The Conglomeration Syndrome in Medical Schools ‐‐ an acute example of leadership difficulties in universities and colleges

Abstract

Tertiary education is a complex, expensive and socially important activity, and medical education is perhaps archetypal of that process. The complexity of the typical medical faculty probably exceeds most other tertiary schools and faculties, largely because the majority of medical educators are committed to patient care, in addition to the usual teaching, research and administrative tasks. Additional demands have been placed upon medical educators by the relatively recent information explosion in biology and medicine, which has increased further the scope and depth of modern medical education. Furthermore, newer concepts of health care and health maintenance, and rising public expectations concerning health services, have placed considerable pressure on medical educators to produce not only more graduates, but graduates who are better equipped to meet the current needs of society. In these circumstances, it soon became obvious that medical education had to be expanded, re-formed and re-organised in terms of style and content, if it was going to fulfil its obligations to society. This process is by no means complete, but the changes which have been introduced have met with some degree of resistance and conflict, and they have tended to complicate rather than simplify medical education. Consequently, additional stress has been placed upon the organisation and administration of medical faculties. Although medical education has grown in size, complexity and social and economic importance, until it now rivals large organisations in the government and private sectors, it seems to have been largely ignored by organisational researchers. It is unlikely that medical educators will themselves investigate the organisation and administration of medical education, for there are no significant professional, career or financial incentives in this area of research (Walton, 1981), and most medical educators have neither the aptitude, talent nor inclination to work in this area (Rogers & Blendon, 1978). It is for these reasons that the administration and organisation of medical education is not being studied adequately, and this is a cause of concern for at least a few medical educators (for example, Ingersoll, 1975; Maddison, 1978; Walton, 1981), but what areas are in need of immediate attention? If medical schools are to cope satisfactorily with the various challenges, demands and responsibilities which presently confront them, then effective leadership, which is believed to be critical to the success of a teaching establishment (Alty, Gorman & Baker, 1981), and indeed to the success of any organisation (Hersey & Blanchard, 1977; Rheinhart, 1981; Sinetar, 1981), will be a decisive factor in determining how