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The social mission of medical schools

A recent study published in the Annals of Internal Medicine entitled “The Social Mission of Medical Education: Ranking the Schools”[1] has received a lot of attention in the medical education community in the US.  The study tracked 60,043 doctors who had graduated from 141 US medical schools between 1999 and 2001. The study developed a ranking tool known as “the social mission score” and measured the performance of US medical schools on the following metrics: graduating doctors who practise primary care, who work in medically underserved areas, and who are under-represented minorities.

13 Dec 2010

By Dr Lesley Russell

A recent study published in the Annals of Internal Medicine entitled “The Social Mission of Medical Education: Ranking the Schools” has received a lot of attention in the medical education community in the US.  The study tracked 60,043 doctors who had graduated from 141 US medical schools between 1999 and 2001. The study developed a ranking tool known as “the social mission score” and measured the performance of US medical schools on the following metrics: graduating doctors who practise primary care, who work in medically underserved areas, and who are under-represented minorities. 

In a media release announcing their findings, the authors, from George Washington University, stressed the importance of the study.

“The social mission of medicine and medical education should be important to everyone,” they said.

“It isn’t just about rural areas or just about poor people; it’s about the entire fabric of how we deliver care. As patients are insured through health reform, the first place they will go is the primary care office. Medical schools need to be mindful of the nation’s requirements for primary care, for doctors prepared to work in underserved communities, and for minority physicians to help meet the growing and changing needs of the country.”

Key findings from the study included:

  • Three historically black medical schools – Morehouse College in Atlanta, Meharry Medical College in Nashville, and Howard University in Washington, DC – had the highest social mission rankings;
  • Public and community-based medical schools graduated higher proportions of primary care doctors than did private and non-community-based schools;
  • Medical schools in smaller cities produced more primary care doctors and doctors who practised in underserved communities, but they graduated fewer minorities;
  • Schools with substantial research funding from the National Institutes of Health produced fewer primary care doctors and doctors who went on to practise in underserved areas, and had lower overall social mission scores; and
  • Medical schools in the northeast of the country, where there is a preponderance of private, traditional, and research-intensive medical schools that rank highly in traditional measures, performed poorly on all three goals and had the lowest social mission scores of any region in the country.

The top three medical schools for research in US News & World Report’s 2010 graduate school rankings were Harvard University in Boston, the University of Pennsylvania School of Medicine in Philadelphia, and Johns Hopkins University School of Medicine in Baltimore, in that order. Under this new social mission metric, these three finished 62nd, 122nd, and 129th, respectively. 

The Association of American Medical Colleges (AAMC) was quick to hit back, arguing that social mission ought to be looked at more broadly. The survey, said AAMC, “produces an inaccurate and limited picture. Medical schools meet society’s needs in many ways through their integrated missions in medical education, research and patient care.” 

Interestingly (because I taught there for four years), the AAMC pointed to the Uniformed Services University of the Health Sciences (USUHS), which educates military doctors who treat servicemen and women, but which ranks in the bottom twenty on social mission.  USUHS certainly has a mission, but it’s very narrowly focused and does not extend beyond anyone who is not in uniform.

Medical schools contribute numerous important public goods to society beyond training the future medical workforce. They generate new scientific knowledge, are the home of leading-edge clinical treatments, and often provide substantial health care to underserved communities through their university hospitals and affiliated outpatient clinics.

High levels of research funding clearly indicate an institutional commitment to research and probably indicate missions that value technical medicine and specialisation, rather than training in primary care and practice in underserved areas.  The study proposes that educational ranking systems that place significant weight on research funding may confuse discussions of national educational policy by conflating research values with national clinical needs.

In 1996, Professor Max Kamien wrote that “few http://www.educationforhealth.net/EfHArticleArchive/1357-6283_v16n1s4_713665191.pdf


Published: 13 Dec 2010