Coordinating Flight Paths to Facilitate Interorganizational Cooperation, Interdependence, and Autonomy: Considerations for Organizations Supporting Medical Education Research and Scholarship

There is an ever-growing number of research and scholarship units that support medical education scholars, 1,2 a wealth of medical education or Health Professions Education master’s 3 and PhD 4 training programs, and a variety of groups and committees for medical educators in North America. To effectively serve their membership, organizations (a term we apply broadly to units, programs, and committees) must have a strong sense of who, what, how, and why: Who, precisely, makes up their membership? What makes up the organizational “core business” that is delivered to their membership? How they can effectively engage in their core business? and, more fundamentally, why do they exist as an organization? The answers to these questions are often integrated into organizational missions, vision statements, or guiding principles, and made apparent through organizational decisions and activities. However, for medical education organizations to successfully coexist, the answers to these questions must be unique enough to identify an organizational “home” within the broad range of participants and activities possible within the medical education landscape. Each organization must articulate how its commitment to supporting medical education research and scholarship serves a similar population yet in notably different ways to ensure each organization’s contribution is unique. But in a growing flock of organizations committed to supporting medical education research and scholarship, how can each “bird” (i.e., organization) 5 remain a unique and independent member of the larger flock? To answer this question, we share a metaphor (bird flight) we have used to examine how to navigate a careful balance of cooperation, interdependence, and autonomy. More specifically, in this piece, we will (1) summarize 3 rules of effective flocking behaviour, 5 (2) use the metaphor of birds in a flock to describe 3 ways by which similar organizations can interact, and (3) describe how rules of flocking behavior could be used as a guide to interorganizational collaboration between 2 organizations with similar missions to support medical education research and scholarship in North America. For this piece, the 2 organizations of interest are the Medical Education Scholarship Research and Evaluation (MESRE) and the Research in Medical Education (RIME) Planning Committee. Flocking behavior in birds is demonstrated most vividly in a murmuration 6—where massive numbers of starlings fly in intricately coordinated patterns that quickly shift and reshape while in flight. This murmuration is possible when each bird in the flock complies with 3 rules of flocking behaviour 5: (1) Alignment—where each bird steers toward the same average heading or intended direction, (2) Cohesion—where each bird tries to stay together so as not to stray from the flock, (3) Separation—where each bird maintains a certain distance from the others to avoid overcrowding. While none of us are ornithologists (or even birdwatchers), we believe that the metaphor of independent birds in larger flock is a useful lens through which to examine the potential for interorganizational collaboration, specifically the partnership between similar organizations: MESRE and RIME. The 3 rules of flocking behavior run parallel to 3 different ways in which organizations can collaborate 7: cooperation (akin to alignment), interdependence (akin to cohesion), and autonomy (akin to separation); see summary in Figure 1.Figure 1: Overview: Rules of flocking behavior and interorganizational collaboration, including practices in birds and organizations that reflect alignment, cohesion, and separation in support of interorganizational cooperation, interdependence, and autonomy.Before we explore how the rules of flocking behavior can shed light on the ways organizations collaborate, let us briefly describe the organizations (which the authors currently chair or cochair) that led us to this metaphor. MESRE and RIME are 2 organizations under the umbrella of the Association of American Medical Colleges’ Group on Educational Affairs (GEA). Both are committed to supporting and celebrating medical education research and scholarship, and those who engage in research and scholarship, but do so in different ways (summarized in Table 1). For example, one emphasizes skill development and capacity building, and the other on showcasing research excellence; one focuses on community building, the other on providing forums for discussion; one fostering medical education scholarship among newcomers, and the other recognizing cutting-edge scholarship.Table 1: Description of the Core Values of RIME, Identified in Balmer et al, 9 and the MESRE Mission StatementaIn the analysis that follows, we use the rules of flocking behavior 5 (see Figure 1) to help organize our examination on how MESRE and RIME might collaborate in support of medical education research and scholarship. The first rule of flocking behavior, alignment, focuses our examination on determining whether the 2 organizations share a similar sense of direction or purpose. MESRE and RIME both exist to support medical education research and scholarship. Table 1 provides examples of alignment in how these organizations support medical education research and scholarship: from a commitment to supporting social-justice research and discourse to providing a forum for dissemination of findings. But how do we cooperate to maintain alignment? This year, MESRE supported RIME’s URiM mentorship program 8 by serving on its committee and identifying opportunities for RIME interns to work with MESRE members. The second rule of flocking behavior, cohesion, focuses our examination on making sure that neither MESRE nor RIME strays too far from the larger flock’s shared direction. In organizational terms, this can be described as organizational interdependence—where the success of each organization to reach a goal depends on successful partnership with the other. 7 This interdependence is characterized by deliberate relationships formed between 2 (otherwise autonomous) organizations. 7 In our context, we could demonstrate cohesion by working together on projects or deliberately sharing of resources. For example, what information do we have as part of our “core business” that could benefit the other organization? This year, RIME provided feedback to MESRE about common reasons why RIME papers were rejected following extensive review, for the purpose of informing MESRE’s programming designed to help support newer scholars in medical education. The third rule of flocking behavior, separation, focuses our examination on autonomy. For organizations, autonomy remains important as too much interdependence can lead to organizational crowding 7—where multiple organizations are attempting to reach similar goals for the same membership. In our organizations, this leads us to consider how can MESRE and RIME continue to act autonomously but stay within the shared governance of GEA? How do we ensure that we stay “true” to our slightly different audiences within the medical education research and scholarship landscape? How do we ensure our practices are sufficiently (and visibly) distinct to members and other organizations? This year, RIME engaged in an exercise to describe core values that underpin decision making, 9 engaged MESRE for discussion and feedback on the identified core values, and RIME drew inspiration from a mission mapping exercise undertaken by MESRE. These formal documents allow for space for each organization to purposefully describe areas of similarity but maintain autonomy. The rules of flocking behavior shed light on how RIME and MESRE can both support medical education research and scholarship in North America. In essence, this metaphor has helped us articulate how our organizations can effectively serve similar populations yet in notably different ways. We argue that MESRE and RIME can balance cooperation (alignment), interdependence (cohesion), and autonomy (separation) to support medical education research and scholarship in North America. The growth in medical education research and scholarship 10 and accompanying training programs, 3,4 while desired, could unintentionally create organizational crowding, resulting in inefficient use of resources and overtaxing the same population of medical education scholars. Explicit conversations about interorganizational collaboration permit, and encourage, the notion of mutual benefit. Direct discussion amongst the flock, that is, between not only RIME and MESRE but also other organizations supporting medical education research and scholarship, can stimulate a sense of mutual accountability—to each other and the broader medical education community. This type of discussion can also clarify how we can more effectively hold the flight path, work together, and, at the same time, stay distinct so that we fly together in mutual support of medical education research and scholarship.

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