an institution or organization seek to achieve?

1497년 King's College in Aberdeen, Scotland에 최초의 영어권 국가의 의학의 수장이 설립되었다. 이 기관의 목표는 "사회에 대한 봉사를 통해 건강을 추구하는 것"이었는데, 그로부터 500년이 지난 지금, 대학의학은 이 mission을 잃어버렸다. 대학의학이 태초의 의의와 미션을 찾는 것이 중요하다.

In 1497, the first known academic chair of medicine in the English-speaking world was established at King's College in Aberdeen, Scotland. Its mission was the “pursuit of health in the service of society.”1 Five centuries later, academic medicine has lost sight of this mission. It is critical that academic medicine now return to the original meaning and mission.

어떤 사람들은 대학의학의 미션은 지식의 진보를 통한 인류건강의 증진이라고 말한다. 더 흔하게, 대학의학의 리더들은 이 미션이 교육, 연구, 진료의 세 가지로 이루어져있다고 설명한다. 비록 개개 교수들이 이 세 구성요소에 할애할 수 있는 시간이 정확히 1/3씩은 아니겠지만, 현재 academic health center의 미션은 교육, 연구, 진료라는 것은 일반적으로 인정되는 바다. 예컨대, AAMC회장인 Kirch는 2008년의 연설에서 이 세 미션의 균형이 중요함을 강조하였으며, 많은 의과대학과 academic health center는 상호연관된 이 세 가지를 그들의 미션 목록에 나열하고 있다.

Some argue that the mission of academic medicine is to improve human health via the advancement of knowledge.2 More frequently, leaders of academic medicine describe a tripartite mission consisting of education, research, and clinical service.3,4 Although the time allocated to each of these mission components by individual faculty members may be uneven, it is now generally assumed that the contemporary mission (or missions) of an academic health center consist of teaching, research, and clinical practice.3- 5 For example, in his 2008 address as president of the Association of American Medical Colleges, Kirch reiterated the importance of balance among these 3 missions.6 Similarly, the mission statements of many medical schools and academic health centers list the 3 interrelated missions.1

King's College의 최초의 '근대적(modern)'미션에서 의과대학의 학장(chair)이 지정한 유일한 것은 '모든 사람의 건강'이다. 이것이 모든 의료전문직의 궁극적 존재이유로서 남아있지만, 대학의학의 일부분으로서 이 미션은 교육, 연구, 진료라는 세 가지 미션 모델에 의해서 수행되고 있다. 시대가 변함에 따라서 이 세가지는 흥망성쇠를 겪어왔는데 Flexerian era이전에는 진료가 우선되었으나, 2차대전 이후에는 연구에 초점이 맞춰졌고, academic health center에 대한 공공지원이 감소한 최근에는 다시 진료에 무게가 실리고 있다. 교육은, 비록 가끔은 보잘것없게 취급되기도 했지만, academic health center에서 근근히 유지되어오고 있다.

In the first “modern” mission statement at King's College, the chair of medicine was assigned a single mandate: the pursuit of health for all.1 Although this remains the ultimate raison d’être of all health care professions, adherence to this mission on the part of academic medicine continues to be carried out using the tripartite-mission model: teaching the next generation of physicians, performing research to advance the understanding of human biology and the practice of medicine, and providing direct health care for individual patients and populations. These activities have waxed and waned in relationship to one another in academic settings, with clinical care predominating prior to the Flexnerian era, giving way to a research focus after World War II, and again shifting to clinical care in recent years as public support for academic health centers has declined.3,7 Education has maintained a constant, if sometimes tenuous, role in the academic health center.

이 세 가지 활동은 근본적으로 서로 연결되어 있으며 상호의존적이다.

These 3 activities are connected and interdependent in fundamental ways that are, at their core, independent of finances. 

Medical students learn the foundations of basic science from researchers; 

medical students and residents learn their clinical skills under the tutelage of clinicians; 

research depends on the clinical setting for testing hypotheses and conducting safe experimentation to advance knowledge; 

clinical care, in turn, evolves and progresses through the knowledge that results from research. 

Over time, these 3 activities have developed interdependent financial relationships as well.

이 세 가지 역할이 각각 개별적인 것 또는 단순히 연결된 것으로 취급될 때, 이들은 공통된 목표를 달성하기 위한 활동이 되는 것이 아니라 그 자체로 끝나버린다. 이 삼발이모델(tripartite model)에 근거하여 교수들에게 어떤 요구사항이 생겼음에도, 교수들이 이 모든 세 가지에 대해 다 잘 할 것을 기대하게 된다. 이러한 기대로부터 'triple-threat faculty member'라는 개념이 등장했다.

When these activities are treated as a single 3-part mission or 3 connected missions, they are in danger of becoming ends in themselves rather than activities that support a common purpose. Furthermore, although the demands on faculty imposed by this tripartite model are significant, the expectation has developed that faculty members will excel in all 3 missions. From this expectation, the concept of the triple-threat faculty member has evolved into an accepted standard for academic medicine.

Whether it was ever possible for more than a small number of productive and highly efficient individuals to achieve excellence in all 3 activities, the triple threat has in recent years been seen increasingly as endangered and counter-productive. Petersdorf and Turner8 observed nearly 15 years ago, “It cannot be done.” For too long, faculty have been expected to achieve substantial productivity in all 3 realms to advance in their careers. This understanding has led some to conclude that the triple-threat model is inefficient and that an alternative, more efficient model of specialization is required in which each faculty member specializes in 1 or 2 areas.9

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공공의 건강 향상이라는 오래된 미션에 다시 초점을 맞추고 대학의학의 역사적 근원을 돌아봐야 할 때이다.

It is time for academic medicine to return to its historic roots by focusing on the long-established mission of improving the health of the public. Academic medicine can do this by uniting and integrating its unique strengths—excellence in education, research, and clinical care—within an administrative structure that encourages and facilitates the use of all resources to support the mission of improving health. The administrative structure that best accomplishes this goal is an integrated health system in which the school of medicine, hospital(s), and research enterprise are within a single integrated structure with strategic planning occurring in all 3 activities and with the ultimate goal of improving the health of the public.

교육, 연구, 진료의 균형이 중요하다. 

In this model, some faculty members may assume all 3 roles as clinicians, teachers, and investigators and can serve as triple threats. Others can and should specialize in 1 or 2 of the 3 roles, and they should be valued and supported for their contributions to the mission. One approach should not be seen as superior to the other. Ultimately, a balance of teaching, research, and professional service is important. That balance should be achieved across the faculty, staff, students, and trainees of the entire academic medical center. Budgetary decisions should be based on the extent to which individual activities contribute to the core mission of improving health.

대학의학의 가장 근본적인 미션, 가장 중요한 사회적책무는 모든 사람의 건강을 향상시키는 것이다. academic medical center의 미션이 그 미션을 지지하고 있는 '행위(activity)'와 혼동될 때에, 대학의학은 영원히 비효율적인 시스템과 혼동된 목표로 인하 위험에 빠질 것이다.

Academic medicine is the acknowledged leader in today's medicine. It also retains its obligation to facilitate and support a mission of social responsibility. The most fundamental and socially responsible mission for academic medicine is working to improve health for all. If the mission of academic medical centers remains confused with the activities in support of the mission, academic medicine is in danger of perpetuating an inefficient system and ultimately a confusing set of goals. Research cannot and should not be a mission in itself, nor should education or clinical care.

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JAMA. 2009 Apr 8;301(14):1475-6. doi: 10.1001/jama.2009.472.

A single mission for academic medicine: improving health.

Ramsey PG1, Miller ED.

Author information

• 1UW Medicine, University of Washington, Box 356350, Seattle, WA 98195-6350, USA. pramsey@u.washington.edu