Commentary: getting to the next phase in medical education--a role for the vice-chair for education.

The author argues that a particular kind of departmental leadership is needed lest medical education become hostage both to distant management through regulatory metrics (which can displace local, institutional creativity) and to the financial pressures within the institution. Departmental chairs themselves have often been seen as barriers to successful integration and redesign of medical school curricula. The vice-chair for education is a critical figure in achieving this new kind of leadership.The author describes three forms of curriculum planning and management: phase 1, where the department chair makes the decisions; phase 2, dominated by regulation from above (in part a reaction to problems with the phase 1 approach); and phase 3, the author's vision of an approach in which decisions occur within departments but with an awareness of the institution as a collaborative system, and grounded in educational theory and research. The vice-chair for education would have a key role, carrying out interdepartmental planning and assessment for the chairs, who would provide them the needed time, training (in leadership and in educational theory and practice), support (from professional educators, with advanced degrees in education), and routes to academic advancement.Responding effectively to a complex and changing environment requires senior leaders at the middle-management level (such as vice-chairs for education) who are well trained in both the content of their specialties and also in interpersonal and collaborative skills, and who have the desire to reach a common future.