Administrative and Managerial Skills for Tomorrow's Medical Professionals: A Needs Assessment

Setting and Problem

A complex and dynamic health care environment requires medical professionals of the future to be trained to deliver high-quality clinical care, as well as help address organizational problems that may be outside the clinical arena. Evidence shows that effective clinician leadership in health care organizations is linked to superior patient care outcomes.¹ However, most physicians are ill prepared to undertake responsibilities requiring organizational and management skills because medical school and residency training offer limited opportunities to learn them.² We present a framework, derived from thematic analysis of qualitative data from semistructured interviews, which identifies key capabilities to enable physicians to innovate solutions to complex organizational problems.

Intervention

We conducted a 2-phase qualitative study. First, we distributed a peer nomination survey to all senior physicians at Tan Tock Seng Hospital in Singapore, asking them to nominate peers who consistently excelled in nonclinical roles, such as leadership or administration in addition to their clinical roles. The second phase consisted of semistructured interviews with individuals who had received multiple nominations from peers. During the interviews, we asked participants to reflect on their experiences when they undertook nonclinical responsibilities in their institution, the capabilities that were necessary for them to excel in the projects they were tasked to handle as their careers progressed, and how they developed these added nonclinical capabilities. We interviewed 18 participants; all interviews were audio-recorded and the data transcribed, coded, and thematically analyzed.

Outcomes to Date

The diverse capabilities that emerged from the data were organized into subthemes, and subsequently into broad themes using the framework of knowledge, skills, and attitudes. These are summarized in the table with a representative quote illustrating each subtheme.

table Summary of Capabilities Needed to Develop T-Shaped Clinicians

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It is noteworthy that some of these subthemes (future orientation, being unafraid to challenge norms, and perseverance) are important to self-regulated learning and are closely related to the personal characteristics (curiosity, motivation, and resilience) and processes mentioned in the development of the “master adaptive learner.”³ In addition to cognitive skills, capabilities that enabled individuals to function in teams (interpersonal skills, empathy, appreciating multiple stakeholder perspectives) were also frequently mentioned. Working in teams is common in health care, and participants emphasized that team skills were particularly important in the context of interacting with colleagues from nonclinical professions, who may have a different mind-set and worldview than those of clinicians.

Participants felt that medical school and specialty training had prepared them well in terms of clinical knowledge, but had not equipped them adequately for the mounting administrative and leadership roles as their careers progressed. They also acknowledged that developing medical professionals equipped for a complex health care system must encompass both deep clinical expertise and a crosscutting range of skills and attitudes to enable clinicians to understand and communicate with others in the system, and to continuously learn and innovate. In addition to clinical acumen, this requires understanding and mastery of a range of skills from other disciplines and the ability to integrate them for knowledge creation, problem-solving, and innovation.⁴ The importance of combining both deep professional expertise with broad cross-disciplinary skills to produce a “T-shaped” professional has been acknowledged in other fields as well.⁵

Beginning to incorporate development of these capabilities in our medical students and residents is the next step. A number of participants emphasized that they had developed these skills and attitudes not through formal curricula, but through immersion in organizational cultures that fostered positive learning experiences and interaction with role models. Future interventions could involve trainees in system-level, cross-professional problem solving, combined with thoughtful pairing of appropriate mentors or coaches, such as the experts identified in this study, and allowing participants to reflect on their experience.