Residency Education, Preventive Medicine, and Population Health Care Improvement: The Dartmouth???Hitchcock Leadership Preventive Medicine Approach

Abstract

In 2003, Dartmouth-Hitchcock Medical Center (DHMC) inaugurated its Leadership Preventive Medicine residency (DHLPMR), which combines two years of leadership preventive medicine (LPM) training with another DHMC residency. The aim of DHLPMR is to attract and develop physicians who seek to become capable of leading change and improvement of the systems where people and health care meet. The capabilities learned by residents are (1) leadership -- including design and redesign -- of small systems in health care, (2) measurement of illness burden in individuals and populations, (3) measurement of the outcomes of health service interventions, (4) leadership of change for improvement of quality, value, and safety of health care of individuals and populations, and (5) reflection on personal professional practice enabling personal and professional development. The DHLPMR program includes completion of an MPH degree at The Dartmouth Institute for Health Policy and Clinical Practice (formerly the Center for Evaluative Clinical Sciences) and a practicum during which the resident leads change to improve health care for a defined population of patients. Residents also complete a longitudinal public health experience in a governmental public health agency. A coach in the resident's home clinical department helps the resident develop his or her practicum proposal, which must then be approved by a practicum review board (PRB). Twelve residents have graduated as of July 2007. Residents have combined anesthesia, family medicine, internal medicine, infectious disease, pain medicine, pathology, psychiatry, pulmonary and critical care medicine, surgery, gastroenterology, geriatric psychiatry, obstetrics-gynecology, and pediatrics with preventive medicine.

Teaching Advanced Leadership Skills in Community Service (ALSCS) to Medical Students

“…Alternatively, the addition of leadership training in residency would bolster any leadership training that occurs in medical school. 12,13 Finally, we cannot compare the ALSCS selective with other selectives, because each selective has a unique evaluation tailored to its objectives. Although only 12 to 14 students-rather than the whole class-take the ALSCS selective each year, this constitutes 10% of the class, a substantial amount given competition for curricular space.…”

“…11 Although the creation of physician leadership programs has begun to extend to a few residency programs, the number of physicians graduating with skills necessary to take on leadership roles in practice remains insufficient given the large challenges facing health care. 6,[11][12][13] To ensure that physician leaders continue to emerge, one option is to integrate leadership training in community service into the undergraduate medical school curricula. Medical students understand that their training forms the core of what they need to know as future physicians.…”

Improving the simple, complicated and complex realities of community-acquired pneumonia

“…This effort was spearheaded by a resident physician who had dedicated time, support and mentorship through the Leadership Preventive Medicine Residency Program and the administrative leadership 29. Of interest, after the graduation of the resident leader of the improvement group and cessation of email feedback to providers for each patient admitted with CAP (year 2005), four of the five CAP measures assessed continued to improve over time.…”

Comment mieux aider les médecins de la relève à assumer des responsabilités de gestion ?

“…Dans ce sens, de nombreux articles relèvent la nécessité de développer les capacités organisationnelles des futurs médecins et de donner aux leaders en émergence des pistes qui leur permettent de gérer ces défis organisationnels [16][17][18][19] . Conscientes de la nécessité de développer la relève et de renforcer les compétences en gestion des médecins destinés à occuper des postes à responsabilités, de nombreuses institutions ont déve-loppé des formations, comme en témoigne par exemple la vaste littérature traitant de la formation des médecins aux compétences de gestion [20][21][22][23] , au leadership [17][18][19][24][25][26][27][28][29][30] , à la recherche et à l'enseignement universitaire [31][32][33] , à la gestion de carrière [34][35][36][37][38][39][40] , à l'interdisciplinarité [41] ou encore à la connaissance de soi [42][43][44] . Pourtant, malgré cette pléthore de possibilités de formation, les résultats ne semblent pas être au rendez-vous.…”