Clinical practice in nursing homes as a key for progress

With the aging of the world's population there has become a major need for the development of nursing homes throughout the world. While some countries provide high quality care for the disabled elderly, in others this is not the case. Education of a medical director has been shown to improve the quality of the nursing home. Physicians need to have knowledge of how to implement continuous quality improvement and culture change. Key medical issues include moving to a restraint free environment, subsyndromal delirium, behavioral disturbances, weight loss, pain management, pressure ulcers, falls, hip fractures, polypharmacy, depression and frailty.

[Requirement profile for leading surgeons: from the perspective of an experienced surgeon]

The present day and future requirement profiles for leading surgeons have become manifold and are defined as such. Many requirements are teachable and learnable, such as economy and management. It is more difficult to form a leading personality out of a capable surgeon and can only succeed if the personal character disposition is already present. Only such personalities will be able to remain authentic as leader of a clinic. Success is based as always on a symbiosis of the learnable basics and the personality structure with the willingness to lead and to serve and not to become tired of it.

The path to physician leadership in community health centers: implications for training

BACKGROUND AND OBJECTIVES

Community health centers are facing a shortage of primary care physicians at a time when government plans have called for an expansion of community health center programs. To succeed with this expansion, community health centers require additional well-trained physician leadership. Our objective was to ascertain how medical directors obtain leadership skills in an attempt to identify the best methods and venues for providing future leadership training programs.

METHODS

Using recorded interviews and focus group data with community health center medical directors, we identified patterns and themes through cross-case content analysis to determine leadership training needs in underserved settings.

RESULTS

Medical directors often enter positions unprepared and can quickly become frustrated by an inability to make system improvements. Medical directors seek multiple ways to obtain the leadership skills necessary, including conferences, peer networking, mentorship, and formal degree training. Many directors express a desire for additional training, preferring flexibility in curriculum and hands-on components.

CONCLUSIONS

Additional leadership training opportunities for active and future medical directors are needed. Academic medical centers and other training sponsors should consider innovative ways to develop effective physician leadership to provide quality care to underserved communities.

Fetal alcohol syndrome: knowledge and attitudes of family medicine clerkship and residency directors

Fetal alcohol spectrum disorders (FASD) are the leading preventable causes of developmental disabilities with serious permanent consequences. Regardless of the increased awareness of fetal alcohol syndrome (FAS), 13% of women in the United States drink alcohol during pregnancy. Health care professionals do not routinely assess the frequency and quantity of alcohol use by their patients. This study examined the knowledge, skills, and practices of family medicine residency and clerkship directors and assessed the time devoted and format of FAS curricula in the programs. A self-administered anonymous survey was sent to the residency and clerkship directors (N=571). Response rate of clerkship directors was 52% and residency directors 46%. Both groups showed high level of knowledge of FASD and of alcohol counseling practices for pregnant women. Although almost two thirds of the residency programs had FASD integrated in the curriculum, an equivalent fraction of predoctoral programs did not. More than half of the clerkship directors without FASD in their curriculum agreed that a need exists for its inclusion. These findings raise important medical education and policy issues and provide insight into the disparity in FASD content of curricula between predoctoral and family medicine residency programs in the United States. The role of physician counseling in primary prevention of FAS should continue to be stressed in predoctoral and residency education.

Are your docs management ready?

Hospital chief executives are tapping physicians for upper management roles beyond the traditional chief medical officer and other primarily clinical positions. But often, these highly educated, entrepreneurial and strong-willed individuals need help acquiring the business and people skills to successfully make the transition.

Most wired. CMIOs steadily on the rise

These tech-savvy physicians will play a big role as meaningful use requirements put more emphasis on integrating IT and quality. Just asking doctors to volunteer some time to serve on a committee "just doesn't fly anymore".

Commentary: Mentoring the mentor: executive coaching for clinical departmental executive officers

Departmental executive officers (DEOs), department chairs, and department heads in medical schools are often hired on the basis of their accomplishments in research as well as their skills in administration, management, and leadership. These individuals are also expected to be expert in multiple areas, including negotiation, finance and budgeting, mentoring, and personnel management. At the same time, they are expected to maintain and perhaps even enhance their personal academic standing for the purposes of raising the level of departmental and institutional prestige and for recruiting the next generation of physicians and scientists. In the corporate world, employers understand the importance of training new leaders in requisite skill enhancement that will lead to success in their new positions. These individuals are often provided with extensive executive training to develop the necessary competencies to make them successful leaders. Among the tools employed for this purpose are the use of personal coaches or executive training courses. The authors propose that the use of executive coaching in academic medicine may be of benefit for new DEOs. Experience using an executive coach suggests that this was a valuable growth experience for new leaders in the institution.

Teaching and learning the physician manager role: psychiatry residents' perspectives

BACKGROUND

Despite widespread consensus that additional training in administration is needed to prepare physicians for practice, little is known about how best to teach managerial competencies and how to integrate teaching into existing postgraduate curricula.

AIM

This study aimed to elicit resident perspectives on administrative curriculum development following exposure to a pilot physician manager curriculum at the University of Toronto.

METHODS

The authors held five focus groups of psychiatry residents at the University of Toronto during 2008, engaging 40 trainees. Resident perspectives on barriers to teaching and learning administrative skills, preferred curriculum content and format and suggestions for integration of administrative training into the residency programme were elicited.

RESULTS

Identified barriers to learning include lack of physician manager role clarity, dearth of learning opportunities and multiple competing demands on residents' time. Residents value a formal administrative curriculum and propose additional opportunities for experiential learning such as elective rotations and mentorship opportunities. Suggested strategies for integrating administrative teaching into residency include faculty development, rotation-specific administrative objectives and end of rotation resident evaluations.

CONCLUSION

Our findings provide valuable learner input into an emerging educational framework aiming to address barriers to teaching administrative skills during residency and facilitate longitudinal reinforcement of learning.

Perspective: Educating physicians to lead hospitals

The percentage of hospitals that are physician led has been steadily declining and now stands at or near an all-time low. What price do the health care system and the people it serves pay for this decline in physician leadership? What might health care look like if medical educators devoted more time and attention to developing future physicians as organizational leaders? What changes would medical schools need to make to prepare medical students to play such a role? What advantages might accrue for patients, communities, and physicians themselves if more hospitals were physician led? Because hospitals are a vital resource in caring for the sick, promoting health, and addressing the challenges facing the U.S. health care system, it is now more important than ever before to explore how medical education can complement its traditional focus on the molecular, cellular, and organismal levels of health and disease with insight into the organizational dimensions of patient care. The authors believe the time is ripe to rethink medical education's role in preparing tomorrow's physicians as leaders.

Preparing psychiatric residents for the "real world": a practice management curriculum

OBJECTIVE

The authors describe a course designed for residents to develop the knowledge and skills necessary to collaborate and successfully compete in today's complex health care environment and to achieve competency in systems-based practice.

METHODS

Postgraduation surveys demonstrated a need for improvement in preparing residents for practice management issues. The authors outline a 32-week practice management curriculum for postgraduate-year 3 (PGY 3) psychiatric residents.

RESULTS

The course was rated highly by residents in terms of topics covered, faculty involvement, and overall expectations. The project assignments completed by the residents were effective in creating objective change in the resident outpatient practice.

CONCLUSION

Practice management is an essential part of residency training and can be successfully integrated into the residents' clinical practice experience. Future steps include assessment of the graduates at 1 and 5 years postgraduation to evaluate the long-term efficacy of the course.

Teaching the physician-manager role to psychiatric residents: development and implementation of a pilot curriculum

OBJECTIVE

The authors describe a pilot physician-manager curriculum designed to address the learning needs of psychiatric residents in administrative psychiatry and health systems.

METHODS

The pilot curriculum includes a junior and a senior toolkit of four workshops each. The junior toolkit introduces postgraduate-year two (PGY-2) residents to the principles of teamwork, conflict resolution, quality improvement, and program planning and evaluation. The senior toolkit exposes PGY-4 residents to leadership and change management, organizational structures, mental health and addictions reform, and self and career development. Following curriculum implementation at the University of Toronto, residents rated the importance and clinical relevance of curriculum objectives and commented on the strengths and weaknesses of the workshops and areas needing improvement.

RESULTS

The pilot curriculum was successfully introduced at the University of Toronto in 2006. Residents rated the curriculum very highly and commented that interactive learning and contextually relevant topics are essential in meeting their needs.

CONCLUSION

It is possible to successfully introduce a physician-manager curriculum early during psychiatric residency training, to match the specific needs of clinical rotations. Interactive techniques and clinical illustrations may be crucial in facilitating teaching and learning the physician-manager role. The authors discuss barriers, facilitators, and critical success factors in implementing such a curriculum.

Injury data in British Columbia: policy maker perspectives on knowledge transfer

Provincial and regional decision makers in the injury prevention field were interviewed in British Columbia (B.C.) to obtain their views about best processes for the transfer or dissemination of relevant data. These decision makers (n = 13) indicated that data should provide them with a holistic and comprehensive picture to support their decision processes. In addition, they felt information about injury types and rates should be linked backward to determinants or causes and forward to consequences or outcomes. This complete chain of data is needed for planning and evaluating health promotion interventions. It was also felt that data providers needed to devote more effort to fostering effective receptor capacity, so that injury prevention professionals will be better able to understand, interpret and apply the data. These findings can likely be generalized to other jurisdictions and policy areas, and offer additional insight into the practicalities of knowledge transfer and exchange in researcher/decision maker partnerships.

The future of management education and training for physician leaders

Learn how the job descriptions of physician executives are likely to expand as integrated health systems become more complex.