Could reality TV save academic medicine?

Imagine a future where medical schools are answerable to shareholders, where patients decide how doctors should be trained, or where academics compete on TV game shows to win research grants …

This could be the future of academic medicine by 2025, according to members of the International Campaign to Revitalise Academic Medicine (ICRAM), launched by the BMJ and partners in November 2003.

Their vision for the future is published simultaneously today by the BMJ (www.bmj.com), the open access international medical journal PLoS Medicine (www.plosmedicine.org) and the Milbank Memorial Fund (www.milbank.org).

In the first scenario, academic medicine flourished in the private sector and medical research, training and service became commercial business activities. But, although overall efficiency and effectiveness improved, equity and innovation suffered.

Academic medicine disappeared altogether in the second scenario. Instead, teaching, learning, and researching were integrated with mainstream health care. Team work fostered, but stability and decision making was threatened.

In scenario three, the public were in charge. They determined research priorities through game shows or citizen’s juries and students received most of their training from expert patients. But scientific advances were subject to fads and there was little regulation of health information.

In the final two scenarios, academic medicine engaged fully with all stakeholders and focused on improving global health. Global networks flourished and medical training was energised. But lack of political will and fears of “dumbing down” hampered progress.

“None of these scenarios will come to exist as we have described them, but the future is likely to contain some elements from each of them,” say the authors. “Our main hope is that other groups may find them useful in thinking about both the present and the future of academic medicine … we seek not agreement but broader thinking.”

Four commentaries, also published by the BMJ, discuss the implications of the scenarios for its stakeholders: the public, patients, practitioners, politicians, and policy makers.

All agree that the scenarios offer exciting insights into how academic medicine should evolve, and that if change is going to happen, everyone will have to let go of preconceived notions. “If academic medicine is to remain a leading player in the business of health, it has to do better,” concludes one author.