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Integrating the diverse structures of academic medical centers -- Integrating clinical care delivery systems -- Leadership in the academic medical center -- Fixing the broken pipeline of AMC scientists -- Resolving conflicts of interest -- Commercializing research discoveries -- Resolving the physician workforce crisis -- The changing demographics of America's AMCs -- Teaching medical professionalism in the AMC -- Financing the missions of the AMC -- Developing strategic regional and global collaborations -- Ensuring governmental support and oversight of the AMC.

Medical schools and teaching hospitals have been hit particularly hard by the financial crisis affecting health care in the United States. To compete financially, many academic medical centers have recruited wealthy foreign patients and established luxury primary care clinics. At these clinics, patients are offered tests supported by little evidence of their clinical and/or cost effectiveness, which erodes the scientific underpinnings of medical practice. Given widespread disparities in health, wealth, and access to care, as well as growing cynicism and dissatisfaction with medicine among trainees, the promotion by these institutions of an overt, two-tiered system of care, which exacerbates inequities and injustice, erodes professional ethics. Academic medical centers should divert their intellectual and financial resources away from luxury primary care and toward more equitable and just programs designed to promote individual, community, and global health. The public and its legislators should, in turn, provide adequate funds to enable this. Ways for academic medicine to facilitate this largesse are discussed.

Many professional organizations and governmental bodies recommend disclosing financial conflicts of interest to potential research participants. Three possible goals of such disclosures are to inform the decision making of potential research participants, to protect against liability, and to deter conflicts of interest. We reviewed US academic medical centers' policies regarding the disclosure of conflicts of interest in research. Forty-eight percent mentioned disclosing conflicts to potential research participants. Of those, 58% included verbatim language that could be used in informed consent documents. Considerable variability exists concerning the specific information that should be disclosed. Most of the institutions' policies are consistent with the goal of protection from legal liability.

The clinical research landscape has changed dramatically in recent years in terms of both volume and complexity. This poses new challenges for Institutional Review Boards' (IRBs) review efficiency and quality, especially at large academic medical centers. This article discusses the technical facets of IRB modernization. We analyzed the information technology used by IRBs in large academic institutions across the United States. We found that large academic medical centers have a high electronic IRB adoption rate; however, the capabilities of electronic IRB systems vary greatly. We discuss potential use-cases of a fully exploited electronic IRB system that promise to streamline the clinical research work flow. The key to that approach utilizes a structured and standardized information model for the IRB application.

Cover -- Half Title -- Title -- Copyright -- Contents -- List of Tables and Figures -- Dedication -- Introduction -- 1 Overview -- 2 Educating Physicians for the Real World -- 3 The Creation of Partners HealthCare System, Inc. -- 4 Lessons Learned from the Evolution of an Academic Health Care Network and Integrated Delivery System -- 5 Competition: A View from the Midwest -- 6 Positioning an Academic Medical School for Survival: How Many Moving Targets Must We Hit to Make It? -- 7 Reinventing Education in Medical Schools -- 8 Gathering Momentum for the Next Century: Our Long-Range Strategic Plan -- 9 Academic Medical Centers and the Future of Health Care -- 10 The Challenge to a State System -- 11 Perspectives -- 12 Afterword -- About the Contributors -- Cornell University Medical College Tenth Conference on Health -- Index.

Introduction: the hallmarks of successful academic health science center leadership / Steven A. Wartman and Stewart Gabel -- Academic health science centers in the new world order: optimizing structure and governance for high performance / Jean E. Robillard -- Organizational structure, data, and academic health science center transformation / Robert I. Grossman and Robert Berne -- Contemporary challenges in academic health science center financial management / Jeffrey R. Balser, Edward R. Marx, and John F. Manning -- Conflicts of interest and commitment: policy making in the academic health science center / Raymond J. Hutchinson, Sanjay Saint, and James O. Woolliscroft -- Regulation, accreditation, and the compliance function / Cynthia E. Boyd and Larry J Goodman -- Human resources and personnel management / Harold L. Paz, Billie S. Willits, Deirdre C. Weaver, and Sean Young -- Trainee and student policy / Wilsie S. Bishop and M. David Linville Jr. -- Faculty accountability / Stephen Smith and Peter Davies -- Developing and implementing a communications philospy and supporting policies / William F. Owen, Jr. and Lee Miller -- Community relations / Barbara Atkinson, C.J. Janovy, and Marcia Nielson -- Academic health science centers and global medicine / D. Clay Ackerly, Krishna Udayakumar, Alex Cho, and Victor J. Dzau -- Afterword: "a most complex invention" / Richard I. Levin and Steven A. Wartman.

The leadership and management of academic health centers present challenges as complex as any in the corporate environment. A consensus is emerging about their integrated mission of education, research and service, and this book, first published in 2005 and focusing on value-driven management, provides a truly comprehensive review of these issues available. Based on reports produced by the Blue Ridge Academic Health Group, which has developed a framework for meeting the challenges of improving health in the 21st century, it also contains invited commentaries and case studies from leading authorities in and beyond the United States. It identifies the public policies and organizational practices required to maximise the health status of individuals and the population, and highlights innovative practices. It is essential reading for managers and leaders of clinical and basic science departments in academic health centers, and for all those involved in health systems management studies