Preparing the Next Generation of Physician Leaders: Teaching Management Skills to Medical Students and Residents

Background

Will we have enough candidates to fill leadership positions in academic medicine in the next few decades? Physician education in the 21st century faces a number of challenges, including an increasingly complex health care system, rapid changes in technology, increasing regulation of working and learning hours, and reductions of resources for student and resident education. While most physicians eventually complete the long process of multidimensional growth needed to become a competent practitioner, only some continue their careers as medical leaders or educators, and fewer seek to become educational leaders in undergraduate and graduate medical education. Medical school, residency, and fellowship have always prepared learners to organize, communicate, educate, and administer, but today’s physicians who choose a career path outside of the traditional practice model, or perhaps even within it, need to acquire additional skills that were often not part of traditional medical education.

The seemingly growing refrain for more management and leadership education of physicians, even at the very early career stage, is not new. For instance, in 2004, the Institute of Medicine (IOM) recommended that academic medical centers “develop leaders at all levels who can manage the organizational and system changes necessary to improve health through innovation in health professions education, patient care, and research.” Furthering this charge as it relates to graduate medical education, in 2014 the IOM issued consensus suggestions urging greater outcome measurement of education aimed at such areas as increasing value and health care delivery system effectiveness, as well as improving physician interpersonal skills around coordination of care, communication skills, and patient engagement. Similarly, Jardine et al (2015), as a member of the Council of Review Committee Residents, Leadership Subcommittee of the Accreditation Council for Graduate Medical Education (ACGME), advocated on behalf of residents and fellows for a national leadership curriculum. As a result, this educational content is consistent with the Common Program Requirements for residency and fellowship programs, beyond the development of skills in patient safety and quality improvement.

Moreover, according to Martins (2010), management education for internists should be “spiral,” starting from medical school and expanding to incorporate new activities and responsibilities as the physician matures. A 2015 study by Frich and Brewster conducted a systematic review of the literature and found no fewer than 35 reports on leadership training programs designed exclusively for physicians. The vast majority of these programs focused on skills training and substantive knowledge, while only a small number used more high-impact educational practices involving interactive techniques to increase self-awareness or stressed system-level, as opposed to only individual-level, impact.

On a broader scale, the American Medical Association (AMA) jointly issued with the American Hospital Association (AHA) a “discussion document” identifying principles for developing successful physician, as well as interprofessional, leadership to achieve better integrated health systems. In addition to the mastery of a number of core operational functions (e.g., financial planning), the AMA and AHA emphasize development of strong interpersonal skill sets for physicians, including team-building, communication, and effective negotiation.

As academic medical centers continue to integrate management education into their curricula, current trainees and practicing physicians can access such education through a combination of workshops, residential courses, and online courses. This chapter describes essential managerial and leadership skills and associated learning activities during the graduate medical education phase of training for those who will manage the education of future physicians.