We Are Eroding The Vital link Between Academic Research And Education

I wonder if what I’ve noticed happening to the faculty of United States medical schools applies equally to other segments of the “research university.” Put simply, we are creating two faculties: one devoted to bringing in research grants and publishing as many papers as possible, and the other relegated to handling the teaching load. The separation is not complete, but it is rapidly becoming so, and the vigor of the latter group is not increasing. Many professors will retire in the next decade or so. And when this happens, replacements of quality and dedication will be tough to find as their mission becomes even less prestigious. Many academic health centers have become increasingly concerned more with their rank in the institutional hierarchy of federal or foundation dollars gained than with the quality of education provided. In medical schools, an additional and more recent ingredient is involved—and indeed is essential for survival. This ingredient is the generation of patient-care dollars from faculty practice (see R.H. Ebert and E. Ginsberg, Health Affairs/Supplement, 1988, page 5). These trends have swelled the ranks of pure research and careproviding faculty, and have even created the need for a special, nontenured professoriate to do research and/or patient care. Many of these new faculty members contribute little to teaching a new generation of scientists and physicians. Ask why the pattern should have emerged, much less continue, and more often than not the answer will be, “That’s the name of the game.” For presidents and deans, “the “the game” is a matter of competition and survival, and that’s not all had. Healthy competition and honest peer-review stimulate the best research. Taken to the extreme, however, the atmosphere is detrimental to developing a well-rounded faculty and maintaining both the quality of education and the attractiveness of academic biomedical professions. Take a look at the successful people among the diminishing numbers of young M.D.’s or Ph.D.’s who recently have opted for careers on the faculty of medical schools. By and large, they are very bright, very competitive, highly analytic, and more than a bit single-minded in their goals. They know that landing a postdoctoral fellowship or specialized residency of high repute, gaining a faculty position, being promoted, and earning tenure all require the expedient establishment of a national and international reputation for research. Three ingredients are primary: publish (or appear on the authorship of) as many papers as possible; gain independent funding, and be visible at national and international meetings. To do this with dispatch (for the probationary period is short), one must specialize as early and as narrowly as possible and, above all, impress those above. Don’t look down—or at students. Out Of Touch These successful young “sharks” thus view a relationship or responsibility to students as a chore. Better to have a well-versed postdoc in one’s lab than devote the necessary time to a graduate student or, perish the thought, teach a basic course to medical students. The game has evolved such that most basic science medical education is simplified, team-taught, lecture-intensive, or (increasingly) computer-interactive. Clinical teaching is placed in the hands of resident physicians operating on schedules offering little time for study or contact with supervisory faculty. Staffing of basic science courses that do require substantial student-faculty interaction is increasingly relegated to “non-sharks”—generally, older faculty who have dropped, or are dropping, out of the game. They will retire, not so long from now, as associate professors. Many will be revered by their students for their time, kindness, and dedication, never suspecting how out of touch they had become with the frontiers of their science. Misconduct And Fraud The link between research and patient care (on the one hand) and education (on the other) is in danger. Equally disturbing, the obvious economic forces eroding that link are also putting extreme pressure on academic standards and controls. The scientific literature has become overcrowded, frequently hasty or careless, fragmented, and often redundant. And I suspect that the “sharkness” of the game is not unrelated to the over-representation, misconduct, and outright fraud that has occasionally occuffed in our academic ranks. So what can be done? There are several possibilities. First, curricular schedules and content need to be rethought and redeveloped with priority given to logical sequences and the integration of concepts. At the moment, expediency is the major driving force behind curricula. I believe discovery should be the major objective in all our teaching. Let’s preserve the very best, most inspiring and integrative lectures, the most discovery-laden laboratories. And most important, let’s provide reward, research opportunity, and recognition for those faculty who develop such programs and teach students in that mode. We need our best researchers to become more involved in education. Second, we should consider the concept of DeWitt Stetten (Science 323, page 11, 1986). Stetten argued that grant awards, faculty promotions, tenure decisions, and major prizes should be based on the review of a dozen or fewer publications, rather than the usual laundry list of hundreds of multiauthored fragments. This would promote a more ethical mode of scientific communication. Finally, our granting agencies and foundations urgently need to recognize, perhaps through special categories of awards, the importance of funding high-quality researchers who also devote a major share of their time to students. It is this type of vanishing academician who, after all, is the link between research and education. The link is vital to both faculty development and inspired student response. I hope that its value can re-emerge and be preserved before the “name of the game” is the only show in town. Douglas E. Kelly is Professor and Chairman of the Department of Anatomy and Cell Biology at the University of Southern California School of Medicine.

We Are Eroding The Vital link Between Academic Research And Education

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Douglas Kelly

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October 1988

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