A R T I C L E The Academy Movement: A Structural Approach to Reinvigorating the Educational Mission David M. Irby, PhD, Molly Cooke, MD, Daniel Lowenstein, MD, and Boyd Richards, PhD ABSTRACT Despite its fundamental importance, the educational mis- sion of most medical schools receives far less recognition and support than do the missions of research and patient care. This disparity is based, in part, on the predominance of discipline-based departments, which focus on the more sustainable enterprises of research and patient care. Where departmental teaching is emphasized, it tends to center on trainees directly associated with the depart- ment—leaving medical students unsupported. The au- thors argue that the ongoing erosion of the educational mission will never be reversed unless there are changes in the underlying structure of medical schools. Academies of medical educators are developing at a number of medical schools to advance the school-wide mission of education. The authors describe and compare key features of such organizations at eight medical schools, identified through an informal survey of the Society of Directors of Research in Medical Education, along with direct contacts with specific schools. Although these entities are relatively new, initial assessments suggest that they have already had a major impact on the recognition of teaching efforts by the faculty, fueled curricular reform, promoted educa- tional scholarship, and garnered new resources to support teaching. The academy movement, as a structural ap- proach to change, shows promise for reinvigorating the educational mission of academic medicine. Acad Med. 2004;79:729 –736. T o reaffirm the educational mission of academic medicine, some advocate an expanded definition of scholarship as a means of increasing support for faculty who teach. 1 Others stress the importance of a comprehensive faculty development and teaching schol- ars program. 2 While supporting these proposals, we assert that they, like many before them, are important but insuffi- cient to transform the basic culture of academic medicine. To place education at the center of academic medicine again will require fundamental structural reform. 3 We suggest that new organizational entities such as academies are showing promise for promoting teachers, supporting education, im- proving curriculum, advancing educational scholarship, and changing the culture of academic medicine. In this article, we review the fundamental argument for such organizations, describe eight academies, discuss their similarities and differ- ences in approach, and examine their initial impacts. RATIONALE FOR STRUCTURAL CHANGE The educational mission of U.S. medical schools has been increasingly threatened since the middle of the 20th century, and the situation is more severe now than ever before. 4–6 Historically, universities and medical schools have been organized around departments and other discipline-based programs that are dedicated to seeking new knowledge and improving health care. In addition, clinical departments in medical schools are organized by specialty and dedicated to providing state-of-the-art patient care. Thus, research is central to the mission of all academic departments, and Dr. Irby is vice dean for education and professor of medicine, Division of General Internal Medicine, Department of Medicine, University of Califor- nia, San Francisco (UCSF), California; Dr. Cooke is director, Haile T. Debas Academy of Medical Educators, and professor of medicine, Division of General Internal Medicine, Department of Medicine, UCSF; Dr. Lowen- stein is director of physician-scientist training programs and professor of neurology, Department of Neurology, UCSF; Dr. Richards is director of the office of curriculum and professor of pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas. Correspondence should be addressed to Dr. Irby, Office of Medical Education, School of Medicine, University of California, San Francisco, 521 Parnassus Avenue, Room C-254, San Francisco, CA 94143-0410; telephone: (415) 502-1633; e-mail: irby@medsch.ucsf.edu. Reprints will not be available. For an article on a similar topic, see pp. 783–790. A CADEMIC M EDICINE , V OL . 79, N O . 8/A UGUST 2004 729