Academic

Medicine in the 21st

CenturyRichard I. Levin, MD

April 16, 2008

• Maclean’s #1

• Times of London

21

12

• Science Essentials #1

HippocratesHippocrates460 BC460 BC

Hoffman Hoffman AspirinAspirin18931893

ListerLister AntisepsisAntisepsis18651865

Long Long EtherEther18421842

Osler Graduates Osler Graduates 18721872 RoddickRoddick AsepsisAsepsis

18771877

2008 AD2008 AD460 BC460 BC

HippocratesHippocrates460 BC460 BC

HarveyHarveyCirculationCirculation

16281628

Hoffman Hoffman AspirinAspirin18931893

ListerLister AntisepsisAntisepsis18651865

Long Long EtherEther18421842

Osler Graduates Osler Graduates 18721872 RoddickRoddick AsepsisAsepsis

18771877

Fleming Fleming PenicillinPenicillin19281928

Sabiston Sabiston CABGCABG19621962

WHO WHO SmallpoxSmallpox19771977

Avery Avery DNADNA19441944

Watson & CrickWatson & CrickDouble HelixDouble Helix

19531953

Oldendorf & Oldendorf & HounsfieldHounsfield CAT ScanCAT Scan

19721972

MRI MRI 19801980

Penfield Penfield Montreal Procedure Montreal Procedure 1930s1930s

HarveyHarveyCirculationCirculation

16281628

Flexner Report 1910

Marco Marra John Marco Marra John McPhersonMcPhersonKen DewarKen Dewar

Venter & Collins Venter & Collins Human GenomeHuman Genome

20012001

Challenges to Academic Medicine•Education•Research •Care

““The way we … provide instruction The way we … provide instruction is essentially the same as it was when is essentially the same as it was when our Founding Fathers went to our Founding Fathers went to school...we still educate our students school...we still educate our students based on an agricultural timetable, based on an agricultural timetable, in an industrial setting, yet tell in an industrial setting, yet tell students they live in a digital age.”students they live in a digital age.”

Paige, 2002Paige, 2002

Expansion of Medical Knowledge• 80% of scientists

who ever lived, live now

• 2000 pages of textadded every minute

• 1 days output =5 yrs reading

• Knowledge doublesevery 7 years

Challenges to Medical Education at the

Dawn of the 21st Century

•Inadequate Resources•Expansion of Medical

Knowledge•Time in the human classroom of the hospital has vanished

FACULTYSTUDENTSRESIDENTS

PATIENTS

TEACHINGHOSPITAL

DIAGNOSTICS, TREATMENTS, RECOVERY

1900 - 1990

STUDENTSRESIDENTS

PATIENTS

TEACHINGHOSPITAL

OFFICES

DIAGNOSTICCENTERS

FACULTY

AMBULATORYSURGERY

CONSULTATIONS

2008

Simulation

Challenges to Academic Medicine•Education•Research •Care

Uncovering theBiological Basis of

Disease

Translating Research into

Better Health and Care

Era of Great Risk

New Epidemic of Obesity and Diabetes

Costs per Capita in OECD Countries

National Health Expenditure Trends, 1975–2007 CIHI

Canadian health care costs have TRIPLED since

1975

Graph 6

Public Health Spending Projections, 2007-08 to 2017-18

(in millions of dollars)

2008 Task Force Report on the Financing of the Health System

Castonguay, Venne & Marcotte

Growth of health spending based on current trends (5.8%)Increase in health spending based on current rate of economic growth (3.9%)

42,0

Current System

Teaching Affiliates

MUHC JGH St. Mary’s Douglas

RUIS

McGill Academic Health Network

• Coordinate education, research and care• Recognize special areas of excellence• Capture, elevate and publicize its power

RUIS

JGHJGH St. St.

Mary’sMary’s

Dou

gl

Dou

glasas

MUH

MUHCC

McGill Academic Health Network