The culture of medicine

Jan 1 2009

Everybody is familiar with the stereotypes of medical education from the student perspective: grueling hours, little recognition, and even less glory.

Now a novel Brandeis study published in Academic Medicine this month pulls back the curtain on the dominant environment of academic medicine from the perspective of faculty, the providers of medical education in medical schools.

The study raises questions about how the prevailing culture of academic medicine shapes the delivery of healthcare - from the quality of patient care and physician professionalism, to faculty burnout and leadership opportunities for women, minorities and primary care physicians. The article reports on how medical faculty experience the culture in which they work by examining their relationships to each other, to medical students, and to patients, as a reflection of the broader environment within academic medicine.

Brandeis University senior scientist Dr. Linda Pololi and her colleagues conducted in-depth one-on-one interviews with faculty members in a variety of specialty areas at five prominent medical schools across the country. While the study determined that positive relational aspects of the culture in academic medicine exist, it found that faculty often experienced disconnection, competitive individualism, undervaluing of humanistic qualities, deprecation, disrespect, and the erosion of trust.

"These negative experiences are undermining the central task of medical schools pointed out by the Pew-Fetzer Task Force in the 1990s, to help students, faculty, and medical practitioners to form caring, healing relationships with patients and their communities and with each other," said Pololi.

The study found that serious problems exist in the relational culture affecting medical faculty vitality, professionalism, and general productivity, and are linked to retention. "These aspects of the culture undermine the goals of medical institutions and are antithetical to fostering superior patient care, biomedical research, and educational excellence," explained Pololi. "It is highly laudable that the deans in our participating schools have taken this trail-blazing initiative to explore the extent and causes of this dissatisfaction and to do something about it."

The implications for healthcare are significant. "We have the most technologically advanced and most expensive medical system in the world, but we need compassionate healthcare as well," said Pololi. "We cannot teach compassion for patients without practicing it among ourselves; we cannot learn to be sensitive to cultural diversity in our patients without incorporating the perspectives of women and minority physicians who make up a larger portion of the medical workforce than ever before. We cannot be optimally successful in researching the causes of disease and finding new treatments without rewarding collaboration and openness, rather than competitive individualism."

http://www.brandeis.edu/