Is It Time for Entrustable Professional Activities for Residency Program Directors?

Residency program directors (PDs) play an important role in establishing and leading high-quality graduate medical education programs. However, medical educators have failed to codify the position on a national level, and PDs are often not recognized for the significant role they play. The authors of this Commentary argue that the core entrustable professional activities (EPAs) framework may be a mechanism to further this work and define the roles and responsibilities of the PD position. Based on personal observations as PDs and communications with others in the academic medicine community, the authors used work in competency-based medical education to define a list of potential EPAs for PDs. The benefits of developing these EPAs include being able to define competencies for PDs using a deconstructive process, highlighting the increasingly important role PDs play in leading high-quality graduate medical education programs, using EPAs as a framework to assess PD performance and provide feedback, allowing PDs to focus their professional development efforts on the most important areas for their work, and helping guide the PD recruitment and selection processes.

Quantifying publication scholarly activity of psychiatry residency training directors

OBJECTIVE

The authors quantify the number of PubMed-indexed publications by psychiatry program directors during a 5-year observation period.

METHODS

The authors obtained the names of general adult, child and adolescent, and geriatric psychiatry program directors from the ACGME website and entered them into a PubMed.gov database search. Then, they counted the number of indexed publications from July 2008 to June 2013 and categorized them by academic year.

RESULTS

The median number of publications was one for adult psychiatry program directors (n=184), one for child and adolescent directors (n=121), and three for geriatric psychiatry directors (n=58).

CONCLUSIONS

The number of PubMed-indexed publications for program directors of general adult, child and adolescent, and geriatric psychiatry residencies is relatively low. Further research is needed to identify and examine the challenges facing program directors that may limit their ability to participate in this form of scholarly activity.

Impact of the information age on residency training: communication, access to public information, and clinical care

Access to technology in practice helps physicians manage information, communicate, and research topics; however, those in training receive almost no formal preparation for integrating web-based technologies into practice. One reason for this is that many faculty-aside from junior faculty or those in recent generations-did not grow up using Internet communication, may use it minimally, if at all, in their own practices, and may know little about its forms and varieties. This report presents a case to illustrate how these disparities may play out in the supervisory situation and makes suggestions about helping supervisors integrate technology-awareness into their teaching.

Residency selection: do the perceptions of US programme directors and applicants match?

OBJECTIVES

This study sought to evaluate the practices and perceptions of US residency programme directors (PDs) and residency applicants with reference to the use of social media and Internet resources in the resident doctor selection process.

METHODS

A survey was distributed via e-mail (SurveyMonkey®) to 2592 PDs of programmes in 22 specialties accredited by the Accreditation Council for Graduate Medical Education. A separate survey was distributed to all residency candidates applying for postgraduate year 1 (PGY1) positions at the Saint Barnabas Medical Center, Livingston, New Jersey.

RESULTS

A total of 1200 (46.3%) PDs completed the survey. Overall, 16.3% (n=196) of respondents reported visiting Internet resources to gain more information about applicants, 38.1% (74 of 194) of whom had ranked an applicant lower as a result. American medical graduates (AMGs), US international medical graduates (USIMGs) and non-USIMGs all felt that performance on Step 1 of the US Medical Licensing Examination (USMLE) was a critical aspect of a residency application. More AMGs than USIMGs and non-USIMGs believed that PDs made use of social media resources when evaluating applicants and that their online profiles might influence their rankings.

CONCLUSIONS

Residency candidates universally understand the importance of USMLE Step 1 scores in maintaining a competitive application. However, significant differences exist among AMGs, USIMGs and non-USIMGs in their perceptions of the value of other applicant criteria, which may place some applicants at a disadvantage. A small but growing number of PDs currently use Internet resources to learn more about applicants and base their recruitment decisions in part on the information they encounter. At present, applicants are generally unaware of the implications their online activity may have on their selection for residency. Content guideline programmes that raise awareness of the possible impact of social media on the residency recruitment process are needed and should be delivered early in medical education.

Measuring management training needs of hospital managers in Nepal

INTRODUCTION

This is a study of hospital managers in Nepal, measuring their reported capability to undertake management tasks and explore their views about management development.

METHODS

A questionnaire was administered through hospitals. Respondents were asked to rate a series of management tasks on a scale according to how important it was, for their role and their capability to perform it. These tasks were grouped into different factors. The sample included government hospital of each district and major private or hospitals run bu non-government organizations.

RESULTS

A total of 31 hospitals were visited in 18 districts. Information was obtained from 103 managers from different professions. In most hospitals visited, overall management was provided by the doctors. Few had undergone some training to take on management responsibilities. All types of managers, regardless of profession or type of hospital, reported a 'competence gap'for each factor defined as the difference between reported importance and capability. Non-government managers consistently rated themselves as beingmore capable than government managers, but the difference was only significant when it concerned managing People. The need for a separate cadre of managers was supported by 85% of respondents but a majority of doctors (57%) felt that the best people to manage hospitals were doctors.

CONCLUSIONS

Consistent with other studies from low income countries, there is an urgent need to provide different modalities of management developmentenabling hospital managers to improve their capabilities. There is widespread need of management training to be made available in Nepal.

Views of Malaysian interns and their supervisors on the adequacy of undergraduate clinical skills training

INTRODUCTION

This study aimed to determine the views of Malaysian interns and their supervisors on whether undergraduate clinical skills training adequately equipped them for internship and their suggestions for improvement.

METHODS

Pre-tested questionnaires covering demographic characteristics, the participants' views on clinical skills training (communication, history taking, physical examination, diagnosis, patient management and procedures) and their suggestions for improvement were sent to all interns and their supervisors through the hospital directors. Data compiled was analysed to determine any significant association.

RESULTS

Out of the 32 hospitals with interns, 22 participated in the study. 521 completed questionnaires (350 interns, 171 supervisors) were analysed. The majority of interns felt that their undergraduate clinical skills training was adequate in all the aspects studied. The majority of supervisors, however, felt that it was grossly inadequate to poor in the areas of communication: breaking bad news (77% supervisors versus 13% interns), dealing with angry patients (75% versus 20%), giving information (59% versus 3%), communicating with patients' families (53% versus 7%); adult resuscitation: intubation (72% versus 23%), defibrillation (77% versus 31%), use of drugs (62% versus 19%); and all aspects of child resuscitation. This was statistically significant (p < 0.05). Suggestions for improvement included more clinical exposure, communication skills workshop and monitoring of logbooks.

CONCLUSION

This study suggests that there are deficiencies, particularly in communication and resuscitation skills training, in undergraduate clinical skills training. In-depth studies are required to identify ways to improve training.

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.

[A study to compare formal duties of medical directors of Italian public hospitals with actual activities performer]

It is difficult to identify, from a regulatory point of view, the actual competencies of medical directors of public hospitals in Italy. A questionnaire survey was therefore conducted to identify which are the activities actually performed by this professional. One hundred twenty local health authorities participated in the survey. Findings reveal that many activities conducted by the hospital medical director, such a mediation with the local health authorities, are not formally recognized and that the medical director actually conducts more complex activities than those formally pertaining to his role.

Multisource feedback: 360-degree assessment of professional skills of clinical directors

For measuring behaviour of National Health Service (NHS) staff, 360-degree assessment is a valuable tool. The important role of a clinical director as a medical leader is increasingly recognized, and attributes of a good clinical director can be defined. Set against these attributes, a 360-degree assessment tool has been designed. The job description for clinical directors has been used to develop a questionnaire sent to senior hospital staff. The views of staff within the hospital are similar irrespective of gender, post held or length of time in post. Analysis has shown that three independent factors can be distilled, namely operational management, interpersonal skills and creative/strategic thinking. A simple validated questionnaire has been developed and successfully introduced for the 360-degree assessment of clinical directors.

The CMIO--a new leader for health systems

Physician leadership is a critical success factor for health information technology initiatives, but best practices for structuring the role and skills required for such leadership remain undefined. The authors conducted structured interviews with five physician information technology leaders, or Chief Medical Information Officers (CMIOs), at health systems that broadly used health information technology. The study aimed to identify the individual skills and organizational structure necessary for a CMIO to be effective. The interviews found that the CMIOs had significant management experience prior to serving as a CMIO and were positioned and supported within each health system similar to other executive leaders; only one of the five CMIOs had formal informatics training. A review of the findings advocates for the CMIO to have a strong background and role as a physician executive supported by knowledge in informatics, as opposed to being a highly trained informaticist with secondary management expertise or support.

Leadership in academic medicine: reflections from administrative exile

Physicians are drawn into diverse leadership roles in academic medicine, but little in our education and training prepares us for these responsibilities. Fortunately, there is growing convergence in the literature on the attributes of successful leaders for knowledge-based organisations. Top-performing leaders seem to be self-effacing team-builders who eschew rapid-cycle strategic planning and management trends, focusing instead on strategic and incremental changes that will gradually transform their organisations. Academic physicians and search committees often concentrate on personal achievement and intellectual or technical mastery in research and clinical care. In contrast, the literature on leadership suggests other-directed skills matter more, eg mentorship, learning and teaching competencies, and so-called emotional intelligence. As a corollary, teaching hospitals, universities, and professional colleges or societies are long-term organisations with a rich history. Leadership in such a context demands stewardship of tradition along with patient pursuit of changes required to ensure that the organisation evolves successfully.

Competencies, essential training, and resources viewed by designated institutional officials as important to the position in graduate medical education

PURPOSE

In 1998, the Accreditation Council for Graduate Medical Education (ACGME) added the stipulation that each institution providing graduate medical education (GME) have a Designated Institutional Official (DIO). The authors conducted this study via a cross-sectional survey designed to provide descriptive data on the beliefs held by DIOs regarding required competencies, training and experience, and desired resources for the position.

METHOD

The authors collected data between January 2004 and May 2004 using a multistep process that included a prenotice letter; a survey, cover letter, and stamped return envelope; a thank you/reminder postcard; and a replacement survey with new cover letter and stamped return envelope. Data were summarized using descriptive statistics.

RESULTS

Completed surveys were received from 243 of 363 DIOs (66.9%). Eighty-two percent indicated that DIOs should have specified minimum experience or training requirements. Ten competency items were viewed as essential by greater than 50% of respondents, with five items endorsed by over 95% of respondents: professionalism, verbal communication skills, interpersonal skills, leadership skills, and written communications skills. The percentage of responding DIOs who indicated they would be very likely to use resources were as follows: templates for GME policies, contracts, and affiliation agreements (83.1%); DIO-specific training (58.0%); data on DIO demographics (53.9%); DIO job description templates (46.9%); a clear description of DIO versus program director responsibilities (46.1%); and a DIO certification program (32.1%).

CONCLUSIONS

Designated Institutional Officials supported the idea that there should be minimum experience and requirements and demonstrated remarkable consistency in endorsing essential competencies for the position. DIOs, their respective institutions, the ACGME, and other GME organizations and associations may use the data from this study to develop the role further.

Doctor‐managers as decision makers in hospitals and health centres

PURPOSE

This paper describes factors influencing doctor-managers' decision making in specialised health care, health centres and at different levels of management.

DESIGN/METHODOLOGY/APPROACH

Data were collected as part of a survey on physicians graduating in 1977-1991 as drawn from the register of the Finnish Medical Association. The study sample was formed by selecting all physicians born on odd days (n=4144) from the baseline group (n=8232). The category of doctor-managers comprised physicians reporting as their main occupation: principal or assistant principal physician of hospital, medical director or principal physician of health centre, senior ward physician of hospital, and health centre physician in charge of a population area.

FINDINGS

Independent of gender, all doctor-managers responding to the survey reported that the most important base for decision making was personal professional experience. Position in organisation (first-line manager, principal physician) had no impact on the base of decision making. Doctor-managers in primary health care utilised knowledge on norms and knowledge available from their organisation in support of their decision making to a greater degree compared with doctor-managers in specialised health care.

RESEARCH IMPLICATIONS

Evolution discourse from public administration is not yet receiving much response in Finnish doctor-managers' activities, instead, they still act as clinicians.

ORIGINALITY/VALUE

Facing the growing challenges of the future, the paper shows that doctor-managers should reconstruct their orientation and to act more like managers.