CHALLENGES TO EFFECTIVE MEDICAL-SCHOOL LEADERSHIP PERSPECTIVES OF 22 CURRENT AND FORMER DEANS

A persistent decline in the average tenure of medical school deans and a concern about the implications for medical school leadership led th e Council of Deans of the Association of American Medical Colleges to commission the 1996-1997 study reported here. The author conducted ope n-ended interviews with a broad spectrum of 22 current and former dean s, selected to achieve an appropriate distribution with regard to key characteristics of their schools and to assure the relevance of the fi ndings to a broad range of settings. His in-depth analysis of the tran scribed interviews, using standard qualitative techniques, was designe d to illuminate the challenges confronting deans and suggest strategie s to address them. The respondents consistently identified two forces in the health care environment that had had profound impacts on their role as deans and that frequently posed conflicts between the clinical and educational enterprises: a decline in the resources available to medical schools following an era of abundance, and unprecedented compe tition in the clinical arena. Analysis of their accounts of the proble ms they encountered in managing in this changed environment revealed s everal underlying sources: imbalance between the breadth of their resp onsibilities and their authority to manage; lack of clarity in the dea n's mandate; inadequate institutional support for pursuing the mission s of the school; insufficient attention to identifying requisite exper tise and abilities for effective performance on the job as dean; and a n anachronistic search process. The respondents offered numerous recom mendations for addressing these problems, reflecting optimism about th e prospects for purposeful change. While medical schools have unique f eatures among educational institutions, the author concludes that the challenges that deans face and the strategies proposed for addressing them promise to have substantial relevance for academic leadership in other settings.