Vice President and Principal
The major themes at this year’s Association of American Medical Colleges (AAMC) Learn, Serve, Lead conference would have seemed completely out of place a decade ago. Back then, if you had heard about a conference focusing its plenary sessions on civil discourse, climate change, and anti-racism, you would never have known you were talking about an academic medicine meeting.
But in 2022, that is exactly what the AAMC positioned front and center on its agenda.
Several CFAR team members attended the AAMC’s annual meeting in Nashville last month. In contrast with meetings of the past, conference sessions were no longer focused solely on reducing medical errors, enabling breakthroughs in scientific research, handling accreditation challenges, or experimenting with value-based healthcare models. Instead, the AAMC promoted a social agenda that expanded far beyond the traditional walls of medicine but seemingly influences every aspect of delivering safe, effective, and equitable care.
This shift in focus was of particular interest to us at CFAR given our longstanding work in organizational culture and our distinct application of systems thinking with our clients.
What We Learned
In the opening plenary session, AAMC President and CEO David Skorton, MD, facilitated a lively conversation between Cornell West, Ph.D., and Robert George, JD, DPhil, about civil discourse. George defined civil discourse as consisting of talking and, above all, listening to another person with a different point of view “in a truth-seeking spirit with a willingness to learn.” He said it entails a recognition of one’s own fallibility—that we could be wrong, not only about the minor or trivial things but also about deeply held beliefs. West emphasized that civil discourse goes beyond simply getting along with somebody you disagree with—that it fundamentally involves connecting to what it means to be a human being.
Skorton, in the AAMC leadership plenary session, shared his own thoughts on what keeps him up at night as the top leader of AAMC, highlighting four key issues:
- The first was diversity, equity, and inclusion (DEI) efforts in medical schools and a focus on health equity for patient outcomes.
- Next came the well-being—mental health, primarily—of learners in both undergraduate and graduate medical education.
- Third, Skorton wondered how the AAMC can support legislation and policies that protect the professional interactions and relationships between clinicians and patients.
- His fourth key issue was concern about free speech for medical professionals. He expressed worry that the AAMC has been receiving more requests to speak out on issues that local leaders fear they cannot speak out about, including misinformation, hate, and speech that permits violence against medical professionals.
Following these weighty topics, the AAMC also featured a plenary on climate change. The speakers—Renee Salas, MD, MPH, MS, Aaron Bernstein, MD, MPH, and Shaneeta Johnson, MD, MBA—drew attention to numerous health consequences of a warming planet and emphasized the healthcare industry’s substantial contributions to the climate crisis.
Salas called on clinicians to consider the influence of climate change on their diagnoses and treatment plans, one example being the adverse cardiovascular and neurological effects of air pollution from fossil fuels. She also urged audience members to counteract the industry’s historical trends and contributions to global warming, including the use of fossil fuel-based energy to keep operating rooms temperature-controlled all day (regardless of whether a procedure is going on) and standard anesthetic gasses that add significantly to greenhouse gas emissions. The speakers’ discussion connected the issues of climate change and environmental justice with health inequities to persuade the audience to take up this crisis within their healthcare organizations.
A CFAR Interpretation
We view this lineup of topics at AAMC as evidence of a recent shift in the discipline of medicine—a social evolution, if you will. Although high-quality and lower-cost care remain important goals, in 2020 the healthcare industry was thrust into the social spotlight differently than it had been in the past. While it is well known that racial disparities in health outcomes exist for numerous disease processes, the disproportionate deaths among people of color from COVID-19 heightened society’s attention on the medical field and raised the field’s sense of urgency amidst the social unrest that followed from the murders of George Floyd, Breonna Taylor, and others.
Healthcare, as with any industry, is a system within a larger system. As complex a field as healthcare is on its own, it co-exists and interacts with many other systems, such as the broader economy, politics, law, and the media, to name a few. From the change in the AAMC’s agenda, it appears that some healthcare leaders are beginning to act on the reality that issues previously thought to be healthcare-specific—like the patient-clinician relationship, physicians’ status in the hierarchy of medicine, or the choice of what food hospitals serve their patients or what materials they purchase for the operating room—are influenced heavily by phenomena outside of healthcare. There are many unique characteristics of healthcare, but it does not function in a bubble; recognizing this and acting on it signifies a greater awareness by leaders in academic medicine of the societal trends that shape and define what is possible in healthcare environments.
These observations demonstrate the systems thinking lens through which we approach our work with all our clients.
Exploring the Implications of the AAMC Meeting in Our Work with Clients
Coming home from the AAMC Learn, Serve, Lead 2022 meeting, we reflected on where we have been experiencing these trends in our client work. While CFAR has decades of experience helping healthcare leaders and organizations assess and adapt their cultures, a few current examples came to mind.
CFAR recently worked with a new medical school to embed health equity into its identity and vision for its graduates. We also partnered with a non-profit organization to develop their strategy for a program designed to advance health equity both within the U.S. and globally. Drawing on our experiences of bringing awareness to the cultural context in our work, we helped to develop a strategic roadmap for an institute dedicated to transforming medical education by focusing on the core elements of integrity and caring to improve health for all. We have also supported efforts to embed practices of civil discourse in academic medicine.
Recently, we have engaged with several academic health systems that are redefining their organizational values and subsequently their culture. The timing of this work coincides with the Great Resignation and a growing recognition that healthcare workers prioritize many social and personal issues—such as a focus on DEI in recruitment and retention efforts, freedom to speak up about political issues, or supporting employees’ mental health—that their employers previously had not addressed as thoroughly as they would have liked.
Interestingly, we have not yet observed climate change as a major factor in our healthcare clients’ strategies, cultures, or leadership team priorities. As the AAMC’s newer priorities begin to ripple throughout academic medicine, we appreciate that we will need to bring a heightened awareness to our work to help clients explore the implications of these issues in their own organizations.
Looking ahead, we are eager to partner with our clients to embrace this significant evolution in the social focus of academic medicine and the healthcare industry more broadly.