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 the Council of Deans of the Association of American Medical Colleges to commission the 1996-1997 study reported here. The author conducted open-ended interviews with a broad spectrum of 22 current and former deans, selected to achieve an appropriate distribution with regard to key characteristics of their schools and to assure the relevance of the findings to a broad range of settings. His in-depth analysis of the transcribed interviews, using standard qualitative techniques, was designed to illuminate the challenges confronting deans and suggest strategies 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 competition in the clinical arena. Analysis of their accounts of the problems they encountered in managing in this changed environment revealed several underlying sources: imbalance between the breadth of their responsibilities and their authority to manage; lack of clarity in the dean's mandate; inadequate institutional support for pursuing the missions of the school; insufficient attention to identifying requisite expertise and abilities for effective performance on the job as dean; and an anachronistic search process. The respondents offered numerous recommendations for addressing these problems, reflecting optimism about the prospects for purposeful change. While medical schools have unique features 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.