Educators, not managers

There is a heartfelt letter in Academic medicine. Is is from a former graduate specialty program director (PD) (TK Swoboda) and to me it speaks of what happens when teaching and education is industrialised along the lines of the fast-food business under the influence of corporate HR.

When I began as a PD, I believed that I had reached one of the most important academic jobs in my clinical specialty. I loved the work of developing curriculum and assessment instruments for my residents. It felt innovative, needed, and important. I could see how my work was directly related to the effectiveness of our residents’ education.

This changed with the Accreditation Council for Graduate Medical Education’s (ACGME’s) Next Accreditation System (NAS). Immediately, I became a manager of our program’s dashboard on the ACGME Accreditation Data System (ADS) and had little time for any innovative educational work due to the continual need for upkeep of the complex ADS data. The “fun” educational work became the domain of less experienced assistant or associate PDs. The job of PD had fundamentally changed overnight. It became a managing job, while leadership and innovation became a smaller secondary role.

What are the consequences of this change? American medical education is in the process of losing many experienced PDs who do not want to just be a manager. 

This is just one manifestation of what Michael Power in his book The Audit Society described as ‘rituals of verification’ Education as applied HR.