1. Disruptive Innovation October 24, 2012 Dan Hunt, MD, MBA Senior Director, Accreditation Services Association of American Medical Colleges

2. Disruptive Innovations Hunts Regional Campus Pyramid Governance Policy Personnel Respect

3. Curriculum ForcesSite of Training Educational Program Basic Science University Salary L ocated in Academic Medical Center/Hospital Regional Campus Evolution Academic Physicians Accreditation/Licensing

4. Located in Involvement Outside of the Academic Center Ambulatory Clinic Family Medicine Curriculum ForcesSite of Training Educational Program Basic Science University Salary Academic Physicians Accreditation/Licensing Ambulatory Clinic Community Physicians Academic Medical Center/Hospital

5. Increase class size $ = Community Physician Input Community Physicians Academic Medical Center/Hospital Clerkship Second Year Community Placement Clerkship Curriculum Forces Educational Program Basic Science Academic Physicians Accreditation/Licensing Site of Training Clerkship Community Based Educators

6. = Community Stakeholder Input Community Placement Integrated Third Year First & Second Year Increase class size $ Community Physicians Curriculum Forces Educational Program Basic Science Academic Physicians Accreditation/Licensing Community Stakeholders Site of Training Academic Center/Hospital Fourth Year Community Based Educators

7. Disruptive Innovations The Regional Campus Pyramid Governance Policy Personnel Respect Stifling innovation, no input on committees, sharing tuition, face in community

8. The Regional Campus Pyramid Governance Policy Personnel Respect Hiring the empire builder instead of the team player

9. The Regional Campus Pyramid Governance Policy Personnel Respect No checks and balances across sites

10. The Regional Campus Pyramid Governance Policy Personnel Respect Absence of clear decision making process over campus activities

11. Disruptive Innovations: Part 2 Clay Christensen

12. Disruptive Mini-mill Steel Technology Rebar Bars and Rods Structural Steel Sheet Steel Profit Margin

13. Disruptive Mini-mill Steel Technology Rebar Bars and Rods Structural Steel Sheet Steel Profit Margin Quality of Mini Mill Steel

14. Disruptive Mini-mill Steel Technology Rebar Bars and Rods Structural Steel Sheet Steel Profit Margin Quality of Mini Mill Steel

15. Disruptive Mini-mill Steel Technology Rebar Bars and Rods Structural Steel Sheet Steel Profit Margin Quality of Mini Mill Steel

16. Disruptive Mini-mill Steel Technology Rebar Bars and Rods Structural Steel Sheet Steel Profit Margin Quality of Mini Mill Steel

17. Up-market Drift Creates a Vacuum Expedited when customers are migrating up Expedited when up-market means better profit margins Difficult to reduce costs and create a less expensive product by the successful industry Nature abhors a vacuum and will find a way to fill it

18. Migration of medical students into more advanced specialties Primary Secondary Tertiary Sub Specialty Profit Margin

19. "When Nurses want to be called Doctor New York Times 11/2/2011

20. So the Question is not Should we use innovative curriculum?…… It is To what end do we use it?