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Turner A, Ryan M, Wolvaardt J. We know but we hope: A qualitative study of the opinions and experiences on the inclusion of management, health economics and research in the medical curriculum. PLoS One 2022; 17:e0276512. [PMID: 36269759 PMCID: PMC9586360 DOI: 10.1371/journal.pone.0276512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
The achievement of global and national health goals requires a health workforce that is sufficient and trained. Despite considerable steps in medical education, the teaching of management, health economics and research skills for medical doctors are often neglected in medical curricula. This study explored the opinions and experiences of medical doctors and academic educationalists on the inclusion of management, health economics and research in the medical curriculum. A qualitative study was undertaken at four medical schools in Southern Africa (February to April 2021). The study population was medical doctors and academic educationalists. Semi-structured interviews with purposively sampled participants were conducted. All interviews were recorded and professionally transcribed. Constructivist grounded theory guided the analysis with the use of ATLAS.ti version 9.1.7.0 software. In total, 21 academic educationalists and 28 medical doctors were interviewed. In the first theme We know, participants acknowledged the constraints of medical schools but were adamant that management needed to be taught intentionally and explicitly. The teaching and assessment of management and health economics was generally reported to be ad hoc and unstructured. There was a desire that graduates are able to use, but not necessarily do research. In comparison to management and research, support for the inclusion of health economics in the curriculum was insignificant. Under We hope, educationalists hoped that the formal clinical teaching will somehow instil values and best practices of management and that medical doctors would become health advocates. Most participants wished that research training could be optimised, especially in relation to the duration of allocated time; the timing in the curriculum and the learning outcomes. Despite acknowledgement that management and research are topics that need to be taught, educationalists appeared to rely on chance to teach and assess management in particular. These qualitative study findings will be used to develop a discrete choice experiment to inform optimal curricula design.
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Affiliation(s)
- Astrid Turner
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- * E-mail:
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, King’s College, Aberdeen, Scotland
| | - Jacqueline Wolvaardt
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Hofmann R, Vermunt JD. Professional learning, organisational change and clinical leadership development outcomes. MEDICAL EDUCATION 2021; 55:252-265. [PMID: 32776364 DOI: 10.1111/medu.14343] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The aim of this study is to develop a conceptually sound outcome model for clinical leadership (CL) development in healthcare, linking individual professional learning and organisational change. Frontline doctors' CL is often offered as a solution to healthcare challenges worldwide. However, there is a paucity of rigorous evidence of effectiveness of CL development, or theories supporting it. Importantly, the literature currently lacks robust outcome models for CL development, impeding robust impact evaluations. METHODS This multi-source, sequential integrated mixed-methods study draws on systematic content analysis of NHS policy documents and empirical data from a CL programme evaluation study: exploratory factor analysis (EFA) of 142 participants' survey responses and thematic qualitative analysis of 30 in-depth participant interviews across six cohorts. Through integrating findings from the three analyses we examine: (a) the expected organisational outcomes of CL, (b) individual learning outcomes of CL development, and (c) the mechanisms linking the two. RESULTS The policy analysis identified three desired solutions to key healthcare problems which CL is expected to offer: Speeding up good practice, Inter-professional collaboration and dialogue, and Change and transformation. Triangulating the EFA results with the qualitative analysis produced five individual outcome constructs: Self-efficacy, Engaging stakeholders, Agency, Boundary-crossing expertise, and Willingness to take risks and to learn from risks and failures. Further qualitative analysis uncovered key mechanisms linking the individual outcomes with the desired organisational changes. DISCUSSION Despite significant investments into CL development in the UK and worldwide, the absence of conceptually robust and operationally specific outcome models linking individual and organisational impact impedes rigorous evaluations of programme effectiveness. Our study developed a novel individual and organisational outcome model including a theory of change for clinical leadership. Our findings further contribute to professional learning theory in medical settings by conceptualising and operationalising the mechanisms operating between individual and organisational learning outcomes.
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Affiliation(s)
- Riikka Hofmann
- Faculty of Education, University of Cambridge, Cambridge, UK
| | - Jan D Vermunt
- Eindhoven School of Education (ESoE), Eindhoven University of Technology (TU/e), Eindhoven, The Netherlands
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Myers CG, Mayo AT, Kachalia A, Polsky D, Sutcliffe KM. Covid-19 has made clear why all physicians need to know about the business of healthcare. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/2516043521990255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Amid longstanding recognition that healthcare challenges are often managerial, not just clinical, many have called for greater attention to developing physicians’ business management abilities. However, the Covid-19 pandemic has amplified the urgency of building physicians’ business knowledge and skills—from understanding health economics and finances to managing dynamics of collaborative leadership and change—in order to respond to pandemic-induced business challenges that threaten healthcare organizations. Unfortunately, existing efforts to develop these critical skills among physicians remain limited, focusing primarily on early-career physicians-in-training or later-career physicians in formal leadership positions. These efforts leave a wide swath of frontline physician leaders “in the middle” without systematic resources for developing their business management abilities. We advocate for several key changes to professional practices and policies to help bring business of health knowledge and skills to the foreground for all physicians, both in the pandemic and beyond.
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Affiliation(s)
- Christopher G Myers
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
- Hopkins Business of Health Initiative, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Armstrong Institute for Patient Safety & Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Anna T Mayo
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
- Hopkins Business of Health Initiative, Johns Hopkins University, Baltimore, MD, USA
| | - Allen Kachalia
- Hopkins Business of Health Initiative, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Armstrong Institute for Patient Safety & Quality, Johns Hopkins Medicine, Baltimore, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Polsky
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
- Hopkins Business of Health Initiative, Johns Hopkins University, Baltimore, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kathleen M Sutcliffe
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
- Hopkins Business of Health Initiative, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Armstrong Institute for Patient Safety & Quality, Johns Hopkins Medicine, Baltimore, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Weeks K, Swanson M, Manorot A, Conley G, Nellis J, Charlton M, Reed A. Viewpoints on Healthcare Delivery Science Education Among Practicing Physicians in a Rural State. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:29-39. [PMID: 33469404 PMCID: PMC7810585 DOI: 10.2147/amep.s285463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Healthcare Delivery Science Education (HDSE) covers important aspects of the business of medicine, including, operations management, managerial accounting, entrepreneurship, finance, marketing, negotiations, e-health and policy/advocacy. We need to investigate and understand practicing physicians' viewpoints on HDSE in order to inform interventions capable of preventing the double loss phenomena and improving medical and continuing medical education opportunities in HDSE. This qualitative study aims to provide a rich, contextualized understanding of the HDSE experiences and interests of physicians practicing in a rural state through the intensive study of particular cases. MATERIALS AND METHODS We interviewed 18 practicing physicians from a rural, Midwestern state over the telephone about their viewpoints on past experiences obtaining HDSE, interest in HDSE, barriers to pursuing HDSE, and interest in an example HDSE certificate program. RESULTS Salient themes in our study were that physicians were interested in HDSE and believed HDSE could lead to improved patient care and practice efficiency. However, many of the respondents had not received longitudinal, diversified, didactic or practical HDSE. Time limited many physicians from pursuing HDSE opportunities. Many physicians in the study were interested in the example HDSE certificate program. DISCUSSION AND CONCLUSIONS Physicians in our qualitative study were interested in obtaining HDSE and had not received diversified, didactic HDSE in the past. Our research suggests innovative HDSE programs will likely be utilized and pursued if they are developed.
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Affiliation(s)
- Kristin Weeks
- Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Morgan Swanson
- Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Amanda Manorot
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Gabriel Conley
- Medical Training Program, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Business, Tippie College of Business, University of Iowa, Iowa City, IA, USA
| | - Joseph Nellis
- Department of Surgery, Duke University, Durham, NC, USA
| | - Mary Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Alan Reed
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Abstract
AbstractThe marketization of public healthcare has brought about organizational transformations, affecting health professionals' ways of working in hospitals and outpatient organizations. As a result of the reforms in the 1990s, the principle of business-like healthcare has been introduced in the Italian health system. This paper presents the main findings of a study of specialist doctors working in two local health organizations in the Tuscany region. Drawing on semi-structured interviews with specialist doctors working in an outpatient setting, the article examines the manifold reactions to changes of the medical profession within outpatient settings. In particular, the combination of professional and organizational dimensions has been taken into consideration. The results show that a change is involving outpatient specialist doctors' identity: organizational change affects several dimensions of the medical professional ethos. The change has been understood by categorizing three major types of approaches to medical professionalism, which are aimed to understand the complexity of the domain and to summarize professionals' reactions: the first is linked to a traditional model of professionalism; the second accepts partially business-like organizational issues, while trying to create individual spaces of autonomy in daily tasks; the third co-opts new organizational issues, which become part of the medical professional ethos.
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White BAA, White HD, Bledsoe C, Hendricks R, Arroliga AC. Conflict Management Education in the Intensive Care Unit. Am J Crit Care 2020; 29:e135-e138. [PMID: 33130869 DOI: 10.4037/ajcc2020886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Conflicts in medical settings affect both team function and patient care, yet a standardized curriculum for conflict management in clinical teams does not exist. OBJECTIVES To evaluate the effects of an educational intervention for conflict management on knowledge and perceptions and to identify trends in preferred conflict management style among intensive care unit workers. METHODS A conflict management education intervention was created for an intensive care team. The intervention was 1 hour long and incorporated the Thomas-Kilmann Conflict Mode Instrument as well as conflict management concepts, self-reflection, and active learning through discussion and reviewing clinical cases. Descriptive statistics were prepared on the participants' preferred conflict management modes. A pretest/posttest was analyzed to evaluate knowledge and perceptions of conflict before and after the intervention, and 3 open-ended questions on the posttest were reviewed for categories. RESULTS Forty-nine intensive care providers participated in the intervention. The largest portion of participants had an avoiding conflict management mode (32%), followed by compromising (30%), accommodating (25%), collaborating (9%), and competing (5%). Pretest/posttest data were collected for 31 participants and showed that knowledge (P < .001) and perception (P = .004) scores increased significantly after the conflict management intervention. CONCLUSIONS The conflict management educational intervention improved the participants' knowledge and affected perceptions. Categorization of open-ended questions suggested that intensive care providers are interested in concrete information that will help with conflict resolution, and some participants understood that mindfulness and awareness would improve professional interactions or reduce conflict.
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Affiliation(s)
- Bobbie Ann Adair White
- Bobbie Ann Adair White is an adjunct associate professor, MGH Institute of Health Professions, Health Professions Education, Boston, Massachusetts
| | - Heath D. White
- Heath D. White is the chair for the Critical Care Council, Baylor Scott & White Health, Division of Pulmonary, Critical Care & Sleep Medicine, Temple, Texas and an assistant professor, Texas A&M University, College of Medicine
| | - Christie Bledsoe
- Christie Bledsoe and Randy Hendricks are associate professors, University of Mary Hardin-Baylor, College of Education, Belton, Texas
| | - Randy Hendricks
- Christie Bledsoe and Randy Hendricks are associate professors, University of Mary Hardin-Baylor, College of Education, Belton, Texas
| | - Alejandro C. Arroliga
- Alejandro C. Arroliga is the system chief medical officer, Baylor Scott & White Health
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Weeks K, Swanson M, Hansen H, Merritt K, Nellis J, Charlton M, Reed A. An Unmet Need in Healthcare Leadership: A Survey of Practicing Physicians' Perspectives on Healthcare Delivery Science Education. J Healthc Leadersh 2020; 12:95-102. [PMID: 33117033 PMCID: PMC7548321 DOI: 10.2147/jhl.s265377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Healthcare delivery science education (HDSE) is increasingly needed by physicians balancing clinical care, practice management, and leadership responsibilities in their daily lives. However, most practicing physicians have received little HDSE in undergraduate through residency training. The purpose of this study is to 1) quantify the perception of the need for HDSE and interest in HDSE among a diverse sample of physicians, and 2) determine if perspectives on HDSE vary by specialty, rurality, and years in practice. Methods Using a cross-sectional, single state, mailed questionnaire, we surveyed 170 physicians about their perspectives on HDSE and interest in an HDSE program. Descriptive statistics and a multivariable logistic regression are presented. Results Among the 70.5% of responding eligible physicians, 75% of physicians had less HDSE than they would like and 90% were interested in obtaining more HDSE. Thirty-five percent of physicians were interested in joining the described HDSE program. The most prevalent barriers to obtaining HDSE were a lack of time and existing programs. Physician perspectives were similar across specialties, years in practice, and rurality. Conclusion There is a high unmet need for HDSE among physicians. Diverse and innovative HDSE programming needs to be developed to meet this need. Programming should be developed not only for physicians but also for undergraduate through residency training programs.
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Affiliation(s)
- Kristin Weeks
- Medical Scientist Training Program, Carver College of Medicine, Iowa City, IA, USA
| | - Morgan Swanson
- Medical Scientist Training Program, Carver College of Medicine, Iowa City, IA, USA
| | | | | | - Joseph Nellis
- Department of Surgery, Duke University, Durham, NC, USA
| | - Mary Charlton
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Alan Reed
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Abstract
Background and aimMedical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled.MethodCouched in extant international literature, this paper provides a conceptual framework to analyse ML’s potential in the context of healthcare’s complex, multifaceted setting.ResultsWe identify four interrelated levels of analysis, or domains, that influence ML’s potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems.
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Giacomelli G, Ferré F, Furlan M, Nuti S. Involving hybrid professionals in top management decision-making: How managerial training can make the difference. Health Serv Manage Res 2019; 32:168-179. [PMID: 31060388 PMCID: PMC7324121 DOI: 10.1177/0951484819844778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hybrid professionals have a two-fold – professional and managerial – role, which
requires appropriate management skills. Investing on managerial training
programs aims to empower professionals with managerial skills and competencies.
Does this pay back? Assessing the impact of such training programs is still a
limited practice. This paper explores whether participation in managerial
training programs in healthcare can enhance the involvement of hybrid
professionals (namely, clinical directors) in top management decision-making.
The mediational effects of knowledge of performance information and its use are
explored. Survey data were collected from more than 3000 clinical directors of 69 public
health authorities from five regional healthcare systems in Italy. Relationships
between participation in managerial training programs, performance management
practices (i.e., knowledge and use of performance information) and the level of
clinicians’ involvement by the top management were studied using a three-path
mediation analysis with structural equation modelling. Propensity score matching
was also performed to mitigate selection bias. Knowledge and use of performance information positively mediate, both
independently and sequentially, the relationship between clinical directors'
participation in managerial training programs and the level of their involvement
in decision-making. The results of the study suggest that managerial training can support hybrid
professionals in engaging with managerialism and playing upward influence on top
management decision-making.
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Affiliation(s)
- Giorgio Giacomelli
- Management and Health Laboratory (MeS), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa (Italy)
| | - Francesca Ferré
- Management and Health Laboratory (MeS), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa (Italy)
| | - Manuela Furlan
- Management and Health Laboratory (MeS), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa (Italy)
| | - Sabina Nuti
- Management and Health Laboratory (MeS), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa (Italy)
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Ahmed MS, Pronovost PJ. Optimizing Leadership Roles of the Medical Executive Committee Within Community Hospitals. Am J Med Qual 2019; 34:200-201. [DOI: 10.1177/1062860618795259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M. Shafeeq Ahmed
- Johns Hopkins Medicine—Howard County General Hospital, Columbia, MD
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Tudor Car L, Kyaw BM, Atun R. The role of eLearning in health management and leadership capacity building in health system: a systematic review. HUMAN RESOURCES FOR HEALTH 2018; 16:44. [PMID: 30176899 PMCID: PMC6122658 DOI: 10.1186/s12960-018-0305-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/07/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND Health leadership and management are essential for ensuring resilient health systems. Relevant training opportunities are often scarce, and the use of digital education could help address this gap. Our aim was to assess the effectiveness of eLearning for healthcare leadership and management capacity building. METHODS We performed a systematic review on the effectiveness of eLearning for health leadership and management training. We also reviewed literature on relevant competencies and training programmes. We conceptualise the role of health leadership and management capacity building in health system strengthening and explore the use of eLearning in this area. RESULTS No evidence was found on the effectiveness of eLearning for health leadership and management capacity guiding. Evidence on health leadership and management education effectiveness in general is scarce and descriptive and reports learning outcomes. We explore how various forms of eLearning can help meet specific requirements of health leadership and management training. CONCLUSIONS Literature on the effectiveness of health leadership and management education is scarce. The use of eLearning could support this type of training by making it more accessible and tailored. Future research should be carried out in diverse settings, assume experimental designs, evaluate the use of information technology and report health system outcomes.
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Affiliation(s)
- Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Singapore, 308232 Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Level 2, Faculty Building, South Kensington Campus, London, SW7 2AZ United Kingdom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Harvard, Boston, MA 02115 United States of America
| | - Bhone Myint Kyaw
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Singapore, 308232 Singapore
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Harvard, Boston, MA 02115 United States of America
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Myers CG, Pronovost PJ. Making Management Skills a Core Component of Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:582-584. [PMID: 28248694 DOI: 10.1097/acm.0000000000001627] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Physicians are being called upon to engage in greater leadership and management in increasingly complex and dynamic health care organizations. Yet, management skills are largely undeveloped in medical education. Without formal management training in the medical curriculum, physicians are left to cultivate their leadership and management abilities through a haphazard array of training programs or simply through trial and error, with consequences that may range from frustration among staff to reduced quality of care and increased risk of patient harm. To address this issue, the authors posit that medical education needs a more systematic focus on topics related to management and organization, such as individual decision making, interpersonal communication, team knowledge sharing, and organizational culture. They encourage medical schools to partner with business school faculty or other organizational scholars to offer a "Management 101" course in the medical curriculum to provide physicians-in-training with an understanding of these topics and raise the quality of physician leadership and management in modern health care organizations.
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Affiliation(s)
- Christopher G Myers
- C.G. Myers is assistant professor, Carey Business School, Johns Hopkins University, and core faculty, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. P.J. Pronovost is senior vice president for patient safety and quality, Johns Hopkins Medicine, director, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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