FULFILLING THE SOCIAL-CONTRACT BETWEEN MEDICAL-SCHOOLS AND THE PUBLIC

To gain a better understanding of the effects of medical schools relat ed to transformations in medical practice, science, and public expecta tions, the Association of American Medical Colleges (AAMC) established the Advisory Panel on the Mission and Organization of Medical Schools (APMOMS) in 1994. Recognizing the privileges academic medicine enjoys as well as the power of and the strain on its special relationship wi th the American public, APMOMS formed the Working Group on Fulfilling the Social Contract. That group focused on the question: What are the roles and responsibilities involved in the social contract between med ical schools and various interested communities and constituencies? Th is article reports the working group's findings. The group describes t he historical and philosophical reasons supporting the concept of a so cial contract and asserts that medical schools have individual and col lective social contracts with various subsets of the public, referred to as ''stakeholders.'' Obligations derive implicitly from the generou s public funding and other benefits medical school receive, Schools' p rimary obligation is to improve the nation's health. This obligation i s carried out most directly by educating the next generation of physic ians and biomedical scientists in a manner that instills appropriate p rofessional attitudes, values, and skills. Group members identified 27 core stakeholders (e.g., government, patients, local residents, etc.) and outlined the expectations those stakeholders have of medical scho ols and the expectations medical schools have of those stakeholders. T he group conducted a survey to test how leaders at medical schools res ponded to the notion of a social contract, to gather data on school le aders perceptions of what groups they considered their schools' most i mportant stakeholders, and to determine how likely it was that the sch ools' and the stakeholders' expectations of each other were being met. Responses from 69 deans suggested that the survey provoked thinking a bout the broad issue of the social contract and stakeholders. Leaders on the same campuses disagreed about what groups were the most importa nt stakeholders. Similarly, the responses revealed a lack of national consensus about the most important stakeholders, although certain grou ps were consistently included in the responses. The group concludes th at medical school leaders should examine their assumptions and perspec tives about their institutions' stakeholders and consider the interest s of the stakeholders in activities such as strategic planning, policy making, and program development.