ARTICLE

The competencies of the CanMEDS Leader role

Developing the moves and agility for a dance on shifting sands

The competencies of the CanMEDS Leader role

Developing the moves and agility for a dance on shifting sands

Saleem Razack, MD

 

The CanMEDS Leader role is about collective ownership and stewardship in the health care system. Physicians balance both management skills (preserving organizational homeostasis) and leadership skills (disrupting for change). The tension between leading and managing requires considerable wisdom. I use three scenarios to illustrate the Leader role and show how the curriculum for physicians must include skill-building in systems understanding, in addition to the usual focus on biomedical and epidemiologic sciences, and skills in humanistic interaction.

 

KEY WORDS: CanMEDS roles, leadership development, systems sciences

 

What does it take to lead in the health care system, and why are physicians well-placed to do so? More important, what will it take to lead in tomorrow’s health care system, and what competencies must we develop in the residents and students in our programs today to meet the challenges of tomorrow? Is there something different about health care now versus the past? Is health care really changing that quickly, or would a colleague from the 1970s have said the same thing about the system of the day? In training physician leaders of tomorrow, are we trying to develop their moves for a dance on shifting sands.

 

By some measures, health care is the fastest growing “business” in the developed world.1 What are the motives and values behind this business, and how ought they to be incorporated into day-to-day decision-making and processes of care?

 

In this essay, I consider these questions through the lens of training future physicians to be engaged agents of change within our rapidly evolving health care system. I will use the three scenarios above, barely disguised as they are from my own and my colleagues’ practices, as examples of how physicians lead on a daily basis. In this way, I hope to define the basic curriculum of physician leadership.

 

Training students and residents to be agents of positive change

The CanMEDS competencies of the Royal College of Physicians and Surgeons of Canada (RCPSC),2 now also adopted by the Canadian College of Family Physicians,3 consist of a series of seven roles that define the activities of a physician in day-to-day practice. They are used as an organizing framework for many undergraduate MD programs, residency training, and continuing professional development curricula. Top

 

Originally implemented by the RCPSC in 2001,4 the seven original roles were: Medical expert, Communicator, Collaborator, Scholar, Advocate, Manager, and Professional. Educators in the health professions can see how a combination of experiential exposures (the traditional rotations through various services) and classroom instruction (workshops, lectures, and the like) in a training program would be able to assure a comprehensive training experience for their residents or students to prepare them well for the challenges of practice.

 

For instance, in the Communicator role, a program might identify breaking bad news as a key element in which trainees should develop competence. Through exposure and curriculum mapping, the program leadership might develop a simulation-based workshop to prepare trainees for clinical exposure, and then develop an objective structured clinical exam, in which trainees would be observed and their performance assessed in terms of how they are able to deliver bad news to a simulated patient. The program might then identify critical care rotations as places where there is opportunity for the trainee to use these skills. Finally, in practice, there might be practice audit procedures in which the physician is observed in the act of breaking bad news and given feedback by peers.

 

In 2015, the CanMEDS roles were revised to reflect the realities of evolving practice. Some tweaks were made here and there to all of the roles, but the changes to the Manager role were revolutionary, and its name was changed to Leader role.5 There was passionate debate among those of us involved in the discussion about this change, reflecting the tension between leading for change and managing to provide good stewardship. Just as tension on a violin string has the potential to create beautiful music, I believe that the Leadership role creates a sweet spot of opportunity where we can be engaged agents of positive change in health care, humbly and collaboratively, to ensure better health outcomes in the populations we serve.

 

Defining the CanMEDS Leader role

The essence of the Leader role is about collective ownership (with many stakeholders) and stewardship within the health care system(s). It encompasses four key competencies (each broken down into component enabling competencies).

 

Physicians are able to:

  1. Contribute to the improvement of health care delivery in teams, organizations, and systems
  2. Engage in the stewardship of health care resources
  3. Demonstrate leadership in professional practice
  4. Manage career planning, finances, and health human resources in a practice6

 

In the Leader role, physicians enact both leadership and management skills, where management can be considered actions that preserve organizational homeostasis and leadership is thought of as disrupting, safely, for change. Physicians are asked to manage the health care system and resources through effective stewardship, and themselves and their relationship with others through personal effectiveness strategies and an understanding of health human resources. They are also asked to lead desired change in professional practice.

 

The tension between leading and managing lies in a physician developing the phronesis7 for negotiating the complex world of health organizations, having the prudence of thought to act to preserve a desired organizational homeostasis when appropriate (managing), and disrupting, safely, for change when appropriate (leading). It is developing this wisdom through critical reflective practice supervision, supplemented with well-chosen and well-placed didactic instruction, that lies at the heart of any Leader role curriculum.  Top

 

Scenario 1: Understanding how organizations work

In the Pediatric Intensive Care Unit (PICU), the period between 0800 and 0815 frequently involves surgeons passionately advocating with raised voices for their planned operating theatre cases that require post-operative care in the PICU, a nursing team that feels harassed and overworked, and a physician who knows that there has to be a better way to organize bed flow.

 

In this scenario, a unit is having difficulty accommodating demand. In such a complex scenario, there are many players with competing and sometimes conflicting demands: staffing requirements, safety, accessibility, and cost.

 

What skills does the physician require to even begin to tackle this issue? The first and foremost involves systems analysis sciences. When I teach on rounds in the PICU at the Montreal Children’s Hospital, in addition to discussing physiology and modeling humanism (with varying degrees of success), I introduce a conversion of systems sciences. It might be as simple as reviewing how a medication order progresses from a thought to a signed order and, finally, to a dispensed and safely delivered drug. The point is to have the students and residents consider how processes of care are organized, and how this organization has the potential to affect very real outcomes. Top

 

There is an informal curriculum of valuing multiple ways of knowing here as well: just as we like to see ourselves as “applied physiologists” (i.e., science), taking the science and applying it to patients in respectful and humane ways (i.e., humanism), we are also agents within systems and must also be applied systems scientists with the skill to analyze and change systems. None of these three forms of knowledge predominates over the other, and all are required for effective health care and excellent patient outcomes.

 

In the real-life scenario 1, we discovered that even when we delayed or canceled cases, 95% of the time, we would have been able to accommodate them later in the day because of the ripple effect of discharges from other units. This led to a policy of defining clear criteria for the automatic greenlighting of surgical cases, an institutional commitment to prioritize PICU transfers in daily bed management, and the creation of a weekly OR bed huddle in which operating theatre cases requiring PICU were distributed evenly throughout the week. This represented a huge culture change of accepting a calculated risk in our unit. The key leadership learning for a physician was to focus on the vision, communicate that vision, and work collaboratively on concerns.

 

We can explicitly teach and evaluate systems sciences through links with experts in management, including the growing cadre of physician colleagues with additional management training. Adding to familiar domains, such as patient safety and quality improvement, newer domains, such as organizational behaviour and human factors engineering, will also come to the fore of a systems science curriculum. In addition to formal instruction, promoting systems sciences understanding occurs in discussions around bed flow, say, where, reflective practice is supported as part of the supervision. Top

 

Scenario 2: Having a voice in health care organizations

The hospital budget report for the last fiscal year is out, and the news is not good. There has been a cost overrun of 10%, which will have to be recouped in the coming fiscal year. After a meeting of nurse managers and hospital administrators, eight beds have been cut from the general inpatient wards. It is winter, and the influenza virus is upon us. No physicians were present at any of the planning meetings on the cuts, as they are seen as independent practitioners with privileges at the hospital, not as employees.

 

Here, we see the marginalization of the physician voice in organizational decisions around health care. A cynic might see the institution’s motivations here as potentially strategic, but this is not necessarily so. In most health care organizational settings in Canada, physicians are, indeed, autonomous professionals who are given “privileges” to practise in a particular setting, such as a hospital.

 

A risk to that approach is that, without conscious effort, the important voice of physicians in health care organizations can be muted. Critics will point out that there are many physicians in positions of hospital administration, but I see two issues with this critique. First, when physicians become administrators, when they act in the administrative role, are they physicians or administrators? The question is not banal. Medical acts are subject to professional regulation through peer review. Are administrative acts similarly regulated? Second, a look at the statistics shows low physician participation in key hospital administrative positions in both Canada (3-3.7%)8 and the United States (15.9%).9

 

Teaching residents and students to assert their voice in health care organizations is about citizenship. Indeed, it is about differentiating what it means to be a citizen in an organization from what it means to be a subject of the sovereign authority of an organization, where that authority is understood as not including the subject. Citizenship is attitudinal, but it is also structural, needing to be deliberately built into decision-making processes. Top

 

Critical skills in analyzing decision-making within organizations must also be developed, and we must give trainees opportunities to think strategically about the micro- and meso-level structures of the health care system. An example of this approach would be for residents themselves to propose solutions to the issues arising from the human resource shortages, guided in the systems analysis process by skilled faculty members.

 

Scenario 3: Social accountability - the driving value of the “business” of health care

The provincial transport system for critically ill children has as a policy that parents cannot accompany their child in transit; they take commercial flights following the transfer. About 90% of the children affected by this policy are from Indigenous communities. A physician working in tertiary care begins to speak out in local and national media for change, bringing many community partners and colleagues into the effort, and he frames his argument for change in terms of truth and reconciliation. Top

 

Social accountability of medical schools has been set by the World Health Organization as a requirement to orient their mission-based activities in clinical care, teaching, and research to the needs of the population they serve.10 Often within this definition, special attention is given to vulnerable and marginalized populations.

 

In scenario 3, we see high-level advocacy to include demonstrated skills in stakeholder engagement, political aspects of leadership, and the attitudinal component of reserving special attention for vulnerable and marginalized populations. As indicators of access and safety are worse for patients from marginalized groups, notions of equity, diversity, and inclusion are integral parts of leadership.11,12 The physician leader, here, coordinated political efforts involving community, physician groups, and media, resulting in the provincial government changing a policy. Top

 

The CanMEDS framework already includes a distinct Advocate role. Why situate the work described in scenario 3 in the Leader role as well? Put simply, advocacy is about identifying changes to improve the health of populations, whereas effective leadership is about understanding the best approaches to make those desired changes. Advocacy and leadership are inextricably linked. I would posit that for the physician leader, the explicit link lies in professional codes. In an old version of the Hippocratic Oath, physicians swore that whatever houses they visit, whether the person were “bond or free,” they would treat them equally.13

 

What does this mean in terms of training residents and students for the Leader role? Much of what we teach in this role will be about what and how: what is going on (systems analysis, budgets, etc.) and how to fix it (the principles of change, strategic thinking, etc.). In addition, we must also talk about why we are working as positive citizens in the health care system. To perform a budgetary analysis for a specific inpatient unit, for example, without explicitly stating the goal of improving health outcomes through access to quality care, tells only half of the story and runs the risk of minimizing the importance of the core values of the business we are in — access and quality. Top

 

A sage professor of management once reminded me that not all businesses have profit as their core motive. There are specific business models and practices of nongovernmental and charitable organizations, for instance. Health care, at least in Canada, is no exception, and we need to be explicit in Leader role training about its specific social accountability motive.

 

Teaching how to dance on shifting sands

The central thesis of this essay is that the curriculum for physicians needs to favour science, humanism, and systems understanding. Training in the Leader role clearly requires fostering notions of flexibility and resilience. The backbone is about knowing the core of what we do and why we do it, and the flexibility is about finding the ways and means to accomplish this core mission in different ways within a changing context. Doing so will require that our teachers also receive new training — faculty development that allows them to grow in their roles as flexible leaders. Top

 

If we remember the mantra of what (systems sciences), how (leading for change), and why (for better health outcomes for the population, including those who are vulnerable and marginalized) as we design innovative ways to teach the Leader role, the physicians of tomorrow will be well placed to be positive agents of change and engaged citizens in ever-evolving health care systems.

 

References

1.Jakovjevic M, Getzen TE. Growth of global health spending share in low and middle income countries. Front Pharmacol 2016;7:21. doi:10.3389/fphar.2016.00021

2.Frank JR, Snell L, Sherbino J. The draft CanMEDS 2015 physician competency framework–series IV. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. Available: https://tinyurl.com/yanaqga4

3.Working Group on Curricular Review. CanMEDS-family medicine. Mississauga, Ont.: College of Family Physicians of Canada; 2009. Available: https://tinyurl.com/hzrrea4

4.Frank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach 2007;29(7):642-7.

5.Dath D, Chan MK, Abbott C. CanMEDS 2015: from manager to leader. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.

6.Frank JR, Snell L, Sherbino J, editors. CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.

7.Hofman B. Medicine as practical wisdom (phronesis). Poiesis Prax 2002;1:135-49. doi:10.1007/s10202-002-0012-3.

8.Hewitt A. Health leaders and managers in Canada: the human resources dilemma. Ottawa: Canadian College of Health Services Executives; 2006: 18. Available:

https://tinyurl.com/y7j4bp3u

9.2018 members and fellows profile. Chicago: American College of Healthcare Executives; 2018. Available: https://tinyurl.com/hl4xsql

10.Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Med Educ 2009;43(9):887-94. doi:10.1111/j.1365-2923.2009.03413.x

11.Coffey RM, Andrews RM, Moy E. Racial, ethnic, and socioeconomic disparities in estimates of AHRQ patient safety indicators. Med Care 2005;43(3):48-57.

12.Romano PS, Geppert JJ, Davies S, Miller MR, Elixhauser A, McDonald KM. A national profile of patient Safety in U.S. hospitals. Health Aff (Millwood) 2003;22(2):154-66.

13.Jones WHS (editor). Oath: Hippocrates Jusjurandum. Boston: Perseus Digital Library, Tufts University; n.d. Available: https://tinyurl.com/yadkv9zu

 

Author

Saleem Razack, MD, is a professor of pediatrics, a member of the Centre for Medical Education, and director of the Office of Social Accountability and Community Engagement at McGill University, Montréal. He also serves as a CanMEDS educator at the Royal College of Physicians and Surgeons of Canada. Top

 

Correspondence to:

saleem.razack@mcgill.ca

 

This article has been peer reviewed.

 

The competencies of the CanMEDS Leader role

Developing the moves and agility for a dance on shifting sands

Saleem Razack, MD

 

The CanMEDS Leader role is about collective ownership and stewardship in the health care system. Physicians balance both management skills (preserving organizational homeostasis) and leadership skills (disrupting for change). The tension between leading and managing requires considerable wisdom. I use three scenarios to illustrate the Leader role and show how the curriculum for physicians must include skill-building in systems understanding, in addition to the usual focus on biomedical and epidemiologic sciences, and skills in humanistic interaction.

 

KEY WORDS: CanMEDS roles, leadership development, systems sciences

 

What does it take to lead in the health care system, and why are physicians well-placed to do so? More important, what will it take to lead in tomorrow’s health care system, and what competencies must we develop in the residents and students in our programs today to meet the challenges of tomorrow? Is there something different about health care now versus the past? Is health care really changing that quickly, or would a colleague from the 1970s have said the same thing about the system of the day? In training physician leaders of tomorrow, are we trying to develop their moves for a dance on shifting sands.

 

By some measures, health care is the fastest growing “business” in the developed world.1 What are the motives and values behind this business, and how ought they to be incorporated into day-to-day decision-making and processes of care?

 

In this essay, I consider these questions through the lens of training future physicians to be engaged agents of change within our rapidly evolving health care system. I will use the three scenarios above, barely disguised as they are from my own and my colleagues’ practices, as examples of how physicians lead on a daily basis. In this way, I hope to define the basic curriculum of physician leadership.

 

Training students and residents to be agents of positive change

The CanMEDS competencies of the Royal College of Physicians and Surgeons of Canada (RCPSC),2 now also adopted by the Canadian College of Family Physicians,3 consist of a series of seven roles that define the activities of a physician in day-to-day practice. They are used as an organizing framework for many undergraduate MD programs, residency training, and continuing professional development curricula. Top

 

Originally implemented by the RCPSC in 2001,4 the seven original roles were: Medical expert, Communicator, Collaborator, Scholar, Advocate, Manager, and Professional. Educators in the health professions can see how a combination of experiential exposures (the traditional rotations through various services) and classroom instruction (workshops, lectures, and the like) in a training program would be able to assure a comprehensive training experience for their residents or students to prepare them well for the challenges of practice.

 

For instance, in the Communicator role, a program might identify breaking bad news as a key element in which trainees should develop competence. Through exposure and curriculum mapping, the program leadership might develop a simulation-based workshop to prepare trainees for clinical exposure, and then develop an objective structured clinical exam, in which trainees would be observed and their performance assessed in terms of how they are able to deliver bad news to a simulated patient. The program might then identify critical care rotations as places where there is opportunity for the trainee to use these skills. Finally, in practice, there might be practice audit procedures in which the physician is observed in the act of breaking bad news and given feedback by peers.

 

In 2015, the CanMEDS roles were revised to reflect the realities of evolving practice. Some tweaks were made here and there to all of the roles, but the changes to the Manager role were revolutionary, and its name was changed to Leader role.5 There was passionate debate among those of us involved in the discussion about this change, reflecting the tension between leading for change and managing to provide good stewardship. Just as tension on a violin string has the potential to create beautiful music, I believe that the Leadership role creates a sweet spot of opportunity where we can be engaged agents of positive change in health care, humbly and collaboratively, to ensure better health outcomes in the populations we serve.

 

Defining the CanMEDS Leader role

The essence of the Leader role is about collective ownership (with many stakeholders) and stewardship within the health care system(s). It encompasses four key competencies (each broken down into component enabling competencies).

 

Physicians are able to:

  1. Contribute to the improvement of health care delivery in teams, organizations, and systems
  2. Engage in the stewardship of health care resources
  3. Demonstrate leadership in professional practice
  4. Manage career planning, finances, and health human resources in a practice6

 

In the Leader role, physicians enact both leadership and management skills, where management can be considered actions that preserve organizational homeostasis and leadership is thought of as disrupting, safely, for change. Physicians are asked to manage the health care system and resources through effective stewardship, and themselves and their relationship with others through personal effectiveness strategies and an understanding of health human resources. They are also asked to lead desired change in professional practice.

 

The tension between leading and managing lies in a physician developing the phronesis7 for negotiating the complex world of health organizations, having the prudence of thought to act to preserve a desired organizational homeostasis when appropriate (managing), and disrupting, safely, for change when appropriate (leading). It is developing this wisdom through critical reflective practice supervision, supplemented with well-chosen and well-placed didactic instruction, that lies at the heart of any Leader role curriculum.  Top

 

Scenario 1: Understanding how organizations work

In the Pediatric Intensive Care Unit (PICU), the period between 0800 and 0815 frequently involves surgeons passionately advocating with raised voices for their planned operating theatre cases that require post-operative care in the PICU, a nursing team that feels harassed and overworked, and a physician who knows that there has to be a better way to organize bed flow.

 

In this scenario, a unit is having difficulty accommodating demand. In such a complex scenario, there are many players with competing and sometimes conflicting demands: staffing requirements, safety, accessibility, and cost.

 

What skills does the physician require to even begin to tackle this issue? The first and foremost involves systems analysis sciences. When I teach on rounds in the PICU at the Montreal Children’s Hospital, in addition to discussing physiology and modeling humanism (with varying degrees of success), I introduce a conversion of systems sciences. It might be as simple as reviewing how a medication order progresses from a thought to a signed order and, finally, to a dispensed and safely delivered drug. The point is to have the students and residents consider how processes of care are organized, and how this organization has the potential to affect very real outcomes. Top

 

There is an informal curriculum of valuing multiple ways of knowing here as well: just as we like to see ourselves as “applied physiologists” (i.e., science), taking the science and applying it to patients in respectful and humane ways (i.e., humanism), we are also agents within systems and must also be applied systems scientists with the skill to analyze and change systems. None of these three forms of knowledge predominates over the other, and all are required for effective health care and excellent patient outcomes.

 

In the real-life scenario 1, we discovered that even when we delayed or canceled cases, 95% of the time, we would have been able to accommodate them later in the day because of the ripple effect of discharges from other units. This led to a policy of defining clear criteria for the automatic greenlighting of surgical cases, an institutional commitment to prioritize PICU transfers in daily bed management, and the creation of a weekly OR bed huddle in which operating theatre cases requiring PICU were distributed evenly throughout the week. This represented a huge culture change of accepting a calculated risk in our unit. The key leadership learning for a physician was to focus on the vision, communicate that vision, and work collaboratively on concerns.

 

We can explicitly teach and evaluate systems sciences through links with experts in management, including the growing cadre of physician colleagues with additional management training. Adding to familiar domains, such as patient safety and quality improvement, newer domains, such as organizational behaviour and human factors engineering, will also come to the fore of a systems science curriculum. In addition to formal instruction, promoting systems sciences understanding occurs in discussions around bed flow, say, where, reflective practice is supported as part of the supervision. Top

 

Scenario 2: Having a voice in health care organizations

The hospital budget report for the last fiscal year is out, and the news is not good. There has been a cost overrun of 10%, which will have to be recouped in the coming fiscal year. After a meeting of nurse managers and hospital administrators, eight beds have been cut from the general inpatient wards. It is winter, and the influenza virus is upon us. No physicians were present at any of the planning meetings on the cuts, as they are seen as independent practitioners with privileges at the hospital, not as employees.

 

Here, we see the marginalization of the physician voice in organizational decisions around health care. A cynic might see the institution’s motivations here as potentially strategic, but this is not necessarily so. In most health care organizational settings in Canada, physicians are, indeed, autonomous professionals who are given “privileges” to practise in a particular setting, such as a hospital.

 

A risk to that approach is that, without conscious effort, the important voice of physicians in health care organizations can be muted. Critics will point out that there are many physicians in positions of hospital administration, but I see two issues with this critique. First, when physicians become administrators, when they act in the administrative role, are they physicians or administrators? The question is not banal. Medical acts are subject to professional regulation through peer review. Are administrative acts similarly regulated? Second, a look at the statistics shows low physician participation in key hospital administrative positions in both Canada (3-3.7%)8 and the United States (15.9%).9

 

Teaching residents and students to assert their voice in health care organizations is about citizenship. Indeed, it is about differentiating what it means to be a citizen in an organization from what it means to be a subject of the sovereign authority of an organization, where that authority is understood as not including the subject. Citizenship is attitudinal, but it is also structural, needing to be deliberately built into decision-making processes. Top

 

Critical skills in analyzing decision-making within organizations must also be developed, and we must give trainees opportunities to think strategically about the micro- and meso-level structures of the health care system. An example of this approach would be for residents themselves to propose solutions to the issues arising from the human resource shortages, guided in the systems analysis process by skilled faculty members.

 

Scenario 3: Social accountability - the driving value of the “business” of health care

The provincial transport system for critically ill children has as a policy that parents cannot accompany their child in transit; they take commercial flights following the transfer. About 90% of the children affected by this policy are from Indigenous communities. A physician working in tertiary care begins to speak out in local and national media for change, bringing many community partners and colleagues into the effort, and he frames his argument for change in terms of truth and reconciliation. Top

 

Social accountability of medical schools has been set by the World Health Organization as a requirement to orient their mission-based activities in clinical care, teaching, and research to the needs of the population they serve.10 Often within this definition, special attention is given to vulnerable and marginalized populations.

 

In scenario 3, we see high-level advocacy to include demonstrated skills in stakeholder engagement, political aspects of leadership, and the attitudinal component of reserving special attention for vulnerable and marginalized populations. As indicators of access and safety are worse for patients from marginalized groups, notions of equity, diversity, and inclusion are integral parts of leadership.11,12 The physician leader, here, coordinated political efforts involving community, physician groups, and media, resulting in the provincial government changing a policy. Top

 

The CanMEDS framework already includes a distinct Advocate role. Why situate the work described in scenario 3 in the Leader role as well? Put simply, advocacy is about identifying changes to improve the health of populations, whereas effective leadership is about understanding the best approaches to make those desired changes. Advocacy and leadership are inextricably linked. I would posit that for the physician leader, the explicit link lies in professional codes. In an old version of the Hippocratic Oath, physicians swore that whatever houses they visit, whether the person were “bond or free,” they would treat them equally.13

 

What does this mean in terms of training residents and students for the Leader role? Much of what we teach in this role will be about what and how: what is going on (systems analysis, budgets, etc.) and how to fix it (the principles of change, strategic thinking, etc.). In addition, we must also talk about why we are working as positive citizens in the health care system. To perform a budgetary analysis for a specific inpatient unit, for example, without explicitly stating the goal of improving health outcomes through access to quality care, tells only half of the story and runs the risk of minimizing the importance of the core values of the business we are in — access and quality. Top

 

A sage professor of management once reminded me that not all businesses have profit as their core motive. There are specific business models and practices of nongovernmental and charitable organizations, for instance. Health care, at least in Canada, is no exception, and we need to be explicit in Leader role training about its specific social accountability motive.

 

Teaching how to dance on shifting sands

The central thesis of this essay is that the curriculum for physicians needs to favour science, humanism, and systems understanding. Training in the Leader role clearly requires fostering notions of flexibility and resilience. The backbone is about knowing the core of what we do and why we do it, and the flexibility is about finding the ways and means to accomplish this core mission in different ways within a changing context. Doing so will require that our teachers also receive new training — faculty development that allows them to grow in their roles as flexible leaders. Top

 

If we remember the mantra of what (systems sciences), how (leading for change), and why (for better health outcomes for the population, including those who are vulnerable and marginalized) as we design innovative ways to teach the Leader role, the physicians of tomorrow will be well placed to be positive agents of change and engaged citizens in ever-evolving health care systems.

 

References

1.Jakovjevic M, Getzen TE. Growth of global health spending share in low and middle income countries. Front Pharmacol 2016;7:21. doi:10.3389/fphar.2016.00021

2.Frank JR, Snell L, Sherbino J. The draft CanMEDS 2015 physician competency framework–series IV. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. Available: https://tinyurl.com/yanaqga4

3.Working Group on Curricular Review. CanMEDS-family medicine. Mississauga, Ont.: College of Family Physicians of Canada; 2009. Available: https://tinyurl.com/hzrrea4

4.Frank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach 2007;29(7):642-7.

5.Dath D, Chan MK, Abbott C. CanMEDS 2015: from manager to leader. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.

6.Frank JR, Snell L, Sherbino J, editors. CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.

7.Hofman B. Medicine as practical wisdom (phronesis). Poiesis Prax 2002;1:135-49. doi:10.1007/s10202-002-0012-3.

8.Hewitt A. Health leaders and managers in Canada: the human resources dilemma. Ottawa: Canadian College of Health Services Executives; 2006: 18. Available:

https://tinyurl.com/y7j4bp3u

9.2018 members and fellows profile. Chicago: American College of Healthcare Executives; 2018. Available: https://tinyurl.com/hl4xsql

10.Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Med Educ 2009;43(9):887-94. doi:10.1111/j.1365-2923.2009.03413.x

11.Coffey RM, Andrews RM, Moy E. Racial, ethnic, and socioeconomic disparities in estimates of AHRQ patient safety indicators. Med Care 2005;43(3):48-57.

12.Romano PS, Geppert JJ, Davies S, Miller MR, Elixhauser A, McDonald KM. A national profile of patient Safety in U.S. hospitals. Health Aff (Millwood) 2003;22(2):154-66.

13.Jones WHS (editor). Oath: Hippocrates Jusjurandum. Boston: Perseus Digital Library, Tufts University; n.d. Available: https://tinyurl.com/yadkv9zu

 

Author

Saleem Razack, MD, is a professor of pediatrics, a member of the Centre for Medical Education, and director of the Office of Social Accountability and Community Engagement at McGill University, Montréal. He also serves as a CanMEDS educator at the Royal College of Physicians and Surgeons of Canada. Top

 

Correspondence to:

saleem.razack@mcgill.ca

 

This article has been peer reviewed.