A Gap in Mission: The Disparate Missions of Medical Schools and Teaching Hospitals.

Objective: The social contract mandates that in return for the government-funded labor of residents and fellows, the medical profession trains, to the best of its ability, the physicians of our future. This contract obligates graduate medical education (GME) to utilize all available information to create an optimal learning environment for its trainees. Business research has determined that a clearly defined mission statement is associated with improved employee engagement, retention, and wellness. Given that GME trainees are situated at the intersection of at least two institutions, each with its own separate mission, trainees could potentially be hindered by incongruent missions in the learning environment. The literature on mission statements has analyzed medical schools and hospitals separately; however, investigations comparing the statements of these affiliated institutions have not been conducted. Therefore, we plan to compare the content and assess the consistency of mission statements from affiliated medical schools and hospitals to determine if incongruencies exist. Methods: In 2023, the mission statements from the Association of American Medical Colleges (AAMC) medical schools and affiliated teaching hospitals (n = 163) were aggregated from their public websites. The content of each mission statement was thematically analyzed to assess variation. Results: According to content analysis of the mission statements from 163 AAMC medical school members and affiliated teaching hospitals, less than half of their top priorities are shared by their affiliated hospitals (45%). Additionally, themes of diversity, religion, and global care were found to be contrasting priorities between affiliated institutions. Conclusion: Given the precedence within the business and the observed discrepancies in mission, further research is needed to determine whether collaborating medical schools and hospitals could provide a more favorable graduate training environment by uniting their priorities and identifying shared goals.

Addressing Futility: A Practical Approach.

Limiting or withdrawing nonbeneficial medical care is considered ethically responsible throughout most of critical care and medical ethics literature. Practically, however, setting limits to treatment is often challenging. We review the literature to identify best practices for using the definition of futility as an anchoring concept to aid the ethical practice of ICU clinicians. DATA SOURCES: Source data were obtained from a PubMed literature review. STUDY SELECTION: English language articles were chosen based on relevance to medical futility ethics, end-of-life care in the ICU, or communication and conflict mitigation strategies. DATA EXTRACTION: Independent evaluation of selected articles for recurrent content themes as relevant to our clinical case were compared among authors and based on consensus, quantitative and qualitative data from these sources were referenced directly. DATA SYNTHESIS: When life-sustaining treatment is unlikely to achieve a meaningful benefit such as symptom improvement, continued care may be discordant with the patient's goals. Institutional and cultural norms, unconscious biases, and difficulty with navigating conflicts all influence how un(comfortable) clinicians feel in setting limits to futile care. Defining futility in light of the patient's goals and values, focusing on outcomes rather than interventions, and being proactive in communication with families are the staples of medically meaningful critical care. Palliative measures should be framed affirmatively, and clinicians should be transparent about the limits of medicine. CONCLUSIONS: Clinicians have an ethical obligation not to provide futile care. To practice accordingly, we must clearly understand the nature and forms of futility. Armed with this understanding, our discussions with family and surrogates in the ICU should fundamentally comprise 1) eliciting the patient's values and goals, 2) communicating which interventions serve those values and goals and which do not, and 3) offering only those interventions whose likely outcomes are in line with said values and goals.