○의과대학의 미션: 사회에 대한 봉사를 통한 건강의 추구

의과대학의 미션: 사회에 대한 봉사를 통한 건강의 추구

The missions of medical schools: the pursuit of health in the service of society

Ray M Lewkonia

Mission statements and role documents of medical schools in the United Kingdom, United States, Canada and Australia have been examined on their Internet Web sites and categorised in purpose, content and presentation. The format and content are highly variable, but there is a common vision of three integral roles, namely, education, advancement of knowledge and service to society. Other frequent themes include tradition and historical perspective, service for designated communities, and benchmarking to accreditation standards. Differences in content reflect variable interpretation of the notion of "mission", and local or national characteristics such as institutional affiliations, the types, levels and organisation of medical education, relationships with health systems, and extent of multi-professional education. Outcomes data and measures of medical school performance referenced to the institution's stated missions are rarely encountered.

'미션'은 인터넷을 통해 공공에게 보여진다. 이 웹사이트와 문서, 링크된 정보들이 의학교육과 대학의학 전반에 대한 아이디어와 접근법을 교류하는 가치있는 새 자원이 된다.

Mission documents placed on the Internet are in the public domain. These Web sites and documents and linked information constitute a valuable new resource for international exchange of approaches and ideas in medical education and generally in academic medicine. Routine inclusion of outcome or performance data could help to demonstrate the community roles and social accountability of medical schools This paper proposes that partial standardisation of these Web documents could enhance their value both internally and for external readers. A generic descriptive statement template is offered.

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Introduction

RSM의 다섯 가지 권고사항 중 첫 번째는 "공공적 책무성과 전문직의 서비스를 위하여 각 대학은 조직의 statement of mission, goals and objectives를 개발하고 공포해야 하며, 여기에는 인구집단 차원과 개개인 차원의 결과를 바탕으로 기관의 목표에 얼마나 도달했는가에 대한 평가전략을 포함해야 한다"이다.

The University of Aberdeen, Scotland records on its Web site [1] that the first academic chair of medicine in the English-speaking world was established in 1497 at King's College, Aberdeen with an original mission of the pursuit of health in the service of society. Five centuries later, in 1991 a group of distinguished medical academics from the United States, Canada, the United Kingdom, and Australia met under the sponsorship of the Royal Society of Medicine (RSM) Foundation and produced a report on the missions of medical schools [2]. This was promulgated in the context of "a long-term implicit social contract that has existed between the medical establishment and the society that it serves". The first of five recommendations in the RSM report was that, in the interests of public accountability and professional service, each school should develop and publicize an institutional statement of mission, goals and objectives, to include strategies for evaluating progress towards the institution's objectives using population-based and individual outcomes. This and the other recommendations regarding faculty development, education and sensitivity to population health needs were intended to promote increased responsiveness to the expectations of stakeholders, that is social accountability. One decade later Internet technology has enabled medical schools to readily publicise their missions and institutional priorities in the public domain.

The mission documents from medical schools in the United Kingdom, United States, Canada, and Australia have been examined with regard to the aims of the schools in general and the content proposed in the RSM report with regard to social accountability.

Methods

The Internet Web sites of medical schools in the four countries were located from listings on the Web sites of accrediting bodies – the American Association of Medical Colleges (AAMC) [3] and the Liaison Council for Medical Education (LCME) [4], the Association of Canadian Medical Colleges (ACMC) [5], the General Medical Council (GMC) [6] and the Quality Assurance Authority (QAA) [7] of the United Kingdom, and the Australian Medical Council (AMC) [8]. The medical school Web sites were inspected for mission statements, and if these were not found, statements of philosophy or purpose or other similar documents were sought. Sometimes the mission was described in a dean's message or a strategic plan, in admissions policies or general curriculum outlines. The Web sites and the mission statements often have links to internal departmental sites, each with their own mission documents.

Mission statement에 등장하는 주제들 Themes in mission statements

All medical schools in the four countries have described their missions and related descriptive information on their Web sites, and it is notable that all of the Web-based presentations are different. Five general themes were noted in the presentation of mission documents, with more than one of these being included on many sites – 

tripartite responsibility, 

tradition and historical perspective, 

service for specified communities, 

benchmarking to templates of accrediting organisations, and 

(least often) performance and outcome data. 

Narrative examples are given in order of diminishing frequency:

세 가지 의무(교육,연구,진료) Tripartite responsibility

Typical descriptive statements list the three realms of education, research and clinical service, usually in that sequence, sometimes with elaboration of the concepts:

전통과 역사적 관점 Tradition and historical perspective

Long established schools are less likely to state an explicit mission, perhaps because it has been achieved, instead describing their history of service, their scientific reputation and distinction of their staff and graduates as leaders implying the expectation of future success for their students:

특정 집단에 대한 봉사 Service for specified communities

Delineation of populations supported by the medical school appears most often in the statements of young medical schools and those established in areas of relatively low population density. These service-orientated statements are more likely to mention other health professions and multi-professional service models:

인증기관의 템플릿 벤치마킹 Benchmarking to templates of accrediting organisations

This is seen particularly in the descriptive statements of British medical schools. Curricular design has been influenced throughout the U.K. by Tomorrow's Doctors, a 1993 publication of the GMC [9]. The most consistent organization of information was found in QAA documents in its first category entitled "aims and objectives" of the school. QAA reports relate to curricular structure and implementation, and do not deal with outcomes for graduates or populations. The effects of the QAA framework has been evident in school mission documents, for example:

퍼포먼스 자료와 순위 Performance data and ratings

Aggregate data on career paths is available in the Canadian Post-MD Education Registry [10]. Outcome information other than research success is not commonly given on individual medical school Web sites, and is selective:

기관 구조 Institutional structure

The nature of the medical school is not always evident from the name of the institution, and they include: 

(a) graduate schools in research-orientated academic medical centres – most common in the U.S., 

(b) schools that train more than one type of health professional, administratively integrated with a university, 

(c) hospital-based or community-based medical school affiliated with a university. 

Extracts from two Web sites illustrate examples of striking differences in conceptions of a "school" environment:

Mission statement의 목적과 의미 The purpose and semantics of mission documents

Mission statements have been defined for the (not-for-profit) health care sector in the United States as formal documents that attempt to capture an organization's unique and enduring purpose and practices [11]. Important functions include...

목적의식 제시 giving a sense of purpose, 

구성원에게 동기부여 motivating employees to identify with the organisation, 

외부 stakeholder의 관심사에 대한 인식 giving recognition to the interests of external stakeholders, and 

자원 배분 절차의 향상 to improve the resource allocation process. 

Each of these could be translated to the medical school context. However, expression of the concept of "mission" for medical schools was found to be extremely variable in all four countries. Some Web sites have a succinct vision with brief elaboration and in others the mission is expressed in a large multi-part strategy document.

형태는 다양하더라도 대체로 비슷한 표현을 사용함

Although the formats vary, the mission documents generally use similar expressions in all four countries. 

Words are selected to convey great expectations of academic accomplishment for students and staff. 

Verbs are chosen that predict achievement, the nouns offer the promise of success, and the phrases look to the future. 

The wording speaks to institutional reputation, and the goals of attracting academically effective staff and good students to the school [12]. Examples of words used to characterize the capabilities of schools and the expectations of qualities to be imbued into students are listed below:

Institutional performance: Advance, aim, aspire, build, develop, enable, encourage, ensure, expand, facilitate, foster, implement, lead, prepare, produce, provide, strive.

Desirable attributes: Commitment, compassion, excellence, highest standards, humanitarian or humanistic, innovation, leadership, life-long learning, outstanding, quality, self-reliant, strong.

Discussion

Universal goals of all medical schools are contained in the succinct Scottish version of the 15th century: The pursuit of health in the service of society[1]. The actual wording with which this is expressed in later renditions is of less importance than the manner is which the goals are to be achieved. Beyond the style of prose and presentation, the Web sites portray the operation of individual medical schools, and provide some insight into structural differences. Details of curricula and educational governance in the majority of medical schools in the United States and Canada have been published [13]. Neither these outlines nor the public domain reports of the accrediting agencies conform with the mission document concept proposed in the RSM report that was used as a reference point for this study (Figure 1). Although the RSM report was not issued by an official organisation, its recommendations were authoritative and important. The documents that are available generally do not address the manner in which medical school outcomes are evaluated nor whether the schools' stated objectives have been attained, using individual and population-based outcomes. For example, if a medical school was established primarily to serve a particular population, it would be helpful for the public and similar schools to know how many graduates were actually in practice in that community several years after completion of training.

The accreditation processes in the four countries are important in determining the goals of medical schools. However, it is necessary to differentiate accreditation of medical education from assessment of medical schools in relation to their overall mission. Their achievements need to be framed in the expectations of the community or society that supports and funds the institution. To use an educational analogy, medical schools may demonstrate ability and competence in the test circumstances of accreditation, but the appropriate measures of outcome as fulfilment of objectives are evaluation of performance and quality. The intellectual significance of seeking outcomes information follows the proposition that medical academics should apply to their educational endeavors the sort of critical scientific thinking that is expected in their clinical and research work [14,15].

사업이나 보건분야의 mission statement는 '만질 수 있는 결과물'또는 서비스 대한 것이다. 그러나 의과대학의 '결과물(product)' 또는 '시장(market)'은 대단히 복잡하다. 그렇지만 여전히 유용한 성과지표들이 존재한다.

Mission statements developed for businesses and health care [11,16] are directed towards tangible products and services. For medical schools the "product" and the market are extremely complex. Here measurement of outcomes has to address intricate behaviors with many variables. It is very difficult to attribute specific physician competencies or health benefits for patients to particular segments of medical education, because of the multiple stages of medical school courses, postgraduate training and continuing medical education. Attribution of individual or group performance to their medical school's mission or objectives is even more tenuous. Nevertheless, there are useful outcome data that can be collected [4,9]. Frameworks have been proposed to evaluate the outcomes of revised and innovative curricula [17], and there are examples of data from graduate recollections and subjective opinions [18], and of educational outcome benefits [19].

It has been said that a socially responsible medical school perceives the needs of society and reacts accordingly, and a socially accountable school also consults society about priorities and provides evidence of impact of its deeds [20]. Fulfilment of the mission of serving the health needs of populations is a fundamental issue in social accountability of medical schools [21]. Three categories of assessment have been suggested in this regard – planning or input, doing or activity, and impacting or output [20,22]. The most recently established medical schools with mandates to support health care for under-serviced areas appear to have timely opportunities for prospective study of social accountability and population impact, in conjunction with their local health systems [23].

의과대학의 사회적 책무성 차원에 있어서, 보건의료시스템에 대한 공적인 의무와 연결되는 몇 가지 개념들이 있다. 의과대학의 mission은 다양하기 때문에, 이러한 정보에 대한 잘못된 해석이 있을 수 있다. 따라서 대중에게 공개되는 의과대학의 문서들은 목표(objectives), 구성원(community), 전통(tradition), 자원(institutional resources)의 맥락을 매우 정확히 할 필요가 있다. 

In considering the social accountability of medical schools there are several concepts that run in parallel with public accountability of health care systems. 

The advantages of standardization in public disclosure of health system outcomes include comparisons of the quality of care, comparisons of performance over time, amongst providers, and against defined standards of practice [24].

There are also potential disadvantages such as inappropriate focus on what is measured, and negative implications if results from different types of institution are compared in a competitive construct. 

This concern of potential misinterpretation of information is also applicable for medical schools because of the variability of their missions. Public presentation of medical school documentation should be done in a manner that makes clear the context of their objectives, community, traditions, and their institutional resources.

인터넷상에는 의과대학의 다양한 활동에 대한 정보가 가득하다. 이는 전 세계 의학공동체의 새로운 자원이며, 기관의 가치와 아이디어를 전파하기 위한 수단이기도 하다. 의과대학의 mission statement에 대한 일반적인 템플릿을 만드는 것도 가능할 것이다. 미션과 비전의 개념에 대한 해석도 다양하기 때문에 'descriptive statements or profile'이라고 부르는 것이 더 적절할 수도 있다. 사용한 단어가 더 일반적이거나 평이할수록 측정가능한 성과를 구체화하기 어렵다. 따라서 내용을 균일하게 하는 것이 reference를 위해서도 바람직하고, 배경이나 자료원을 이해하기에도 좋다. 

A rich store of information about the activities of medical schools is available on the Internet. This is a new resource base for the international medical community and a means to disseminate institutional values and ideas. The World Directory of Medical Schools includes 1647 schools in 157 countries [25]. Although all are listed as medical schools or medical colleges (and some have more elaborate titles in keeping with their many roles in addition to scholastic work) these are very heterogeneous organizations. It would be of value to have a general template for medical school mission statements placed on Web sites in the public domain. Because of differing interpretation of the concept of "mission" and "vision", these might be more appropriately called descriptive statements or profiles. The more general and prosaic the wording of the document, the more difficult is it to specify the measurable outcomes. Uniformity of content would therefore be helpful for reference, and in understanding the background or source of published work in international academic medicine, especially in medical education and population health. Figure 2 is a proposed generic template for the main headings and subheadings for medical school descriptive Web sites. The branched hierarchy hypertext capabilities of the Web permit links not only to appropriate sites in the same institution, but also to health system resources affiliated with the school, to the Web sites of medical school accrediting bodies, and to sites that provide general educational objectives [26]. Special or innovative programs that may be of interest to other schools can also be showcased, one example being the Web site of Dalhousie University Medical School, Canada [27].

It is acknowledged that several of the Internet documents abstracted for this article were not written to provide a comprehensive description of a medical school for external information. What was found in seeking statements consistent with the suggestions of the RSM report [2] was quite haphazard. Construction of a single Web portal to medical school descriptive statements, initially derived from the sources used in this study [3-8], could encourage consistency and enhance exchange of concepts and ideas in medical education and generally in international academic medicine.

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BMC Med Educ. 2001;1:4. Epub 2001 Oct 18.

The missions of medical schools: the pursuit of health in the service of society.

Lewkonia RM.

Author information

Abstract

Mission statements and role documents of medical schools in the United Kingdom, United States, Canada and Australia have been examined on their Internet Web sites and categorised in purpose, content and presentation. The format and content are highly variable, but there is a common vision of three integral roles, namely, education, advancement of knowledge and service to society. Other frequent themes include tradition and historical perspective, service for designated communities, and benchmarking to accreditation standards. Differences in content reflect variable interpretation of the notion of "mission", and local or national characteristics such as institutional affiliations, the types, levels and organisation of medical education, relationships with health systems, and extent of multi-professional education. Outcomes data and measures of medical school performance referenced to the institution's stated missions are rarely encountered. Mission documents placed on the Internet are in the public domain. These Web sites and documents and linked information constitute a valuable new resource for international exchange of approaches and ideas in medical education and generally in academic medicine. Routine inclusion of outcome or performance data could help to demonstrate the community roles and social accountability of medical schools This paper proposes that partial standardisation of these Web documents could enhance their value both internally and for external readers. A generic descriptive statement template is offered.

PMID:

 

11696255

 

[PubMed - indexed for MEDLINE] 

PMCID:

 

PMC59665

 

Free PMC Article