In an earlier post I described I described four “tribes” in our Brody School of Medicine, each of which carefully maintains its boundaries: the Basic Scientists, the Clinical Scientists, the Educators and the Administrators. For more information, refer to that post by clicking here. Recently I interviewed a faculty member well-regarded for his ability to span those boundaries.

Dr. David Collier is a general pediatrician who spends 75% of his time working with programs in childhood obesity, arguably the most costly medical problem in Eastern North Carolina. Obesity can be described as the perfect medical problem. Only 1/100 to 1/1000 of the onsets are medical, and the rest are behavioral; however, obesity caused by behavior begins to create other medical problems that in turn affect behavior, and the vicious cycle begins to spin out of control. Currently, 30% of the children in Eastern North Carolina are obese in contrast to the 15% average nationwide.

This combination of behavioral and medical problems can only be treated with the combination of medical and social approaches, and this demands that he find collaborators with skills he does not have. For instance, in behavior management it is useful to work with psychologists as well as business people who understand how we all make purchasing decisions. Collaborations of this nature require a willingness to think beyond one’s usual discipline.

As an example, Dr. Collier is working on an obesity program with 4-H, commenting “They know kids!” In another case is working with the university’s Department of Physical Therapy to understand lower extremity problems; there is no value in changing someone’s behavior with an exercise program that blows out their knees.

Collaborations of this sort can be difficult in Medicine. Basic science students and medical students matriculate under completely different circumstances, and it affects their views of each other for years afterward. Whereas medical students take on a tremendous amount of work through a rigorous schedule and highly structured clinical settings, basic scientists have to create their own rigor and structure in the course of their learning and research.

Each has to make a choice about the scope of their impact on the world. A practicing physician can achieve clear outcomes, but one patient at a time. A research scientist on the other hand can impact millions but acknowledges that the odds of achieving the clear outcome can be long. To some extent each can feel envious of the other and it can contribute to dysfunctional relationships. Add this dynamic to the overall competition for rewards and resources in a medical school, and collaboration becomes a high art.

Accordingly, it can be easier to create such partnerships outside of one’s own institution than within it. Trust is essential, but Dr. Collier believes that success in complex collaborations is most likely where the people involved have skills that are complementary, with little redundancy. For example, when doctors collaborate with 4-H, there is low redundancy of capabilities but high shared interest. The next key is a willingness to relinquish control in the interest of creating an equal partnership. When the basic and clinical tribes do come together, there is a sweet spot with a high payoff that rewards the commitment to span boundaries.

Next week, I’ll share the insights of a faculty member who spanned boundaries to create new horizons with an academic unit outside of the Brody School of Medicine.

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