Untangling approaches to management and leadership across systems of medical education

Abstract

AimsHow future doctors might be educated and trained in order to meet the population and system needs of countries is currently being debated. Incorporation of a broad range of capabilities, encompassed within categories of management and, increasingly, leadership, form part of this discussion. The purpose of this paper is to outline a framework by which countries’ progress in this area might be assessed and compared.MethodsKey databases and journals related to this area were reviewed. From relevant articles potential factors impacting on the incorporation of aspects of management and leadership within medical education and training were identified. These factors were tested via an online survey during 2013 with six members of a European Association of doctors who promote medical involvement in hospital management, including members from countries less represented in the health management literature.ResultsA framework for analysing how management and leadership education is being approached within different systems of healthcare is developed and presented.ConclusionsMore systematic work across a wider range of countries is needed if we are to have a better understanding of how countries within and beyond Europe are approaching and progressing the education of doctors in management and leadership.

Review of determinants of national medical leadership development

“…One paper reports on a national ML programme18 and one reflects on the (lack of evidence on) return on investments of a national programme 33. Two papers focus on leadership development in medical education,34 35 while the recent Hartley paper provides a framework for comparing and assessing national ML development among nations 36…”

“…McKimm and colleagues argue that the Medical Leadership Competency Framework in the UK has reinforced the embedment of ML development in all UK specialty training curricula. Following the international comparative method provided by Hartley, such frameworks are seen as crucially fundamental to ML development worldwide 36. Even so, gradual shifts in meaning and focus of the ML concept during specific phases of national ML development should be considered, and it is at such times that the popular distinction between ‘managerial leadership’ and ‘medical leadership’ emerges 33…”

“…Jorm and Parker argue that integrating a lot of leadership training into the medical curriculum is perhaps wasted because physicians often return to their daily clinical work settings where they are not encouraged or enabled to employ their new set of skills 33. However, ML training ‘drip fed’ throughout the duration of medical education’36 (p.36) could prevent such a ‘wash-out’ effect. However, training in stages is not the only factor to be considered.…”

“…The work of ML trainers and teachers should be continuously evaluated according to well-founded rigorous theoretical bases and best practices that are proven to be effective in their appropriate context. Hence, specifying effective requirements for ML education are essential when developing, deploying and evaluating effective ML programmes, and this includes a contingent of proficient educationalists 36. Aligning leadership curricula with existing competency frameworks would create opportunities to standardise particular learning activities and assessment methods and to enable the comparing of the outcomes of such new elements of medical education 18 35…”

Unlocking medical leadership’s potential: a multilevel virtuous circle?

“…In healthcare, changes have been triggered by shifting combinations of market, bureaucratic and statist (or political-democratic) logics, which have caused doctors to revisit the traditional medical professional logics that have historically governed national and regional systems of healthcare delivery 9 16–19. Such hybridisation, which has led to a questioning of what it means to be a medical professional in increasingly complex healthcare systems, has been an important driving force behind the emergence of doctors’ latest professional guise—that of ‘medical leader’ 20. The ‘promise’ of ML, cloaked in doctors’ emerging role as a ‘leader’, rests in the new non-clinical competencies with which they attempt to address the growing needs of interdisciplinary (net)working, cocreative innovation and continuous quality improvement 5.…”