Of warps and woofs

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Abstract
The author likens some major aspects of academic medical centers to tightly and carefully woven tapestries. The metaphor is intended to highlight the complexity of medical centers and to help those who are working to promote meaningful and sustainable innovations in medical education. Underlying the presentation is the premise that there already exist several “good ideas” to improve medical education, and that deeper understanding of the barriers to change can promote adoption of these ideas and others. Three tapestries are presented. Each has a vertical “warp” representing one dimension of an academic medical center, and each has a horizontal “woof” representing an interrelated dimension. (In one tapestry, for example, departmental resources constitute the warp and the faculty functions of teaching, research, and service constitute the woof.) In each tapestry, the warp is presently the dominant feature. In each, strengthening or empowering the woof is seen as a step that would facilitate change. Because educational change is a difficult and inevitably slow process, those who work for change are counseled to be patient and have realistic expectations.

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