Medical education needs management training


“Management is about coping with complexity. Leadership is about coping with change.”
– John Kotter

Even before the results of the recent presidential election were in, few necessities were as present in our daily lives as the need to cope with constant change. This is true across all facets of personal and professional experience in America, but perhaps nowhere more than in health care. Over the next generation, we need to cope with 180-degree changes — from volume to value, from autonomous, individualistic practice to working in teams and organizations, from paper to digital – changes that upend every aspect of our daily work life.

As John Kotter, one of the great gurus of management thinking said, helping others cope with change is perhaps the core competency of being a leader. As physicians are increasingly expected to lead teams and organizations, it’s a competency that is ever more relevant. To only focus on the importance of leading other healthcare workers, however, misses a key point: whether it’s receiving a new diagnosis, starting a new medication, or having a baby, our patients are constantly interacting with us at moments when they need to cope with profound change in their lives. The skills and competencies of being an effective leader and manager couldn’t be more relevant to being a great physician.

But leaders are born and not made, right? You can’t teach someone to be a great leader, they just are, or they’re not. Well, several decades of rigorous management science research have fully debunked that myth.

So, if the skills and competencies of being a great leader are critical to being a great physician and they can be taught, then why isn’t leadership and management training more prevalent in undergraduate, graduate, and continuing medical education? There are many answers to that question.

One already needs to master a vast body of knowledge, skills, and competencies in basic and clinical science in order to be a physician; there is a constant battle for real estate in the medical curriculum — just ask your friendly dean of medical education about the vast matrix of politics and competing priorities that they have to navigate each year. And, while the importance of leadership and management training seems self-evident to many of us, there may be some unconverted out there, even in positions of relative influence. Finally, even if leadership and management were to become a more core focus of healthcare training, educators would need to deal with the fact that much of what is tested by the profession’s gatekeepers is knowledge of basic science and clinical medicine. Healthcare education is, itself, a profoundly change resistant institution.

Despite this complex landscape, there are reasons to hope that major changes in healthcare education are afoot. Based on a 2015 survey of curriculums that Diana Wohler, one of our former trainees, conducted, 57 of 141 undergraduate medical institutions in the United States offer explicit instruction in leadership and teams. I’ve had the privilege over the last seven years to develop training programs in leadership and management for learners at all levels, from medical students to residents to junior faculty to executives. People in healthcare are invariably highly intelligent, talented and motivated and want do the right thing for patients and society. When they accept the importance of this type of training and are presented the material in an engaging, interactive way, their growth as leaders and managers tends to be nearly instantaneous and exponential. The privilege of interacting with and learning from these trainees has been one of a handful of professional experiences over the last decade that feed my hope for the future of the profession.

Hopefully, then, we are nearing a tipping point, beyond which medical trainees might be just as likely to encounter Chip and Dan Heath’s phenomenal change management framework from the book Switch as they are to encounter the Kreb’s cycle. When that is common practice in every medical school around the country, we will truly be training the next generation of leaders in healthcare.

Andrew L. Ellner is course director, Harvard Medical School Center for Primary Care’s executive education offerings, including Charting the Future of Primary Care: Building Teams to Manage Complexity

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