Fitz and I met in 2016 when I came to George Washington University, and I immediately felt at ease. I looked around his office and there it was littered with photos of Fitz with his family, his patients, copies of his books, and a man that had a long service to his country. When we met, I noticed his wide smile, hearty laugh, and had the immediate feeling that we were cut from the same mold. We both had begun our careers wanting to optimize the potential of the kids we cared for. Besides the four-decade age difference, he treated me as a colleague. I was a nurse. He was a pediatrician. Together, we could work to make a difference… I didn’t quite know what that would look like, but he did.
A pediatrician by training, Dr. Fitz Mullan’s 50-year career included time as a civil rights worker, National Health Services Corps leader, federal administrator, assistant surgeon general, senior advisor to Surgeon General C. Everett Koop, writer, researcher and advocate for social justice. He was deeply committed to social justice, health equity, and improving health workforce policies. Fitz has coined a few terms, but one that lends itself to our work in equity is his term “Social Mission”. Social mission refers to an institution’s commitment to social equity in everything it does- from admissions and faculty hiring policies, to curriculum development, the extent of community-based experiential learning, and, ultimately measured in their graduates’ outcomes, i.e., who they graduate, and where and how they practice.
In 2010, he published a paper in an effort to rank medical schools in terms of their social mission. He and his team looked at the graduating classes of medical schools going back about a decade, and said, “Ten years later, where are the graduates? Are they in shortage areas? Are they in primary care? Are they individuals from underrepresented minority groups?” They ranked all of the 141 schools (osteopathic and allopathic medicine) and discovered quite an appreciable spread when the three factors were combined. These factors were termed “social mission”. The “social mission of medical schools” ranking study got a lot of attention because it kind of flipped the traditional order. The marquee, well-known schools tended to be toward the bottom of the list while schools that were less well-known—regional, rural—tended to be toward the top. (Health Affairs, 2020).
He penned a JAMA article in 2017 where he said: “Education, research, and service are well-established missions of health professions schools and teaching hospitals in the United States. The role of social mission in these institutions is vitally important but less clear. Broadly defined, the social mission of a health professions school is the contribution of the school in its mission, programs, and the performance of its graduates, faculty, and leadership to enhancing health equity and to addressing the health disparities of the society in which it exists. School characteristics that are associated with commitment to social mission, include community engagement, promotion of diversity, reduction in health disparities, the responsible use of health resources, and a focus on the social determinants of health.”
Dr. Mullan has a long history of engagement with nursing education, and dedication to U.S. and international health workforce issues. His work focused on equity in health professions education. I have become increasingly interested in how early childhood poverty and adversity affect long-term neurocognitive and school outcomes. In a four year BSN program, we talk a lot about pediatrics and we certainly discuss public health, but it is rare that we discuss how early childhood adversity impacts long-term health and education. We should. It should be in our curriculum. He helped me think about this in a bigger context. How could we integrate this idea of social mission into broader health professions education? From my perspective, the question becomes “are nursing schools already doing this?” “Which ones and how well?”
Nursing education programs have increasingly focused on the NCLEX licensure exam, and preparing nurses for jobs in hospitals. It is the premise of the work that Fitz and I have done (in collaboration with our colleague Dr. Polly Pittman) that for new nurse graduates to contribute to building a culture of health, schools of nursing must adopt a social mission that infuses all of their policies and programs. The issues associated with social mission also constitute key items in what has recently become the Robert Wood Johnson Foundation focus: Culture of Health. The difference is that social mission is the educational framework needed in order to activate nursing in a variety of practice settings to contribute more purposefully to building a culture of health in the United States. In other words, the social mission of nursing education programs is a necessary precursor to building a culture of health.
Fitz’s legacy continues. The Mullan Institute conducts research on innovative roles of health workers, measuring social mission in health professions education, diversity in admissions to health professions schools, the impact of the National Health Service Corps, and now social mission in nursing education. Dr. Mullan saw this work as an essential part of the effort to build a fairer, better health system, recently calling health workforce and equity “the north stars of my professional life.” The Mullan Institute houses the Beyond Flexner Alliance, a national movement to promote social mission in health profession education founded by Dr. Mullan. It also houses two fellowship programs—the Atlantic Fellows for Health Equity and the Residency Fellowship in Health Policy—that demonstrate Dr. Mullan’s role as an inspiring mentor, teacher and leader to scores of physicians and public health professionals.
-Ashley Darcy-Mahoney, PhD, NNP, FAAN, Community of Practice Member
Dr. Ashley Darcy-Mahoney is a neonatal nurse practitioner and researcher, has worked throughout her career to advance nursing research, education and practice, with a focus on neonatology, infant health and developmental pediatrics. Her research has led to the creation of programs that improve health and developmental outcomes for at-risk and preterm infants.
- Mullan F. (2017) Social Mission in Health Professions Education: Beyond Flexner. JAMA: 318(2):122–123. doi:10.1001/jama.2017.7286
- Hassmiller, S. (2020). Legacies and Lessons: A Final Conversation with Fitzhugh Mullan.
- Health Affairs: 39 (20)