Rankings, Plaudits, And Awards Are Not Measures Of Academic Excellence
By
Leonard Zwelling
Harvard Medical School has withdrawn from the annual US News and World Report rankings. Dean George Q. Daley is quoted in The Wall Street Journal:
“Rankings cannot meaningfully reflect the high aspirations for educational excellence, graduate preparedness, and compassionate and equitable patient care that we strive to foster in our medical education program,” he said.
I’m no fan of Harvard, but good for them!
Academic medical centers have gotten caught up in a host of external rating systems and awards that bear absolutely no relation to their missions.
Let’s be frank about what academic medical centers are supposed to do.
First, they provide the best patient care available by using the training and experience of the faculty and staff, and the latest in technology to deliver care that actually changes the natural history of human diseases and also seeks to prevent disorders from taking a toll on individual people.
Second, they do research that ought to seek to discover basic principles of human and other life science in the hope of translating that knowledge into new methods of diagnosis and treatment of human disease.
Third, academic centers seek to instill in the next generation of care givers and researchers the drive to lifelong learning and the importance of making contributions to humanity through research, patient care and additional education of the next generation.
That’s what academic centers do and Harvard Medical School is part of a large academic center in Boston and Cambridge, Massachusetts. Like MD Anderson in Houston or Baylor in Houston or the UT Health Sciences Center in Houston, those are the missions of academic centers. The mission is not to advance in the rankings of a lay publication or seek recognition as being a great employer to the classified staff. Those things are nice, but they are the icing on the cake and may or may not be indicative of how good the actual cake is.
It appears that a generation of academic leaders has forgotten what the actual missions of their institutions are and instead seek the plaudits of outside entities ill-equipped to judge the quality of the patient care, the research, or the education provided at these centers.
The quality of patient care is best assessed by objective measures of care quality to the extent that this is possible. Patient satisfaction is not an indicator of the excellence of clinical judgment by the faculty. Patient satisfaction is a measure of how nice the experience of care was for the patient. Most of my patients when I cared for cancer patients were most concerned about getting better, not what color my tie was. (That’s when doctors wore ties.)
The quality of research is very tough to assess because the real measure of quality can only occur over many years. A pretty good indicator of that timeline is the years between a seminal discovery and the award of a Nobel Prize (a true indicator of research excellence).
Educational quality can only be reflected in the careers of the graduates from an academic program. It takes years to realize the fruits of the educational mission of any academic institution.
In other words, academic medicine is complicated and the good it does can only be measured over years. Academic health systems may be among the most complex of systems and require constant energy input to prevent them from disordered entropy. How do you measure that? You do it over a lengthy time scale. And, you do it yourself. That is what the leaders of these institutions get paid to do.
No one would argue that Harvard Medical School has not produced clinical, research, and teaching excellence in their graduates. Harvard, to its credit, like Yale and Harvard Law Schools, has become disenchanted with a lay publication milking them for data and then ranking them.
Just say for me, MD Anderson should do the same and withdraw from all of these superficial measures of excellence and get back to basics—patient care, research, education. Get the best faculty to do that, and the rest will take care of itself. And the best faculty are the best clinicians, investigators and mentors, not the nicest people. Nice is not in the mission.
My best doctors, best lab mentors, and best teachers were not always nice. But they were demanding and excellent. My satisfaction with their personalities was not their concern. They instilled high values in me and I am grateful for it. So were my patients, my research collaborators, and my students.
That’s what counts in academic medicine not rankings, plaudits, and awards. If you are going to lead an academic center, you better know the mission, how to measure progress, and what is irrelevant.
