Academic medical centers, threatened by erosion of infrastructure, declining academic workforce, marketplace forces diminishing quality and access, and shrinking funds, must not rely on managed care, the pharmaceutical industry, or foundations to provide necessary support. They must communicate the dangers they face and persuade government to…

Rural health care can thrive if innovative tactics are used. Four principles can influence health care services: (1) an integrative approach is needed; (2) recognition that competition is a dominant mode; (3) cultural and professional ethnocentricity are counterproductive; and (4) the possibilities are limitless. (Author/MSE)

It is proposed that the need for collaboration between physicians and nurses is increasing with new health care needs and delivery systems, and that practitioners and educators must help improve the relationship. The phenomenon of collaboration, reasons for promoting it, barriers to achieving collaborative relationships, and change strategies are…

Noting the relatively constant percentage of minority students enrolling in medical schools since 1974, this paper urges academic medical centers to actively participate in the campaign by the Association of American Medical Colleges to double the number of underrepresented minority matriculants by the year 2000. Recommended strategies include…

The Harvard University Medical School (Massachusetts) and a community health maintenance organization (HMO) have formed the first medical school department to be based in a freestanding HMO, replicating the conventional teaching hospital clinical teaching model in a managed care situation. The model is seen as potentially transforming medical…

Health care reforms will dramatically change the culture of medical schools in areas of patient care, research, and education programs. Academic medical centers must construct mutually beneficial partnerships that will position them to take advantage of the opportunities rather than leave them without the diversity of resources needed to make…

This discussion of traditional academic medicine's resistance to changes in practice, technology, and finances looks at three current problems in medical education and two in biomedical research. Solutions are proposed, based on redefinition of the relationship between universities and medical schools and expansion of the conventional narrow focus…

Because there are no universal standards for educational technology, curricular materials in medical education cannot be easily managed, reused, or shared with other educators and institutions. A standardized, object-oriented architecture is needed to facilitate these processes. The Instructional Management Systems specification, which has emerged…

An imaginary curriculum on use of information technology for medical purposes is described. The six core courses address these topics: introduction to complexity; decisions and outcomes; scarcity and conflict; teamwork and organizations; representing knowledge and action; and groupware and collaboration. The curriculum is based on the conception…

This paper uses an organizational systems model in examining academic health centers and health maintenance organizations to identify common needs, mutual interests, areas for potential collaboration, and bridging strategies. These include health care systems development, professional education, information management systems, and health services…

Presents the results of the Association of American Medical Colleges' Working Group on Adapting to Resource Constraints, focusing on four areas: size of the academic enterprise, organizational models and their relationships to the clinical enterprise, faculty tenure and compensation, and partnerships with capital-intensive entities. Outlines…

Five global health-related dilemmas requiring action are discussed, including (1) worldwide population aging; (2) rising worldwide poverty; (3) ethical dilemmas of new technologies; (4) need for adequate and affordable health care systems; and (5) need to allocate scarce resources to meet infinite health care demands. Five actions are recommended,…