Making Doctors Effective Managers and Leaders: A Matter of Health and Well-Being

Pilot study exploring the presence of leadership curricula in undergraduate medical education

INTRODUCTION

The physician's role in the healthcare delivery system extends beyond patient care to include numerous critical leadership roles in healthcare. In addition to treating patients, physicians manage multidisciplinary teams and influence policies to optimise public health. Yet, leadership education is not currently emphasised as part of undergraduate medical education. The purpose of this pilot study was to survey US allopathic medical schools about their current leadership curricula for medical students, including aspects that promote or inhibit effective curricular implementation.

METHODS

A survey was developed and administered to representatives at US allopathic medical schools regarding the presence and nature of leadership curricula for medical students currently in place, as well as barriers to effective implementation.

RESULTS

A total of 41 of 144 medical schools (28%) responded to the survey. Of the schools that responded, 25 schools reported the presence of a leadership curriculum. Primary competencies and goals were similar among these institutions, but the structure of the curriculum and how it is being implemented varied. The study did not identify consistent methods of assessing student leadership competencies. Themes of improved communication and integration within the curriculum emerged as actions promoting successful implementation. Financial restraints and buy-in among stakeholder groups (eg, faculty, staff and students) were mentioned most frequently as barriers to the effective implementation of leadership curricula.

CONCLUSIONS

Although leadership education within undergraduate medical education is emphasised by a variety of groups, including the Association of American Medical Colleges, medical schools do not appear to universally address this topic. The Liaison Committee on Medical Education, the primary accrediting body for medical schools, does not currently require leadership education as a core topic for accreditation. To provide effective education on leadership to medical students, administrative bodies could improve their support for this topic by considering the factors identified that both hinder and promote implementation.

Navigating between two figured worlds: A constructivist grounded theory study on residents' workplace experiences with health care management tasks

INTRODUCTION

Medical residents may be required to handle health care management (HCM) tasks alongside their clinical duties, despite not having received training to perform them. However, little research has been done on how medical residents acquire HCM skills at the workplace and how these experiences impact their learning.

METHODS

We completed a qualitative research study using the Constructivist Grounded Theory approach inform by the Figured World theory. To gather data, we held focus groups and conducted semi-structured interviews with 22 medical residents from various disciplines and learning levels at Pontificia Universidad Javeriana. We utilised iterative data collection and analysis, constant comparison methods and theoretical sampling to construct our findings.

RESULTS

We constructed two different worlds to represent how residents acquire HCM skills: the non-managing physician and the physician-as-manager. The former was characterised by a discourse that underplayed the role of the HCM tasks as part of residents' training, was full of negative interactions with the health care team and limited residents' agency. In the latter, residents collaborated and learned from health care team members, had supervisors who modelled how to incorporate HCM tasks into daily activities and expanded residents' agency. Residents developed their professional identity according to the world they were introduced into.

DISCUSSION

Educational leaders must understand that the non-managing physician figured world gives residents a feeling of uprooting and discomfort when carrying out this type of tasks. To transform this world into the physician-as-manager, it is necessary to reconfigure some workplace hierarchies, consolidate interprofessional collaborations and change the discourse perpetuated by influential role models. Supervisors must also strengthen their knowledge of HCM and improve its integration into clinical practice. Any effort to train residents on HCM competencies could be lost if the workplace underscores their value in patient care.

Data Analysis of Physician Competence Research Trend: Social Network Analysis and Topic Modeling Approach

BACKGROUND

Studies on competency in medical education often explore the acquisition, performance, and evaluation of particular skills, knowledge, or behaviors that constitute physician competency. As physician competency reflects social demands according to changes in the medical environment, analyzing the research trends of physician competency by period is necessary to derive major research topics for future studies. Therefore, a more macroscopic method is required to analyze the core competencies of physicians in this era.

OBJECTIVE

This study aimed to analyze research trends related to physicians' competency in reflecting social needs according to changes in the medical environment.

METHODS

We used topic modeling to identify potential research topics by analyzing data from studies related to physician competency published between 2011 and 2020. We preprocessed 1354 articles and extracted 272 keywords.

RESULTS

The terms that appeared most frequently in the research related to physician competency since 2010 were knowledge, hospital, family, job, guidelines, management, and communication. The terms that appeared in most studies were education, model, knowledge, and hospital. Topic modeling revealed that the main topics about physician competency included Evidence-based clinical practice, Community-based healthcare, Patient care, Career and self-management, Continuous professional development, and Communication and cooperation. We divided the studies into 4 periods (2011-2013, 2014-2016, 2017-2019, and 2020-2021) and performed a linear regression analysis. The results showed a change in topics by period. The hot topics that have shown increased interest among scholars over time include Community-based healthcare, Career and self-management, and Continuous professional development.

CONCLUSIONS

On the basis of the analysis of research trends, it is predicted that physician professionalism and community-based medicine will continue to be studied in future studies on physician competency.

Leadership Lessons Learned from the Military

The military provides a valuable resource for the civilian medical education sector to potentially model or adopt strategies used to train emerging leaders. The Department of Defense has a long tradition of cultivating leaders, espousing a culture that emphasizes a value system that promotes selfless service and integrity. In addition to leadership training, and a fostered value system, the military additionally trains leaders to use a defined military decision-making process. This article identifies and shares lessons learned in how the military structures and focuses to accomplish the mission, and develops and invests in military leadership training.

Adaptive leadership of doctors during COVID-19

PURPOSE

This study aims to examine the adaptive leadership of doctors during COVID-19 to understand the leadership competencies required for adaptive events.

DESIGN/METHODOLOGY/APPROACH

Phenomenology-based qualitative design was used. Data were collected from six doctors from the state of Kerala, India using semi-structured interviews.

FINDINGS

Five themes were identified. The first theme, core leadership shows that doctors perceive leaders as educators, learners and social beings. The second theme, adaptive challenges, describes the ambiguous pandemic-related challenges that doctors are facing including, unusual occupational demands, information overload, sociocultural issues and personal intricacies. The third theme reflects that for doctors, adaptive work during the pandemic included - new learning to address unique issues, changing perspectives and establishing and maintaining a safe and engaging workplace environment. The fourth theme describes the adaptive leadership competencies such as regulating distress, providing direction, maintaining disciplined action, fostering collaboration, empowering, understanding organizational linkages, strategic vision and communication skills. The fifth theme elucidates the lacunae in leadership training as perceived by the doctors.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings can help in developing and enhancing competency frameworks for doctors' adaptive leadership.

ORIGINALITY/VALUE

This is one of the earliest studies to systematically examine components of adaptive leadership for doctors during COVID-19 and identify associated competencies.