CULTURES IN CONFLICT - A CHALLENGE TO FACULTY OF ACADEMIC HEALTH CENTERS

Academic health centers (AHCs) are experiencing turmoil in all three o f their traditional missions of teaching, research, and patient care. The authors examine origins of universities and medical education to p lace in,historical context the stresses affecting AHCs at the end of t he 20th century. They describe the cultures of the university to sugge st strategies for successful adaptation to these stresses. Clashes of values and norms of the cultures within universities and AHCs can hind er effective adaptation to external change. Administrators, researcher s,: teachers, and clinicians can have strongly conflicting perspective s. For example, business skill is of increasing importance to the surv ival of the clinical enterprise, but not typically valued by faculty m embers; University faculty have often considered accountability as ant ithetical to academic freedom, and, until recently, accountability was not strongly demanded of AHCs. The authors' conclude that AHC faculty must transcend the outdated view that the roles of the scholar, scien tist, and healer are in opposition to those of the leader and manager. If AHCs are to survive and prosper through their current cultural tra nsition, their faculty must understand all these roles as part of thei r intellectual and organizational responsibility.