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It is ironic that at a time when tenured faculty are experiencing ever-increasing pressure to write research grants and publish higher-impact papers, administrators at most academic health centers have, for the most part, managed to elude having to make scholarly efforts that would be reviewed by academic peers in the form of end-of-year or every-other-year evaluations. Although administrators are hired to solve specific problems in an academic institution, rarely are they subject to academic review with respect to their overall performances or success at problem solving. In what would appear to be an example of an academic double standard, consider the contrast with requirements made of other faculty: A physician in the Department of Medicine or other clinical department is expected to engage in scholarly work (i. e. , obtain research grants or contracts, conduct research, publish articles in peer-reviewed journals) and at the same time be clinically active and teach medical students, residents, and fellows, while a faculty member in the Department of Biochemistry or other basic science department is expected to obtain 250, 000 in grants from the National Institutes of Health, which will pay substantial portions of the faculty member's salary, and publish original research, as well as lecture and tutor medical students, graduate students, and postdoctoral fellows. By contrast, administrators such as deans for medical education, students affairs, etc. , generally are not held accountable for their administrative “results, ” in particular for their efforts as scholars in the academic community. The persistence of this pervasive double standard is perplexing for several reasons, two of which we discuss below. First, the 1990s have witnessed an evolution in the institutional evaluation of faculty “productivity” such that many American academic health centers have begun to develop mechanisms for assessing productivity in (supposedly precise) quantitative terms. The basic currency of these assessment instruments is termed the “relative value unit” (RVU). Academic health center deans have appointed committees to decide the “value” of each function of a faculty member, be he or she an MD—clinician or a PhD—basic scientist, in terms of how the faculty member's activities contribute to the strategic performance and missions of the institution (typically defined as education, research, and clinical care1). Such activities must be quantifiable in units (RVUs), although one could argue that critical educational efforts such as thinking creatively and counseling students or patients may not be readily measurable in numerical terms. Basic scientist faculty members obtain RVUs for activities such as lectures, publications in peer-reviewed journals, service on institutional committees, extramural invited seminars, etc. , albeit not for activities such as preparation of non-funded grants, reading, laboratory group meetings, or counseling efforts, all of which lack precise numerical endpoints. Faculty in clinical departments accumulate RVU credits for the same activities, but also for the numbers of patients they see or the net income they generate for the institution. 2 Administrators who embrace the RVU system see it as a means to imprinting a “business model” on academic health centers because, they argue, all activities of faculty can and should be perceived in an economic context. The RVU is thus regarded as a precise quantitative instrument that provides university administrators with a means for assessing the productivity of the faculty. They rely on RVUs to compare the productive outputs of different faculty members and departments and believe it will help them to control costs associated with the academic mission of the institution. 3 Such information may form the basis for making adjustments in salary or other forms of compensation. 4, 5 Irrespective of the wisdom or necessity to initiate RVU-type assessments at academic health centers, we are struck by the lack of attention that has been given to the quantitative assessment of the productivity of deans, associate and assistant deans, and other senior administrators who hold tenure as faculty members. RVUs have not been described for such individuals when, in fact, their duties ought to be readily subject to such accountability. The second, and complementary, reason that we are troubled that academic health center administrators are not scrutinized with the same kind of annual or biannual accountability required of other faculty members has to do with the enormous amount of curricular experimentation and revision that has gone on at these centers over the past decade. One would think that after making such changes, the deans (and faculty committees) that initiated and implemented them would want objective evaluations of the results. Isn't it puzzling that although a current buzz-word in the performances of physicians and training programs is “outcomes assessment, ”6 academic health center administrators have not provided a detailed, scholarly assessment of the impact of the curricular and/or admission requirement changes that have been made? For example, one might ask the dean of minority programs, “Can we see the `hard data' that evaluate the impact of your innovative recruitment, admission, and retention efforts? What are the philosophical and educational underpinnings of your programs in these areas and what implications do they have vis-à-vis state and federal laws? Are you prepared to produce a scholarly article that summarizes our school's programs and their impacts on medical education and patient care? ” And for a dean of student affairs, isn't it reasonable to expect this individual to critically evaluate how changes in the curriculum have affected the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores of the school's medical students or, more importantly, how these changes have influenced aspects of these students' professional career paths? Wouldn't it be useful if the administrators who had decided to abolish the traditional basic science departments and replaced them with three “research theme departments” were to write an article entitled “The Effects of Abolishing the Departments of Anatomy, Physiology, Pharmacology, and Microbiology on Medical Students' Basic Science and Clinical Training”? Should not such a report, with its quantitative assessment, be used to evaluate the administrators' performances? Published reports such as these would have scholarly value. They could also be particularly useful to senior administrators at other institutions who might be contemplating similar restructuring of departments. In a word, shouldn't all members of academic health center faculty and administration be made accountable in terms of their contributions to the fabric of the center as a scholarly institution? The questions posed in the previous paragraph point to a further problem in academic health centers and one for which administrators bear primary responsibility: Substantial amounts of information and data that pertain to medical students lie fallow in filing cabinets or on floppy discs or hard drives in various administrative offices throughout academic health centers. If a biochemical scientist working on a particular disease were to accumulate laboratory notebooks or computer files filled with definitive data and never published his or her findings, that scientist would be criticized on a number of grounds and would be unlikely to maintain funding for a research program. Why is it, then, that administrators are able to isolate data of potential value to the institution, medical students, and faculty? Academic health center administrators have information about medical students' scores on the Medical College Admission Test, their grade-point averages, grades in courses, subjective assessments of them by faculty, their residency choices (both subspecialty and institution), performances on the USMLE Step 1 and Step 2, etc. These largely untapped pools of data (except for use in dean's letters about individual students when they apply for postgraduate training) could and should be analyzed and utilized in a scholarly way by administrators who are its custodians. In fact, one could go so far to argue that they have a moral responsibility to extract from these data insights that would enhance the quality of life for medical students, improve the curriculum, enlighten colleagues at other academic health centers, and perhaps prove useful in dealing with licensing and legislative bodies. In general terms, isn't the free exchange of information and knowledge a fundamental requirement for a free and progressive society? In the specific case of academic health centers, the scholarly presentation of data and their impacts—both good and bad—has the potential to help all involved in medical education and in the protection of the public's health. In conclusion, isn't it time to hold academic health center administrators to the same standards that are expected for the faculty-at-large, i. e. , requiring annual or biannual evaluation of scholarly activities and productivity? Most administrators have risen from the ranks of the faculty, yet, as we have just observed, such administrators have not generally been scrutinized via an academic assessment of outcomes of their actions. If, in the end, the deans and other administrators shun scholarly work, while at the same time maintaining control over academic resources, we in medical education run the risk of a great disconnection between “them” and “us, ” a critical problem in an era in which new types of leaders are needed as academic health centers evolve. 7–9 By putting all faculty members (deans and non-deans alike) on an intellectual footing and holding them accountable, we help retain and enhance the academic nature of academic health centers.
Glew et al. (Sun,) studied this question.