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Med Center departments struggle to define mission

Adapting to the varied tugs and pulls of research demands and patient care, departments within the Medical Center are quietly ceding territory to research-focused centers and undergoing a drastic shift in purpose.

The growing complexity of medical research is forcing unprecedented amounts of collaboration - increasingly under the official stamp of University-wide centers like the Institute for Genome Sciences and Policy and the Duke Clinical Research Institute - that cannot be cleanly divided by discipline.

When Joseph Nevins, James B. Duke professor of molecular genetics and microbiology, was contemplating the merger of the departments of genetics and microbiology more than two years ago, for example, he anticipated a serious problem: How could a department made up of two previously disparate fields keep its focus?

The answer was to form a structure around four new research centers, simultaneously concentrating research and dispersing faculty within the recently formed molecular genetics and microbiology department, which Nevins now chairs. Instead of symbolizing a revolution, the department has only formalized what is occurring everywhere in the Medical Center, Nevins said.

At the same time, the School of Medicine's planned curriculum revisions are dissolving and integrating courses traditionally divided along department lines. "[Education] now is in a departmental structure," said Dr. Mitch Heflin, an associate professor of medicine. "Some of that is destructuring,... giving it a thematic base."

With the department structure thus losing relevance in both education and research, many administrators say departments are being fragmented and blurred together, and in some cases, pushed to the background.

"There has been some talk within the Medical Center about whether we should have departments at all," said Vice Dean for Research Dr. Ross McKinney.

Although departments will likely remain given the recent round of top chair hires, McKinney noted that the continuous flux of mergers and dissolutions will accelerate.

The importance of departments within the Medical Center has actually fallen steadily since the 1980s, when few researchers strayed outside their departmental boundaries, and organization was almost completely departmentally based, Nevins said.

IGSP Director Huntington Willard said he hoped centers could increase their importance without taking anything away from departments.

"I'm a believer in infinite faculty time and energy. I don't see us as taking away any time from faculty," he said. "I would be very, very disappointed to find a chair complain about that affecting their department."

Meanwhile, administrators will need to come to grips with the intricate web of scientists and physicians organized in a matrix structure, with departments in one direction and research centers in the other. "It could create an administrative nightmare," McKinney said. Associate Dean for Curriculum Assessment Emil Petrusa has already noted the problem of accurately paying individual departments teaching together in the integrated medical school courses.

"There's no question there's a challenge how to organize what's called a matrix structure well... but it's a challenge Duke has to handle," Willard said. "I'm a bit schizophrenic about it myself."

DCRI Director Dr. Robert Califf, one advocate of further limiting the role of medical departments, emphasized the value of concentrating equipment and expertise into broad centers like DCRI.

"To do top-notch science now, you need to have access to massive infrastructure," Califf said, adding that this can only come from University-wide initiatives.

No individual department could build up the massive medical databases and clinical expertise like DCRI has done, or the gene sequencers and large-scale animal studies like IGSP is preparing to do, Califf said.

"In the past, departments would measure themselves by how much they contained," Califf said. "Now, the whole ambiance should be, 'How do we collaborate with others?' If departments measure their worth by how much infrastructure they have between them, [the growth of research centers] will have a negative effect. If they measure success by how much they contribute to medicine, it will be positive."

Faculty remain positive that departments will continue to serve a purpose, albeit an uncertain and shifting one.

At their core, departments will serve as collecting points for like-minded physicians and scientists, McKinney explained. "There's a reason why surgeons hang out together," he said.

Califf echoed McKinney's explanation of this use for departments.

"There still remain disciplines that we can't disregard. People need to be trained as surgeons or gynecologists," he said. "The model is too see [the departments] as a constellation of entities forming and dissolving based on function."

Departments can also serve as the administrative backbone to the programmatic research centers, Nevins explained.

"I see it as the department being the glue, the framework," he said. At the same time, he noted that his own department demonstrated the divergent trend of centers being used for structure: "It's been very important when going from a relatively smaller department before to a much larger department to put some organization in place [with the four centers]."

Willard agreed with this necessity. "You need departments in this day and age for the same reason you need towns and cities," he said. "It's structure."

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