The recent coronavirus pandemic has made us more aware of the gradual decline of academic medicine. Although much has been written about the systemic problems in medicine and academia (mostly in the context of burnout and well-being), the problems in academic medicine extend well beyond these concerns. Structural problems in academic medicine exist within all parts of its tripartite mission: education, clinical care, and research. With clinical care, there are tedious requirements for documentation in difficult-to-navigate electronic medical record systems, demands on productivity in the form of ever-increasing allocated Relative Value Units (RVUs), and senseless demands from managed-care organizations. All of these clinical demands reduce the time for teaching, which, ironically, university deans expect us instructors to increase. Similarly, education has been increasingly regulated by what has been referred to as the “medical-education industrial complex.” Regulatory agencies have introduced changes with possibly negative consequences and no evident benefit. The promise that the new accreditation system would make residency training programs easier to manage has not materialized and, actually, the opposite appears true. In addition, unfunded mandates of questionable value have been introduced, such as the Clinical Skills Verification examination. Academic research—at least in psychiatry—has been experiencing an “intellectual crisis,” leading to the conclusion that “evidence-based medicine does not appear to provide an adequate scientific background for challenges of clinical practice in psychiatry and needs to be integrated with clinical judgment.” Some argue that the scope of evidence-based medicine is limited and should be combined with practice-based evidence in making clinical decisions. And despite the glow that research funding brings to investigators and administrators, the sad fact is that, for the institution, research is a money loser. The pandemic has lifted the veil on even more serious threats to academic medicine. In a recent article, Johns Hopkins University Professor Richard Balon, MD Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology Wayne State University Detroit, Michigan, USA

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美国学术医学的急剧衰落

最近的冠状病毒大流行让我们更加意识到学术医学的逐渐衰落。尽管已经有很多关于医学和学术界的系统性问题的文章（主要是在倦怠和幸福的背景下），但学术医学中的问题远远超出了这些问题。学术医学的结构性问题存在于其三方使命的所有部分：教育、临床护理和研究。对于临床护理，难以导航的电子病历系统中的文档存在繁琐的要求，以不断增加的分配相对价值单元 (RVU) 的形式对生产力的要求，以及管理式护理组织的无意义要求。所有这些临床需求都减少了教学时间，具有讽刺意味的是，大学院长希望我们教师增加教学时间。相似地，教育越来越受到所谓的“医学教育产业综合体”的监管。监管机构已经引入了可能带来负面后果且没有明显好处的变化。新的认证系统将使住院医师培训计划更易于管理的承诺并未实现，实际上，情况恰恰相反。此外，还引入了价值有问题的未资助任务，例如临床技能验证考试。学术研究——至少在精神病学方面——一直在经历“智力危机”，得出的结论是“循证医学似乎没有为精神病学临床实践的挑战提供足够的科学背景，需要与临床实践相结合。判断。一些人认为循证医学的范围是有限的，在做出临床决策时应结合基于实践的证据。尽管研究资金给调查人员和管理人员带来了光彩，但可悲的事实是，对于该机构来说，研究是亏本的。大流行揭开了对学术医学更严重威胁的面纱。在最近的一篇文章中，美国密歇根州底特律韦恩州立大学精神病学、行为神经科学和麻醉学系医学博士 Richard Balon 教授在最近的一篇文章中指出 大流行揭开了对学术医学更严重威胁的面纱。在最近的一篇文章中，美国密歇根州底特律韦恩州立大学精神病学、行为神经科学和麻醉学系医学博士 Richard Balon 教授在最近的一篇文章中指出 大流行揭开了对学术医学更严重威胁的面纱。在最近的一篇文章中，美国密歇根州底特律韦恩州立大学精神病学、行为神经科学和麻醉学系医学博士 Richard Balon 教授在最近的一篇文章中指出