Medical Leadershipin postgraduate medical education

Acknowledgements

The Medical Leadership report is a publication by the Dutch Association of Medical Specialists

Medical Leadership Working Group

Commissioned by the Raad Opleiding (Medical Training Council) of the Dutch Association of Medical specialists.

- Kees Verheyen, trainer in orthopaedics at Isala Zwolle, Chair working group

- Carina Hilders, endowed professor of Medical Management and Leadership, Erasmus University Institute of Health

Policy & Management (iBMG)

- Jesse Habets, resident in radiology at UMC Utrecht

- John Wokke, trainer in neurology at UMC Utrecht

- Bart Leenders, resident in surgery at VieCuri Medisch Centrum

- Martin Schalij, trainer in cardiology at Leiden UMC

- Anne van der Meij, resident in neurology at Leiden UMC

- Marian Mourits, trainer in gynaecology at UMC Groningen

- Auk Dijkstra, educational expert for the Dutch Association of Medical Specialists

- Vivienne Schelfhout, Director of Education, Science & Innovation, Dutch Association of Medical Specialists

- Janwillem van den Berg, education advisor, Dutch Association of Medical Specialists

All of the information included in this report is the property of the Dutch Association of Medical Specialists.

Copying of content or parts thereof is permitted provided the source is cited.

Indemnity

This report entitled ‘Medical Leadership in postgraduate medical education’ has been prepared by the Dutch

Association of Medical Specialists with the utmost care. We nevertheless accept no liability for any error or inaccuracy

of the information provided, neither for damage, nuisance or inconvenience, nor for any other consequences arising

out of, or in connection with, the use of the information.

Copyright

© Dutch Association of Medical Specialists

November 2016

Design: IJzersterk.nu

Medical Leadershipin postgraduate medical education

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PreambleAs a medical specialist, you have ultimate responsibility for the care and treatment of your patient. This responsibility is not limited to purely medical issues. As a specialist, you are increasingly expected to take and demonstrate responsibility when it comes to the patient care process. Medical leadership is a required core competence and plays an important role in your everyday work. But how do you do that? And, as a trainer, how do you teach this to residents?

Clarification, translating theory into practice in the workplace, allowing this awareness to become embedded in the organisation; it all sounds like empty jargon. Nevertheless, this is where our challenge lies. In order to ensure that tomorrow’s medical specialists are really able to demonstrate medical leadership, today’s residents must be trained in it during their postgraduate medical education. Of course, current training programmes already touch on the subject, but it is all too often implicit, so that learning moments are not always recognised or made use of. Naming the basic competences involved in medical leadership and making them a structural part of the training clearly shows both trainers and residents what medical leadership involves on a day-to-day basis.

About this document In November 2015, the Raad Opleiding (Medical Training Council) of the Dutch Association of Medical Specialists commissioned the formation of a Medical Leadership Working Group. This working group was asked to provide advice on how medical leadership could be translated into practice during postgraduate medical training and the everyday practice of residents and trainers.

The working group made every effort to present this in a clear and authoritative report, one in which a systematic description and practical guidelines are given in a basic document together with a guide containing useful tips.

On behalf of the entire working group,

Kees VerheyenChair, Medical Leadership Working Group Dutch Association of Medical Specialists

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CONTENTS

PREAMBLE

01. INTRODUCTION

02. BASIC DOCUMENT MEDICAL LEADERSHIP

03. PRACTICAL TIPS AND EXAMPLES FOR THE DEVELOPMENT OF MEDICAL LEADERSHIP IN POSTGRADUATE MEDICAL EDUCATION

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Dr. Kees Verheyen, trainer in orthopaedics at Isala Zwolle, Chair working group;

‘Taking the lead in improvement processes, particu-larly if these transcend everyday practice, is difficult for medical specialists because they often lack the required knowledge and insight. The goal must be to provide all residents and trainers with basic medi-cal leadership skills, in the interests of straightforward communication on this subject. To me, leadership is

motivating others to follow - and accompanying them on – a vision with the aim of providing good healthcare. In order to do this, it is necessary to check every now and then to make sure they are

indeed still following you….’

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1. Carina Hilders, endowed professor of Medical Management and Leadership, Erasmus University Institute of Health Policy & Management

(iBMG)

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Furthermore, all specialists work within systems and organisations. Increasingly, medical specialists are expected to take responsibility for issues such as quality policy and organisational issues at institutional level, and, in many cases, also at national and interdisciplinary level. In order to do so, they are expected to be well-informed about organisational structure and the institution’s funding system.

Ultimately, the care that medical specialists provide must be accountable, not only in medical terms, but also from a social perspective; protocols should be adhered to where appropriate and individualised care should be given where necessary. Medical specialists have to make sensible choices in times of budgetary restraint. They also have to contribute towards accessible and affordable health care, both now and in the future.

In other words, a great deal is expected of medical specialists. And in our opinion, this is both logical and obligatory. After all, even just providing professional input with regard to these subjects means that medical specialists can help shape the direction of this complex healthcare industry.

This is why we expect medical leadership from all specialists, including those in training.

1.1 DEFINITION There are many different definitions for medical leadership. In this report, we have chosen to use the following definition1:

Medical specialists demonstrate medical leadership by consistently working on personal growth, profes-sionalism and effectiveness, and by taking responsibility for and guiding high-quality care for the patient by linking medical content with managerial, organisational, financial and social themes in line with their position in the healthcare system.

01 Introduction

It is important that all specialists are able to supervise their clinical and outpatient activities and manage time effectively, adequately differentiating between major and minor issues. Medical specialists are also expected to play a coordinating and assertive role; a specialist is the head treatment physician, but must also be able to work in a team, communicate well, ensure things are well-documented, keep emergency situa-tions under control and not be afraid to call people to account. Medical specialists must be committed to both individual patients and healthcare as a whole, and be willing to take their responsibility, including when something has gone wrong or a mistake has been made. Medical leadership demands modesty and self-reflection from specialists. It is important that they can also express this attitude by allowing their own performance to be assessed and including their colleagues in this process.

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1.2 MEDICAL LEADERSHIP WORKING GROUP Medical leadership is one of the key subjects dealt with by the Raad Opleiding (Medical Training Council) of the Dutch Association of Medical Specialists: Leadership skills, in all their forms, are essential in order to perform adequately as a medical specialist. The Raad Opleiding supports the acquirement of basic medical leadership skills by all residents through developing practical tools like this document.2

In late 2015, the Raad Opleiding therefore set up the Medical Leadership Working Group, whose task was to firmly establish the development of leadership competencies in postgraduate medical education, in an as practical and accessible way as possible.

In line with the mission and vision of the Dutch Association of Medical Specialists, the working group is of the conviction that in order to retain influence over their profession and to increase the quality of care, every medical specialist needs to have similar basic medical leadership-related skills at their disposal, and that the communication between all medical specialists on this subject is clear. Medical leadership helps medical specialists to perform at their best.3 The aim of the working group is therefore that medical leadership is implemented on a wide scale in all scientific associations’ training plans, with practical guidelines and examinations.

1.3 APPROACH In order to firmly establish medical leadership in the training programme, it was first decided which basic leadership competencies all medical specialists (and thus all residents) should have at their disposal. This was determined, in addition to input from the working group members, by making use of several sources that focus on this theme, and we are therefore indebted to a large number of groups and working groups. This subject has attracted much attention both nationally and internationally, and various models have been developed with which to identify the subject. These include: - CanMEDS 2015 4

- CanBetter project Medical Leadership 5

- Medical Leadership Framework of the Medical Leadership Platform 6

- Vision Document Students Medical Leadership Platform 7

- British Curriculum for Medical Leadership 8

- LEADS Framework and Sanokondu 9

- Medical Leadership Working Group of De Jonge Specialist (The Young Specialist) 10

- Academy for Medical Specialists (AMS) 11

Several meetings have also taken place with third parties involved with this theme at their institutions.

Using these sources as a guide, a compilation has been made of current views and perspectives on medical leadership. These provide valuable information for establishing the subject in training situations, from a wide social angle at macro level to specific knowledge and skills at micro level.

2. Raad Opleiding (medical training council) Annual Plan 2017, Dutch Association of Medical Specialists

3. ‘Optimaal functioneren van medisch specialisten’ (Optimum performance of medical specialists), Vision document of the Orde van

Medisch Specialisten en Wetenschappelijke Verenigin¬gen, 2013

4. http://www.royalcollege.ca/rcsite/documents/canmeds/canmeds-full-framework-e.pdf

5. http://www.medischevervolgopleidingen.nl/rubrieken/algemene-competenties-canbetter/medisch-leiderschap-in-de-vervolgopleiding/

6. http://platformmedischleiderschap.nl/rml-2/

7. http://platformmedischleiderschap.nl/visiedocument/

8. http://www.leadershipacademy.nhs.uk/wp-content/uploads/2012/11/NHSLeadership-Leadership-Framework-Clinical-LeadershipCompe-

tency-Framework-CLCF.pdf

9. http://leads.in1touch.org/site/resources, https://sites.google.com/site/sanokondu/

10. http://www.dejongespecialist.nl/thema_s/toekomst-innovatie/de-t-i-commissies.html#anchor2894

11. http://www.academiemedischspecialisten.nl/

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1.3.1 Basic competencies for all medical specialists (including residents) Based on the previous, the working group has laid down the basic medical leadership competencies it considers every medical specialist should master. We used the role of ‘leader’ as defined in the CanMEDS 2015 physician competency framework as a starting point, partly because the sources listed above often refer to it, and because it methodically lists the subjects that medical leadership encompasses. The CanMEDS role of professional has also been taken into account as it has overlaps with medical leadership in many areas. For each competency, several subjects are then listed which are relevant and further illustrate the competency.

Competency 1: Contributes to the improvement of health care delivery in teams, organizations, and systems- Meetings - Organisation of hospital and health care - Innovation and creativity - Patient safety

Competency 2:Engages in the stewardship of health care resources- Finance - Change management - Efficiency

Competency 3:Demonstrates leadership in professional practice - Personal leadership - Negotiating (in order to reach a joint agreement) - Incident and conflict management - Supervision and collaboration

Competency 4:Manages career planning, finances, and health human resources in a practice - Time management - Developing a personal vision - Practice and personal life

In the Netherlands, various courses on these subjects have already been developed. However, medical leadership can be practised better in working practise than it can in courses. The working group holds the combination of theory and practise in high esteem because leadership is a competency that is expressed and becomes evident in practical situations; daily exposure is precisely what enables one to develop leadership skills. At present, however, these learning moments are not always recognised.

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1.3.2 In-depth focus and specialisation In addition to describing and establishing basic medical leadership competencies for all residents, it is also useful to describe ways in which talented residents can develop further still in this area. In recent years, various organisations have made great efforts to develop leadership programmes for talented residents.

1.3.3 Basic documentWe have developed a basic document that is in line with everyday practice. For each subject listed under the 4 basic competencies, a specific activity is recommended. We also list the potential learning objec-tives and additional training materials that can be used. This provides both trainer and resident with tools with which to develop specific leadership skills. The resident and trainer determine for each competency where and with which activity these are developed. Residents can include the objectives and agreements in their individual training plan (in Dutch: IOP). This clarifies what is expected from the resident, and enables the trainer to see how the resident performs in practice to be able to provide constructive feedback, thus making the link between learning objectives and working practice. Courses serve as theoretical support.

In the basic document we also examine the subject of ‘advanced medical leadership’, although in doing so we do not claim this is complete, or that we have covered every possible aspect of medical leadership. Our aim here is to create a framework and to provide practical examples so that all scientific associations have tools they can use to include medical leadership in the national training plan, in a structured fashion. The document allows both for professional nuances, while the basics stay the same for all training programmes. In view of the rapid developments occurring within the field of medical leadership it is and shall remain a ‘living document’.

1.3.4 Framework ‘Development of medical leadership in postgraduate medical education’ In addition to the vision and basic document, the third and final part provides a framework, including examples and practical tips, for the development of medical leadership in postgraduate medical educa-tion. This should be regarded as a starting document. Whereas the basic document provides highly practi-cal modules with which to create an Entrustable Professional Activity (EPA), this part can be used to further develop a guideline/learning line for medical leadership in the residents’ training.

1.3.5 Trainers For medical leadership to become a fixed part of the training programme for residents, it is important to connect with the trainers. At present, we see that many trainers are unaware of the various subjects within the theme of medical leadership and about what residents should learn about. This makes it difficult for the trainers to respond effectively. In the Netherlands a course therefore being developed for trainers to support them in coaching residents to develop leadership skills.

SpecialisationTalented residents can grow to becoming experts

IntensificationActivities that deepen on the basic activities

BasisActivities for all residents

Profi

ling

Jesse Habets, resident in radiology, UMC Utrecht

‘Over the last few years, as a board member of the Young Specialist and the Medical Leadership

Platform, I have been closely involved with the theme of medical leadership, including the Dutch MMV/CanBetter project and the development of

leadership/management programmes (AMS Talent Class and TIAS Clinical Business

Administration). What drives me is my passion for medical leadership and the desire to see policy

and management firmly established in preliminary and postgraduate medical training. Taking

responsibility applies for all physicians, on a personal, managerial and

social level.’

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1.3.6 General recommendations The overall aim has to be that all residents have, essentially, gained the same basic knowledge with respect to medical leadership by the end of their training, and that they are able to communicate clearly with each other on the subject. We also make the following recommendations: - Based on the given framework and practical examples, all scientific associations are able to clearly

include medical leadership in their training plan by including the competencies in the EPAs or by developing specific EPAs in this field.

- Trainers and members of the training group are strongly advised to follow, if available, a course on Medical Leadership for Trainers.

- The four competencies that fall under the CanMEDS role of ‘leader’ can be enhanced by linking them with the 12 domains in the Medical Leadership Framework (in Dutch: Raamwerk Medisch Leiderschap). These 12 domains and corresponding competencies formulated by the Medical Leadership Platform help in clearly specifying leadership competencies in real practical learning situations. Moreover, the 12 domains provide structural coverage of content for learning the required knowledge and skills.

- This document provides a number of practical solutions with regard to learning objectives and associated activities. Relevant parties from the professional field are invited to provide new examples and to make them available for everyone.

All documents referred to in this report can be found on the website:www.medischevervolgopleidingen.nl, under Medisch Leiderschap (in Dutch only).

Prof. dr. Carina Hilders, Reinier de Graaf ‘In order to maintain high-quality, accessible and efficient

healthcare in the future, leadership is needed that combines both the management domain and the medical domain. It is the

connection between these two domains that forms the essence of Medical Leadership. This is only possible if we keep an open mind

regarding the desired added value, if we feel responsible for it, and if we realise that the medical profession is an unmissable link

in this respect. Medical Leadership is not a single type of leadership but exists as layers that are in line with the various roles and positions of the healthcare professionals in the care system.

The postgraduate medical education curriculum does not devote attention to the economic, organisational and innovative aspects of healthcare. Specific training in medical leadership must first be given a place in the standard curriculum for postgraduate medical

education.’

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02 Basic Document on Medical Leadership

In this basic document, we describe four competencies that we consider all residents should master at at least a basic level. Practical experience of at least one of the subjects listed under each competency should also be gained.

> Meetings - demonstrates adequate preparation - treats all of those involved with

respect - encourages interaction between all

disciplines involved - gives structure and monitors

progres - summarises well and can draw

conclusions

> Innovation and creativity - knows about methodologies for

developing creative solutions for improving care and is able to make suggestions in this respect

- take a critical approach to existing practices with a view to improving care - demonstrates an openness to new ideas

- takes a proactive approach towards new technologies and treatment methods

- supports colleagues in expressing ideas

- Taking the lead in updating aspects of Electronic Patient Records

www.zorgvisie.nl/Home/Dossiers/E-health/

> Organisation of hospital and health care

- deals with patient care situations and administration promptly and in accordance with the locally applica-ble conventions

- knows the practices and procedures on the nursing unit

- makes issues in the organisation of care open to discussion

- Taking an active lead in drawing up and updating department protocols

- Organising schooling, symposium

Academie voor Medisch Specialisten - Basic course on hospital manage-

ment for residentsMedical Business Education:Online Course 1: Marktwerking in de zorg (market mechanisms in health-care)

- Chairing handover- Chairing multidisciplinary meetings - Participating in resident board,

hospital committees- Seat on national/regional working

groups/committees- Seat on regional interview commit-

tee for residents

Medischevervolgopleidingen.nl:3 videos about chairing meetings Self-evaluation of meetings

VvAA/Academy for Medical Specialists: Course on efficient meetings (time-sav-ing)

Recommended reading: - www.managementsite.nl/kennis-

bank/vergaderen - ’Making Meetings Work’ – Karen

Anderson

Formalisation of learning objectives Examples of activities *Training materials

1. CONTRIBUTES TO THE IMPROVEMENT OF HEALTH CARE DELIVERY IN TEAMS, ORGANIZATIONS, AND SYSTEMS

*Many of the suggested training materials are only available in Dutch. If you are interested in any of these (e.g. so you can have them translated into

your own language), please contact the Raad Opleiding (Medical Training Council) of the Dutch

Association of Medical Specialists by sending an email to raadopleiding@demedischspecialist.nl

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> Patient Safety - is aware of the principles of patient

safety and accepts the associated responsibilities

- registers incidents and complica-tions and demonstrates involvement with regard to feedback

- works according to guidelines and procedures

Charing meeting on qualityActively contribute to ‘Feeling safe to report an incident’-meetings

Medischevervolgopleidingen.nl: - CanBetter theme “Patient Safety” - Inspiration cards

WHO Online Patient Safety Quiz:www.who.int/patientsafety/education/curriculum/en/ Patient voice: active listening; hear what people are really saying: www.mindtools.com/CommSkll/ActiveListening.htm Shared decision making:Negotiating treatment preferences: Physicians’ formulations of patients’ stance. Soc Sci Med. 2016 Jan; 149:26-36

Formalisation of learning objectives Examples of activities *Training materials

> FinanceBasic knowledge of health care funding: production, DOTs (DOT is the Dutch abbreviation for Diagno-sis Treatment Combination), purchasing, financial reports.

Attending executive meetings as an observer, or accompanying firm/executive purchase meetings

Medischevervolgopleidingen.nl: 5 videos about hospital funding; 2 videos about DOT/DBC; OOR (regional training network) hospital funding course overview

Academy for Medical Specialists: Introduction to hospital funding;ONLINE course ‘Betaalbaarheid en kwaliteit van zorg’ (‘Affordability and quality of care’)

Medical Business Education:Online Course 2: Betaalbaarheid van de zorg (Affordability of care)

Recommended reading: - www.zorgvisie.nl/financien; - www.medischcontact.nl/ (o.a. thema

Zorgkosten); - www.zorginstituutnederland.nl

> Change management (not applicable for ‘basic level of skills’)

‘To Wonder & Improve’ project in own hospital

Medischevervolgopleidingen.nl:Video about Verwonder en Verbeter (To Wonder & Improve) sessions

> EfficiencyBasic knowledge of cost effective-ness and efficient care.

Accompanies staff or supervisory board members

Awareness project:Survey and 2 workshops on efficiency, http://www.bewustzijnsproject.nl/aan-de-slag/

OOR UTRECHT:training region Utrecht):Duurzaam dokteren (sustainable medical practice) course for residents

Formalisation of learning objectives Examples of activities *Training materials

2. ENGAGES IN THE STEWARDSHIP OF HEALTH CARE RESOURCES

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> Negotiating (in order to reach a joint agreement)

- negotiates in a respectful way about medical policy, procedures and agreements

Drawing up a duty roster Carrying a pager Cooperation with all hospital col-leagues

Medischevervolgopleidingen.nl:Video about negotiating Inspiration card

Recommended reading: - ‘Getting to yes’ – Fisher - ‘Influence’- Cialdini - ‘Negotiating techniques for health

care professionals’ - Berlin, Lexa

> Personal leadership - the resident has insight into the

various leadership styles and the basic principles of teamwork; reflects on his/her own style and conduct within a team and is aware of his/her role within the treatment team.

- accepts his/her own mistakes and is able to acknowledge these to patients and supervisor, whilst learning from the errors.

- basic knowledge of leadership skills - demonstrates empathy and is able

to bring people together - demonstrates authenticity - demonstrates integrity - has insight into his/her own

personality, core qualities and shortcomings (emotions, prejudic-es).

- demonstrates exemplary conduct - coaches and guides others - takes responsibility - is aware of the ways in which

individual conduct can influence others

- knows different methods with which to get feedback from others

- can discuss personal strengths and weaknesses with supervisor

- demonstrates knowledge of and takes into account of how cultural and religious convictions influence approaches and decision-making

Meeting with departmental group Literature study360 degree feedbackSpokesperson for residents group

Medischevervolgopleidingen.nl:Short film: ‘De zeven eigenschappen van medisch leiderschap’* (The seven traits of medical leadership)

Recommended reading:‘The Seven Habits of Highly Effective People’ by Stephen Covey

Examples of various self-tests: - The Myers-Briggs Type Indicator - LEADS Online Self-Assessment - SCARF Self-assessment online

Course on Presentation skills

Resources on Feedback: - Giving Feedback (Chowdhury RR

and Kalu G. Learning to give feedback in medical education. TOG. Volume 6, Issue 4 October 2004 Pages 243–247)

- KS (Stop – Keep Doing – Start) Process (Stop – Keep Doing – Start: Simple Questions for Improving Performance. (www.mindtools.com/pages/article/SKS-process.htm).

Quiz on Emotional intelligence: competencies like self-awareness and empathy: https://hbr.org/2015/06/quiz-yourself-do-you-lead-with-emo-tional-intelligence

Formalisation of learning objectives Examples of activities *Training materials

3. DEMONSTRATES LEADERSHIP IN PROFESSIONAL PRACTICE

Prof. dr. Marian Mourits, trainer in gynaecology at UMCG

‘You don’t have to be the boss to be a leader. What you do need to understand is

that medical leadership is something linked with other competencies; and with

personal development.’

> Incident and Conflict Management - basic knowledge on reporting

incidents, legal aspects and conflict management

- registers incidents and complica-tions and demonstrates involvement with regard to feedback

- makes problems in the care organisation open to discussion

Coordinating with residents group in the event of conflicts and problems; when to meet & discuss with fellow specialistsReporting on and presentation of incidents / complicationsShadowing complaints officer

OORZON (training region south-east Netherlands):Course on ‘Dealing with incidents & complaints’Course in Health LawOOR UTRECHT (training region Utrecht)::Course on ‘On the boundary of medicine and law’Course on ‘Conflict management in the consulting room’ for residentsOOR VUmc(training region Amsterdam):Course on Health law & ethics

Medischevervolgopleidingen.nl:Video about negotiating;2 videos about successful collabora-tion; Escalation ladderEscalatieladder

Understanding Conflict and Conflict Management: www.nrm.wa.gov.au/media/10646/understanding_conflict_and_conflict_management.pdf

> Supervision and collaboration - being a team with nursing staff and

other health care professionals - effective cooperation with nursing

staff and other health care profes-sionals;

- is able to take responsibility for the patient care process.

- is respectful in interactions with healthcare providers

- is open to and responds to the needs and concerns of healthcare providers with safe and effective care as the goal

- takes advice from nursing staff, supervisors and consultants regarding his/her own diagnostic and therapeutic interventions

- is able to include other healthcare providers in drawing up a care plan during a multidisciplinary meeting or visit

- is able to coach and educate junior residents and senior medical students, and encourage appropri-ate self-supervision

Role in interdisciplinary treatment teamDefining roles (head treatment specialist/ consultant) and executing them

OOR - Various Training Centers in the Netherlands: training course in basic teaching methods and coaching for residents.

VvAA/AMS:Course on Effective communication

Medischevervolgopleidingen.nl:2 short films about successful collabo-ration

Communication with a peer:www.ihi.org/resources/pages/tools/sbartoolkit.aspx

Followership: “First Follower, leader-ship lessons from a dancing guy”: www.youtube.com/watch?v=fW8am-MCVAJQ

Teamwork/Trust:Creating a strong, cohesive group: https://www.mindtools.com/pages/article/building-trust-team.htm

Formalisation of learning objectives Examples of activities *Training materials

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> Timemanagement - time management in clinical/

outpatient practice - setting priorities - efficient handover

- Ward visits and outpatients accord-ing to schedule

- Efficiently leading a handover

Medischevervolgopleidingen.nl:3 videos on time management;Document ‘Tips for time management’

KNMG (Royal Dutch Medical Associa-tion) Career office:Time management workshop for residents

VvAA/AMS:Course on Time and stress management

> Developing a personal vision - takes responsibility for one’s own

Educational Programme and individualisation thereof

- has insight into and carefully considered career perspectives

- vision on the current position and future perspectives of his/her own field of medicine

Drawing up and maintaining one’s own Individual Educational Programme

Medischevervolgopleidingen.nl: - Video about workshop ‘working on

your profile’ - Mirror card ‘how do I adopt a profile

for myself?’ - Inspiration card ‘make your own

profile’

Academy for Medical Specialists:Interview training

> Practice and personal life - balance - setting priorities - knows techniques for - dealing with stress - knows his/her own limits - demonstrates recognition of the

effects of stress on self and others - knows when to ask for help - demonstrates having realistic

expectations of self and others - regards personal health as an - important issue

Sharing/discussing life eventsWork planning

KNMG Career office:Workshop ‘ambitions in balance’

VvAA/AMS: - Course Time- en stressmanagement

Formalisation of learning objectives Examples of activities *Training materials

4. MANAGES CAREER PLANNING, FINANCES, AND HEALTH HUMAN RESOURCES IN A PRACTICE

Prof. dr. Martin Schalij, trainer in cardiology at Leiden UMC

‘Medical leadership begins by formulating a vision on leadership. It is essential that this vision is not only in

line with developments in healthcare or your own department but also with how responsibilities are

allocated. Modern leadership therefore stimulates team development and, more specifically, individual team members taking responsibility, with the aim of making healthcare safe, effective and transparent.’

Conditional courses: - Coach-the-co (Coaching senior

medical students) - At least 1x Interdisciplinary - Education: teamwork or leadership

Optional courses (Intensification and specialisation level): - KNMG CANbetter Medical Leader-

ship & Patient Safety - CME training leadership / Talent

Class AMS - ‘To Wonder & Improve’ - Clinical Business Administration

Course by TIAS in collaboration with DJS and Stichting Medical Business

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Prof. dr. John Wokke, trainer in neurology at UMC Utrecht

‘Medical specialists work in a team together with their colleagues and other health care providers to ensure patients are offered the best treatment and healthcare. Each team

needs a team leader who, just as with a hockey team, maintains an overview and

divides the game among the players. Medi-cal leadership in the workplace is no differ-

ent. Know your place and provide leadership if that’s your role.’

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03 Practical tips and examples for the development of medical leadership in postgraduate medical education

As described earlier, this section may be regarded as a starting document. Whereas the basic document provides highly practical modules with which to create an EPA, this part can be used to further develop a guideline/learning line for medical leadership in the residents’ training.

BASIC PRINCIPLES: - The development of leadership competencies takes place in a learning line throughout the entire

training programme. - The line ranges from simple to complex: - from insight into one’s own leadership qualities to applying leadership competencies in various,

sometimes more complex situations. - Developing knowledge and skills and becoming more competent in situations by applying these in

practice and receiving feedback.

MEDICAL LEADERSHIP IS DESCRIBED IN THE 2015 CANMEDS AS FOLLOWS: The physician:1. Contributes towards the improvement of healthcare in teams, organisations and ‘systems’.2. Manages/co-manages resources for optimum healthcare. 3. Shows leadership in professional practice. 4. Plans his/her career and maintains a good balance between work and private life.

Leadership is not a stand-alone subject, as applies for the other CanMEDS competencies. In practice, leadership competencies will always be applied in combination with other competencies, the most obvious of which being: communication, cooperation and professionalism.

DEVELOPING MEDICAL LEADERSHIP IN THE WORKPLACE Developing competencies in the field of medical leadership does not have to take up extra time. Resi-dents can improve their skills during their everyday activities in the workplace. For example: - Specialists’ ward round. - Collaboration with nursing staff, patient consultations, discussing/arranging post-operative care, and

time management: being able to speak to all patients within a given time. - Efficient handover, setting priorities. - Multidisciplinary meetings - Determining objectives, gaining insight into structure and relationships, getting people to talk. - Transdisciplinary education & peer-to-peer coaching. - Time management, organisation of healthcare, meeting techniques etc. - Dealing with practically formulated problems, e.g. the residents can contribute towards increasing

outpatient clinic efficiency / optimising outpatient clinic logistics.

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TIPS FOR RESIDENTS: HOW CAN I APPLY MEDICAL LEADERSHIP DEVELOPMENT IN MY TRAINING? 1. Take a look at the Main Document on Medical Leadership. 2. For the 4 competencies described, check the following: A. What do I already know/what can I already do, and what do I want to further develop? B. How can I apply this in the activities I will be carrying out in the near future (6 months/year)? C. Formulate your learning objectives, see (in consultation with your trainer/colleagues) what you

need in order to carry out these activities (facilities, literature, training, specific role or task in the activity, supervision/feedback).

3. Record agreements and objectives in your individual training plan. 4. In addition to laying down the specifics of the short-term planning, also make an overall planning for

your development in medical leadership over the remaining years of your training. Make sure you include all the learning objectives.

LEARNING CURVE DURING TRAINING - From simple to complex- From insight to application

Below is a general overview of the development of knowledge and the application of leadership activities during the different stages of development; initial, mid, end. The overview is a concept and therefore not complete. The level at which the resident begins and his/her objectives and activities formulates depends on their personal development and experience, and the time spent in training.

Initial stage - Insight into his/her own personal development - Insight into the role of and recognition of leadership in professional practice - Practical experience in leadership tasks and roles (e.g. time management) - Insight into personal development objectives.

Practice situations - Active contribution in training meetings - Active contribution in handover

Mid stage - Chairing training meetings - Drawing up duty roster (negotiation) - Participating in department’s improvement process - Acquiring sufficient knowledge about hospital funding and organisation.

End stage - Chairing the resident association - Leading a multidisciplinary meeting - Carrying out specific assignments in which medical leadership can be put into practice.

Bart Leenders, resident in surgery at VieCuri MC

‘Medical leadership is more than just being a supervisor. As a resident, I think it’s important that I get the hang of all facets of the subjects,

organisation-wide to personal leadership.’

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Outline of a leadership development activity for the INITIAL stage

Personal leadership (Competency 3: Demonstrating leadership in professional practice. Elaboration of ‘Personal Leadership’) This assignment gives you the opportunity to explore leadership characteristics. Based on targeted questions, you then examine what aspects of medical leadership you have come across in recent weeks. Finally, you formulate your development objectives.

Learning objectives - You have insight into the various leadership styles and basic principles of teamwork. - You reflect on your own style and conduct within a team. - You are aware of your role in the treatment team.

Sub objectives - You have insight into the meaning of medical leadership in professional practice. - You have insight into your own personality traits that contribute towards leadership. - You are able to recognise leadership styles and leadership characteristics in professional practice and in yourself.

1. Short introduction to Medical Leadership > Watch the short film: ‘De zeven eigenschappen van medisch leiderschap’* (The seven traits of medical

leadership – in Dutch only) > Read: ‘The Seven Habits of Highly Effective People’ by Stephen Covey

2. Assignment Analysing medical leadership in everyday practice Use the CanMEDS forms ‘Leading and managing in everyday practice’*. Using these forms, you can get a clear picture of which aspects of leadership you have come across in the past four weeks. The questions allow you to reflect on your conduct and medical leadership development objectives with regard to leadership, management, stewardship, quality improvement, and patient safety. - Draw up a Top 3 list of your own points for improvement. - Also, indicate how you can work on this and how you can demonstrate that you have achieved your

objectives. - Record this in your Individual Training Plan.

3. Background information medischevervolgopleidingen.nl:Short film: ‘De zeven eigenschappen van medisch leiderschap’* (The seven traits of medical leadership)

Recommended reading: ‘The Seven Habits of Highly Effective People’ by Stephen Covey ‘The Seven Habits of Highly Effective People Personal Workbook’ Stephen Covey, Business contact, 2016

Anne van der Meij, resident in neurology at Leiden UMC

‘Right from day 1, enormous responsibility is expected from physicians by and to

society. By incorporating medical leader-ship into medical training at an early stage, medical specialists learn whilst in training

to be self-assured and to take matters into their own hands in a suitable fashion.’

* www.medischevervolgopleidingen.nl/medisch-leiderschap

Visitors address: Dutch Association of Medical Specialists Domus MedicaMercatorlaan 12003528 BL Utrecht (The Netherlands)

Postal address:Postbus 200573502 LB Utrecht (The Netherlands)

www.demedischspecialist.nl