Factors affecting the optimal size of an integrated health care delivery system in an academic medical center are discussed, including: the institution's structure for survival; technology, innovation, and health care costs; and specific characteristics of the institution's education, research, and patient care missions. Several alternative…

Strategies used at several medical schools to address common issues in ambulatory care clerkship programs are presented. These include institutional and policy concerns (institutional resistance, financing, faculty incentives), administrative and implementation problems (logistics, faculty recruitment, student recruitment/placement), and…

Organizational aspects of the Shock Trauma Institute at Loyola University Medical Center (Illinois) are described. The philosophies and conditions that helped determine the institute's organizational structure and success are analyzed, and the institute's role as a multidisciplinary research program is discussed. Structures of the clinical,…

The use of patient encounter recordkeeping systems in four medical programs at three universities (Case Western Reserve University, Ohio; University of Colorado; and University of Rochester, New York) is described and compared. Uses for curriculum evaluation and development, psychometric uses, and administrative issues are discussed. (MSE)

The University of Manitoba (Canada) medical school is introducing teaching in the ambulatory care setting as traditional inpatient wards become less suitable for clerkships. However, few faculty are willing to accommodate students in their clinics, and other educational and administrative difficulties impede program expansion. (MSE)

A University of Alabama plan to improve productivity in the medical school by reallocating institutional funds and changing the handling of professional practice revenues is described, and its effects, strengths, and weaknesses after the first three fiscal years of implementation are examined. Despite some problems, the plan appears to be…

A discussion of management issues at teaching hospitals reviews their history and examines specific challenges in this context, including the ill-defined middle management level, the relative roles of the manager and department heads, separation and integration of managerial, academic, and medical responsibilities, and financing from more than one…

Most of the hospital beds available to the University of Liege (France) for training purposes are in a public teaching hospital with an autonomous legal structure and privileged relationship with the university. Other beds are in other facilities. The financing, supervision, and management structure integrates the institutions and supports medical…

Organization and management of financial resources in the University of Maryland medical school's department of medicine are described, including development of realistic budgets, accounting for sources of income and expenses, uses of subsidies and incentives for more efficient administration, financial reporting, annual administrative retreat,…

The Faculty of Medicine of the Rheinisch-Westfalische Technische Hochschule Aachen (Germany), founded in 1966, has been housed in one building since 1984. The faculty and university hospital are managed by three institutions: the dean (responsible for teaching and research); the clinical directorate (responsible for patient care); and the…

The current approach to research, teaching, clinical service, and administration at academic health centers is reviewed, and the traditional values underpinning this approach are challenged. A new form of faculty management that matches the individual faculty member's priorities and skills with the health center mission and which focuses on the…

The primary care clerkship at George Washington University (District of Columbia) medical school, the only required ambulatory care experience in the curriculum, is described. Topics discussed include the interdisciplinary structure of the program, its goals, curriculum and student evaluation, and challenges faced in implementation (faculty,…

The report describes and evaluates the concept and implementation of an interdisciplinary School of Health Professions (SHP) as well as its key educational features and financial requirements. SHP focuses on primary health care, interprofessional education and care-delivery, and self-paced curricula. Six types of health professions comprise the…

This article proposes that in order for academic medical centers to compete with successful group practices, health maintenance organizations, and integrated health service networks, they must form clinical faculty into a competitive medical group with more price-competitive and user-friendly services, restructure clinical training to be more…

The University of Rochester has developed a third-year medical school clerkship in which students spend the second half of the clerkship in the offices of practicing internists. Participating faculty are carefully chosen and trained. Experience indicates the approach is feasible, academically effective, and acceptable to students and faculty.…