Greater cooperation among Weill Cornell Medical College (WCMC) in New York City, NewYork-Presbyterian Hospital and Cornell's Ithaca campus is a major priority, stressed Cornell President David J. Skorton in delivering his first grand rounds lecture at WCMC Jan. 18. Skorton broadly discussed the public service and outreach roles of academic health centers both at Cornell and the community-at-large.

Skorton, a medical doctor, is a faculty member in internal medicine and pediatrics at the medical college.

"We need to focus planning with agreement among all the institutions and increase the interdependence of the medical college with the hospital and Cornell-Ithaca," Skorton said.

Because an academic health center like WCMC/NewYork- Presbyterian Hospital interacts heavily with the public, it faces unusually complex issues, Skorton said. Human and animal research, he observed, is subject to extraordinarily tight governmental regulations, while patient care activities must be handled as both business and academic enterprises.

"There are peculiar challenges to managing this system," Skorton said. "The question is, what should we do with this well-functioning but brittle enterprise?"

Skorton said that he and his colleagues at WCMC agree that faculty and students, particularly, can break down barriers most efficiently. "The glue between institutions is students and educational programs, and we need to increase opportunities between complementary programs," said Ralph Nachman, M.D., chairman of the Department of Medicine at WCMC.

Through the mid-20th century grand rounds were lectures presented by an experienced clinician diagnosing a patient with a particularly difficult condition before an audience of colleagues. In recent years, with the rise of medical subspecialties, the lectures have become more formal affairs, often presented by visiting experts who comment on rapidly changing medical advances.

Skorton also outlined the medical college's research role. Over the last 10 years, research spending by the medical college has more than doubled, and federal funding for research at the college has increased 49 percent, even though federal biomedical research budgets have leveled off in recent years. In 2006, the medical college spent more than 30 percent of Cornell's overall research budget.

"The growth and differentiation of research activities at the medical college have been incredible," Skorton said, adding that he would like to see the medical college take a closer look at disparities in access to health care services and workforce diversity as research issues.

Skorton's audience -- probably one of the largest in recent memory for a grand rounds lecture -- was impressed by his variation on the academic tradition.

"I think he beautifully outlined the social and economic issues facing medicine and health care today," said Alvin Mushlin, M.D., chair of WCMC's Department of Public Health.

For his part, Skorton -- who jokingly described himself as "a doctor who went wrong, basically" by becoming an administrator -- enjoyed the opportunity to revisit grand rounds. "I feel like I'm coming back home to be in a medicine grand rounds," Skorton said. "Although I must say, when I was an associate chair of medicine we never got turnouts like this at grand rounds."