To meet the challenges of the extraordinary times we are living in and improve health for all, we must catalyze change in academic medicine. PSOM Dean J. Larry Jameson delivered this message at the conclusion of his term as chair of the Board of Directors for the Association of American Medical Colleges.
The Power to Accelerate Needed Change
J. Larry Jameson, MD, PhD
Dean, Perelman School of Medicine (PSOM)
Executive Vice President of the University of
Pennsylvania for the Health System
I want to challenge you – challenge us – to accelerate needed changes in health care and science. We know the potential of the U.S. health care system. We are the innovators of most new medical advances; we have generous funding from the NIH that fuels our breakthrough basic and translational research discoveries; American biotech and pharma industries pioneer most new therapies. We have some of the finest health care facilities in the world. Nevertheless, it is a long-standing tragedy that our health outcomes lag most of the developed world.
Our business community, government, and fellow Americans are losing patience with the cost of health care delivery and challenges with access.
The sources and potential solutions to this paradox are well-known – social determinants of health, persistent health disparities, misallocation of resources, particularly relative to prevention, and a payment system that is overly bureaucratic and not well aligned with incentives to optimize outcomes at lower cost – to name just a few issues.
We cannot wait for others to address these challenges. Change will happen either with us, or to us.
Remember, each of us has the power to act locally in our own communities and in our institutions – in our classrooms, clinics, laboratories, and operating rooms. We own the culture of academic medicine.
We should remember that our profession is largely self-regulated. We created most of our policies – formal and informal. We establish the curriculum – explicit and hidden. Therefore, in principle, we can change these policies and practices.
For example, we can decide whether to embrace more holistic criteria for promotion. We can decide whether we value team science as much as – or more than – individual accomplishments.
At Penn Medicine, we recently added community-engaged research to our formal categories for scholarship; we set explicit expectations for professionalism and review these for appointment and promotion; we expanded our education categories to embrace teaching and mentoring in practical settings like clinics, ICUs, and laboratories, as well as in the classroom.
PSOM medical students Ginikanwa Onyekaba, Katie Krupp, Canada Montgomery, and Austin Cao are part of Penn Medicine’s first-of-its-kind Center for Surgical Health, which provides navigation and support to help under- and uninsured patients receive surgical treatment before it becomes an emergency.
We overtly state that we are united as an anti-racist organization, setting an expectation for our culture.
I hope – and believe – that we have reached an inflection point in the effort to root out racism and bias in medicine. Widespread outrage over racial injustice in the last two years has catalyzed an ongoing movement to effect enduring change.
After years of slow progress, we saw a major uptick in applications to academic medical institutions during the pandemic – that was accompanied by the enrollment of more diverse students into medical school and PhD programs.
We need to build on this momentum, and ensure that our climate is conducive to learning and positive experiences for students from a wide range of backgrounds and experiences. Embracing diversity and inclusion will help us evolve more quickly and successfully.
Bringing Biomedical Research to its Apex
Innovation in research has been, and remains, a critical part of our relevance and our future.
I am trained as a physician-scientist. At each stage of my career, I thought we were approaching the pinnacle of biomedical advances. But we are far from the apex. Around every corner is a stunning unforeseen breakthrough – the emergence of epigenetics for regulating gene expression, the engineering of CAR-T cells to treat cancer, the use of fetal surgery to treat developmental defects like spina bifida, the development of CRISPR-Cas9 for gene editing, and the use of TAVR as a less invasive way to repair heart valves. The tools and opportunities for major research advances have never been greater. The remarkable efficacy and safety of the mRNA vaccines against the SARS-CoV-2 virus shows how much we can accomplish.
These types of advances can rarely be supported by academia alone.
The platform for mRNA vaccines was developed by two scientists at Penn Medicine based upon decades of basic research. But it required collaboration with government and industry to bring this technology to patients.
We can seize this moment in history to build support for translational science and quicken its pace by expanding our partnerships with industry, while being transparent and attentive to conflicts of interest, as we collaborate to find and evaluate new treatments.
In addition to the practical benefits of new therapies, these breakthroughs give our patients hope and reinforce the value of biomedical science to society.
The Joy of Medicine
I have found gratitude and joy in each of my roles in academic medicine. I never expected to be a doctor or a scientist, much less a department chair or dean.
I find that satisfaction comes not from titles but from doing a job well and loving what I do.
I vividly recall a clinical experience as a newly minted intern during one of my first patient encounters. I admitted an elderly man with metastatic prostate cancer. He had lost weight, was listless, and bedridden. He came up from the ER with the common diagnosis of “failure to thrive.” My initial assumption was that he was in the final stages of his disease. However, his potassium level was elevated.
Somewhere from the memory banks of medical school lectures, adrenal insufficiency surfaced in the differential diagnosis.
Testing confirmed the diagnosis, and cortisol replacement dramatically restored his vitality. This diagnosis may not have changed his long-term outcome, but it did improve his quality of life, and reinforced for me the power of knowledge to help people.
I know you have similar stories, and I urge you to reflect on your own memories of making a difference in people’s lives.
This is the joy of medicine.
For most of my career as a physician-scientist, my work has felt more like a hobby than a job. Why else would one wake at 2 a.m. with a novel idea, get out of bed, and head into the lab to get started on the next experiment? It is thrilling when new data turns over a missing piece of an unsolved mechanistic puzzle, ultimately revealing a full picture that is beautiful to behold.
Some of these experiences feel like epiphanies and are shared with graduate students or postdocs in the relative isolation of the laboratory. Others occur during a plenary talk when a large group shares the experience of a new insight as they see the final slide with the “big reveal.”
Research can be arduous with many failures, so we must recognize, celebrate, and remember these dopamine-rich moments of euphoria.
This, too, is the joy of medicine.
Our devotion to teaching and mentoring is arguably the greatest wellspring of joy. I am often surprised when one of my former trainees mentions something I said to them, of which I have no clear recollection, but seemingly provided a memorable pearl or changed their career plans. As you teach students, residents, or colleagues, they will, in turn, use this knowledge to manage untold numbers of patients.
For me, this is like a PCR reaction. Teaching is amplification leading to impact.
The spirit of joy touches every aspect of our work – patient care, research, teaching, and engaging with our communities. It can also be found in leadership roles and in implementing the changes in the culture, traditions, and practices of academic medicine that are essential to our future and to improving the health of our nation.
Our field needs leadership at this time, and you can find joy and satisfaction in leadership, as well as in our traditional missions. I am deeply grateful for our community’s collegiality and sense of purpose.
We can meet the challenges of these extraordinary times.
We can lean into change – to improve patient access and outcomes, to create a stimulating educational environment for a broader group of learners, and to translate new scientific insights into novel therapies and cures for our patients.
I call on each of you to join in this journey to a healthier, more equitable future – to enact the change that we know is needed to fulfill the promise of academic medicine.
The passages above are excerpts from the speech Jameson delivered to the AAMC’s 123rd annual meeting, “Learn Serve Lead 2021” on Nov. 9, 2021. The full transcript and video are available as part of the AAMC’s event recap.