Search results

The purpose of this paper is to provide a summary of a research and consultation project being undertaken by the NHS Institute for Innovation and Improvement and The Academy of Medical Royal Colleges to develop an integrated medical management and leadership competency framework. This will apply to all doctors in training at undergraduate and postgraduate levels and post‐registration.

A literature review and consultation approach has been adopted. By interviewing appropriate stakeholders from medical professional, educational, service and regulatory bodies, a high level of awareness and engagement has been realised. This should pay dividends at the implementation phase.

Whilst some management and leadership is included within current curricula, it is highly variable both in terms of its coverage and relevance. At undergraduate level, it is often covered within professional development modules. At postgraduate level, some exciting initiatives are offered for some doctors but no integrated, systematic and coherent framework exists. Findings from the research are influencing the design and content of the emerging competency framework.

The approach used has provided a good range of information however, neither an exhaustive set of views or a full literature review has been obtained.

Introduction of the Medical Leadership Competency Framework will have a significant impact on how doctors are trained. To be deemed an effective and safe doctor in the future, competence in both clinical and wider non‐clinical competences including management and leadership will be required.

This paper will raise awareness of this important initiative and offer a methodology for other clinical professional groups, nationally and internationally.

The paper aims to explore the beliefs of doctors in leadership roles of the concept of “the dark side”, using data collected from interviews carried out with 45 doctors in medical leadership roles across Australia. The paper looks at the beliefs from the perspectives of doctors who are already in leadership roles themselves; to identify potential barriers they might have encountered and to arrive at better-informed strategies to engage more doctors in the leadership of the Australian health system. The research question is: “What are the beliefs of medical leaders that form the key themes or dimensions of the negative perception of the ‘dark side’?”.

The paper analysed data from two similar qualitative studies examining medical leadership and engagement in Australia by the same author, in collaboration with other researchers, which used in-depth semi-structured interviews with 45 purposively sampled senior medical leaders in leadership roles across Australia in health services, private and public hospitals, professional associations and health departments. The data were analysed using deductive and inductive approaches through a coding framework based on the interview data and literature review, with all sections of coded data grouped into themes.

Medical leaders had four key beliefs about the “dark side” as perceived through the eyes of their own past clinical experience and/or their clinical colleagues. These four beliefs or dimensions of the negative perception colloquially known as “the dark side” are the belief that they lack both managerial and clinical credibility, they have confused identities, they may be in conflict with clinicians, their clinical colleagues lack insight into the complexities of medical leadership and, as a result, doctors are actively discouraged from making the transition from clinical practice to medical leadership roles in the first place.

This research was conducted within the Western developed-nation setting of Australia and only involved interviews with doctors in medical leadership roles. The findings are therefore limited to the doctors’ own perceptions of themselves based on their past experiences and beliefs. Future research involving doctors who have not chosen to transition to leadership roles, or other health practitioners in other settings, may provide a broader perspective. Also, this research was exploratory and descriptive in nature using qualitative methods, and quantitative research can be carried out in the future to extend this research for statistical generalisation.

The paper includes implications for health organisations, training providers, medical employers and health departments and describes a multi-prong strategy to address this important issue.

This paper fulfils an identified need to study the concept of “moving to the dark side” as a negative perception of medical leadership and contributes to the evidence in this under-researched area. This paper has used data from two similar studies, combined together for the first time, with new analysis and coding, looking at the concept of the “dark side” to discover new emergent findings.

This paper aims to examine the views of physicians in senior management positions regarding the distinctive characteristics and roles of leaders in the Israeli health-care system and what might be the interactions between management and leadership.

In total, 13 semi-structured in-depth interviews were conducted with physicians in senior management positions. Interviews were recorded, transcribed and analyzed using the qualitative-phenomenological method.

Interviewees discerned leaders as exhibiting traits of transformational leadership and managers, as expressing characteristics of transactional leadership. Most interviewees asserted that physicians should act as social leaders promoting public health and equality in health care, beyond their clinical practice. They agreed that physicians should fill most senior positions in the health-care system, provided they undergo appropriate training in management, leadership and interdisciplinary collaboration.

Interviewees revealed gaps between the aspiration to lead, perceptions of physicians as leaders and what occurs in reality: physicians wish to assume leadership roles in the health-care system and emphasize the qualities of transformative leadership, but medical education does not include leadership training. Therefore, there is a need to develop training programs for physicians in management and leadership. There is also a need to integrate physicians from various communities to promote local leadership in the health-care field and to reduce disparities. The consideration of health-care leadership is especially applicable in the context of the Covid-19 pandemic, which has placed the question of leadership within and outside of the medical community in a broader social context.

This paper aims to describe the educational philosophy and practice underpinning the Royal Australasian College of Medical Administrators (RACMA) program and how it is aligned with the needs of the Australian and New Zealand health care systems. Preparing future doctors as medical leaders requires keeping pace with developments in medical education and increased sophistication on the part of teaching and supervising faculty.

This paper is a descriptive case study. The data are complemented by workforce data and excerpts from the RACMA Management and Leadership Curriculum.

The RACMA has developed a program informed by current best practices in medical education. The educational underpinnings and instructional practices of the RACMA emphasize leadership as a collaborative social process and the importance of relational leadership in successful modern day practice. The ongoing development of the program has a focus on setting of clear learning objectives, regular and continuous feedback to trainees and reflective practice facilitated by the close relationship between trainees and their preceptor.

Although a site-specific case study, the application of relational models of teaching can be applied in other settings.

The application of relational models of teaching can be applied in other settings.

This paper fulfils a social need to describe successful competency models used for medical leadership development.

This paper fulfils an identified need to define competency models used as a foundation for medical leadership development.

In the management world, leadership is a quality associated with business leaders, social entrepreneurs and political figures. Doctors are rarely considered as possessing or requiring leadership skills. With doctors, one thinks of skill and knowledge, but for some strange reason, leadership is hardly associated with doctors. This paper aims to highlight the leadership aspects unique to doctors. This study highlights why leadership training is imperative for doctors, outlines current status of leadership training for doctors in India and sets out proposals for effective leadership building.

Methodology is based on a two-pronged explanatory approach – the first is review of current literature in the context of leadership training of doctors, and the second is review of circumstances unique to the line of work undertaken by doctors that shed light on the need for leadership.

This paper highlights the imperative need for leadership training for doctors in India. It recommends leadership training on a continuous basis in their career life cycle as with the other professions. It also calls for involvement of all stakeholders in the medical community to foster leadership training – medical educational institutions, hospitals, medical councils and members of the medical fraternity.

Akin to leadership training programs conducted for IT and management professionals, this paper recommends that similar programs be conducted for doctors.

There are very few studies conducted in the Indian context on leadership training needs for doctors. This paper explains the importance of leadership training for doctors and suggests ways it can be implemented throughout the medical education life cycle of a doctor’s career.

Although medical leadership and management (MLM) is increasingly being recognised as important to improving healthcare outcomes, little is understood about current training of medical students in MLM skills and behaviours in the UK. The paper aims to discuss these issues.

This qualitative study used validated structured interviews with expert faculty members from medical schools across the UK to ascertain MLM framework integration, teaching methods employed, evaluation methods and barriers to improvement.

Data were collected from 25 of the 33 UK medical schools (76 per cent response rate), with 23/25 reporting that MLM content is included in their curriculum. More medical schools assessed MLM competencies on admission than at any other time of the curriculum. Only 12 schools had evaluated MLM teaching at the time of data collection. The majority of medical schools reported barriers, including overfilled curricula and reluctance of staff to teach. Whilst 88 per cent of schools planned to increase MLM content over the next two years, there was a lack of consensus on proposed teaching content and methods.

There is widespread inclusion of MLM in UK medical schools’ curricula, despite the existence of barriers. This study identified substantial heterogeneity in MLM teaching and assessment methods which does not meet students’ desired modes of delivery. Examples of national undergraduate MLM teaching exist worldwide, and lessons can be taken from these.

This is the first national evaluation of MLM in undergraduate medical school curricula in the UK, highlighting continuing challenges with executing MLM content despite numerous frameworks and international examples of successful execution.

The purpose of this paper is to describe how Finnish experts perceive future (year 2030) hospital management and leadership.

A total of 33 experts participated in a three-round Argument Delphi process. Opposing views of management and leadership in 2030 were analyzed using inductive content analysis.

The experts’ perceptions were divided into two main categories: management and leadership orientation and future organization. Perceptions relating to management and leadership orientation were classified as relating to patient-centred, clinical dominance, professionally divided and management career options. Perceptions relating to future management and leadership organization were classified as representing shared, pair, team and the individual-centered leadership. The results highlighted the most distinctive issues raised by the participants.

This qualitative study was conducted in the context of Finnish healthcare according to the principles of the Argument Delphi Method. The panel consisted of high-level experts representing a diverse set of roles. However, as suggested in previous literature, these experts may not be the most astute in predicting the future development of hospital organizations.

The findings can be used to develop and renew management and leadership training and management practices in hospitals.

The findings can be exploited in discussions, planning and decision making regarding future management and leadership in hospitals.

Only a few studies have investigated perceptions of future management in hospitals. This study adopted the Argument Delphi Method to identify distinct perceptions on the future orientation and organization of management and leadership in hospitals.

“Becoming” a doctor involves the acquisition of medical knowledge, skills and professional identity. Medical professional identity formation (MPIF) is complex, multi-factorial and closely linked to societal expectations, personal and social identity. Increasingly, doctors are required to engage in leadership/management involving significant identity shift. This paper aims to explore medical professional identity (MPI) and MPIF in relation to doctors as leaders. Selected identity theories are used to enrich the understanding of challenges facing doctors in leadership situations and two concepts are introduced: medical leader identity (MLI) and medical leader identity formation (MLIF) and consideration given to how they can be nurtured within medical practice.

A rapid conceptual review of relevant literature was carried out to identify a set of relevant concepts and theories that could be used to develop a new conceptual framework for MLI and MLIF.

MLIF is crucial for doctors to develop as medical leaders, and, like MPIF, the process begins before medical school with both identities influenced, shaped and challenged throughout doctors’ careers. Individuals require support in developing awareness that their identities are multiple, nested, interconnected and change over time.

This paper draws on concepts from wider literature on professional identity, in relation to how doctors might develop their MLI alongside their MPI. It offers a new perspective on MPI in the light of calls on doctors to “become and be healthcare leaders” and introduces the new concepts of MLI and MLIF.

The purpose of the study is to evaluate the first cohort of the Royal College of Physicians' (RCP) Chief Registrar programme in 2016/7. Chief Registrars provide medical leadership capacity through leadership development posts.

The study adopted a mixed methods design, comprising a monthly survey of the 21 Chief Registrars in the first cohort, interviews with Chief Registrars, and six cases studies where Chief Registrars and colleagues were interviewed.

Chief Registrars enjoyed high levels of practical, professional, and leadership support from their employing organisations, the RCP, and the Faculty of Medical Leadership and Management. They had high degrees of autonomy in their roles. As a result, roles were enacted in different ways, making direct comparative evaluation problematic. In particular, we identified variation on two dimensions: first, the focus on medical leadership generally, or quality improvement more specifically, and second, the focus on personal development or organisational leadership capacity.

The data are limited and drawn from the first cohort's experience. The Chief Registrar scheme, unlike many other leadership fellowships, maintains a high level of clinical practice (with a minimum 40 per cent leadership work). This suggests a clearer preparation for future hybrid leadership roles.

This paper may offer some support and guidance for Chief Registrars and those who work with and support them.

This study adds to the literature on leadership development for doctors in hybrid roles, and highlights the distinctiveness of the scheme compared with other schemes.

The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS.

A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis.

The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis.

The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties.

The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal.

This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.