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

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.

Exploring doctors’ trade-offs between management, research and clinical training in the medical curriculum: a protocol for a discrete choice experiment in Southern Africa

“…Table 1 outlines the attributes and levels for the final DCE that were developed from literature reviews, qualitative research, 4 think-aloud interviews with medical doctors and a quantitative pilot DCE (n=41).…”

“…The medical curriculum is all too often informed by historical content where clinical training surpasses any other topic or competency 1–3. A recent qualitative research study of medical doctors and academic educationalists from four medical schools in Southern Africa found that the teaching of management, and to a lesser extent research, was ad hoc and unstructured 4. There was consensus among participants that both need to be incorporated formally but that this would incur opportunity costs in terms of time taken away from clinical training.…”

Exploring medical curriculum leadership and management training: Perspectives of doctors and medical educators in Botswana

“…The leadership and managerial expectations of doctors are immediate and evolving, even in the absence of formal training. [5,6] '...as an intern I was managing just the ward, as well as the nursing staff there. But now as a resident, I'm now at a point where even at national level, I attend meetings with different stakeholders, where I'm supposed to collaborate with them, work with them, as well as advocate for the community, as well as sort of be the leader with some of the junior people within those meetings…so you should be able to present those leadership skills.... ' [D 2] In the absence of training, doctors have to either 'learn on the job' [D 4] or pursue additional training, often at their own expense.…”

“…[4,5] In 2021, the perceptions of graduates and medical educators (ME) on the roles of leadership and management, and other non-traditional topics in the curriculum, were explored in a doctoral study conducted at four medical schools in southern Africa, including the UB FOM. [6] This short report describes the perceptions of graduates and MEs on leadership and management training at UB, the most recently established participating university which continues to revise its curriculum. Table 1 outlines the current inclusion of leadership and management in the curriculum.…”