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Training the physician executives of the future: the Medical Management Leadership Track at Brigham and Women's Hospital Department of Medicine.

The MLT emerged from collaborations between faculty and residents and was piloted in 2008. The official launch was in July 2009. The program's objective is to provide unique educational experiences at the postgraduate level for physicians with management or business interests, including but not limited to physicians with additional degrees, such as an MBA, MPH, MPP, JD or PhD The goals of the track are threefold:

* To train skilled clinicians who practice medicine (the cornerstone of our residency program).

* To create innovative, data-driven managers within health care systems (building a scientific framework in the process).

* To showcase clinician-manager leadership career paths (elevate health care management science).

Ultimately, long-term objectives for the MLT program include launching its alumni into successful careers reflective of the dual training in both medicine and leadership, and improving the delivery of health care they provide locally, nationally and globally.

Background: The BWH Department of Medicine

"Increasing the number and skills of practicing clinician-managers will improve access to, and the quality and afford ability of, care experienced by patients."

This fundamental approach to clinical care delivery in the BWH DOM, put forth by residency core leaders and strongly echoed by its physician trainees, provides strong insight into the rationale for the development of the MLT. Over the past decade, the number of physicians and trainees with formal training or work experience in the business of medicine was increasing within the department, reflective of national trends. (3) Local efforts to push for health insurance reform in Massachusetts and the national dialogue on delivery innovation in health care in the post-HMO era also shed light on the growing need for physicians to be fluent in the language of medical management.

These forces converged to raise awareness within the residency program for the need for a specific residency track dedicated to issues of health care management and leadership that addressed the shifting role of health care organizations in care delivery.4 Historically, graduates of the BWH internal medicine residency have found success in traditional health care and academic leadership roles, including as physician-scientists. Additionally, BWH had experience with establishing residency programs dedicated to special interests within the field of medicine, including global health and primary care, as well as joint residencies in medicine-genetics, medicine-dermatology and medicine-pediatrics.

Crafting a new track

Stakeholders engaged in planning the MLT from among the department faculty and residents designed program learning objectives, curricula and teaching methods. In addition, non-physician experts in health care management, public health, business and medical administration, including faculty from Harvard Business School, were sought for their input into constructing a comprehensive and practical educational curriculum.

A successful faculty enrichment program within the DOM that combines medicine and business school teaching for burgeoning medical leaders also served as a model. There was interest throughout the department in creating a program designed specifically for trainees who were pursuing or had already pursued advanced degrees in business, law, public health or public policy. By July 2009, the MLT was ready to welcome its first cohort of residents.

Components of the medical management leadership track

Leveraging the breadth and depth of faculty from across BMTH, Harvard Medical School, Partners Healthcare Inc., Harvard Business School and external affiliates, the steering committee crafted a detailed curriculum for MLT residents spanning the three years of internal medicine residency. Applications for the MLT program are open to the entire intern (first-year resident) class. Applicants are asked to select between two core areas of curriculum focus: (a) hospital management, administration and management information systems and (b) health policy and health services.

A hallmark of the program is the Longitudinal Leadership Seminar Series. Invited speakers spend one hour discussing their areas of expertise and career paths with current MLT residents, followed by open-ended question and answer sessions. Specifically, speakers are asked to review a challenge they have faced or are currently facing, emphasizing their approach to problem solving and health care improvement. This exercise provides a glimpse for residents into future career paths within medical leadership that they may be interested in exploring further. Speakers have included hospital CEOs, chief medical officers, chief nursing officers, the director of the NIH, the provost of Harvard University, health policy experts, health economists, department chairpersons, and senior administrators from fields including pharmacy, operations and research management.

Week-long didactic sessions with an intensive focus on the two core areas are organized for the second-and third-year residents during dedicated MLT elective blocks, affording residents the opportunity to hear from several experts in lecture formats and formal site visits. The scheduling of MLT program-wide immersion blocks has included several successful "field trips," such as meetings with physicians currently serving in government leadership roles for the state of Massachusetts, tours of an ambulatory patient-centered medical home clinic and a day-long visit to the Institute for Healthcare Improvement to meet with health policy experts. Sessions such as these provide an in-depth experience in one sphere of health care leadership and offer a chance to network with authorities in the particular sub-field, drawing upon a portfolio of unique perspectives.

During the second year of training, participants in the MLT work together on a group project focused on a quality improvement initiative for an issue identified through discussions among the medical residents. The process is designed to walk residents through the steps of situation analysis and problem solving, and to build fluency in organizational communication, implementation and post-implementation analysis. During the final year of training, senior residents design individual projects focused on developing motivation, team work and conflict resolution skills.

During the three years in training, MLT participants are encouraged to attend conferences, seminars and other enrichment opportunities outside the department of medicine. Financial assistance is provided for these endeavors. Financial assistance is also available for a limited number of residents to pursue an MBA at Harvard Business School through an extended residency training period. Finally, each resident is assigned a physician and non-physician mentor involved in hospital management for career advising.

Successes to date

The first cohort of seven MLT trainees completed the three-year curriculum in June 2012. The numbers of interested residents has steadily grown, and there are currently 39 residents actively participating in the MLT track. To date, four residents have enrolled in the MBA program at Harvard Business School in conjunction with their MLT residency training.

Trainee feedback has been strongly positive. Faculty member who have participated in curriculum development and resident teaching have also found the experience to be valuable and often something "they wish they had had" during their training. The Longitudinal Leadership Seminar Series has been highly praised by trainees. The weeklong immersion blocks have been well-received, but are also constantly being re-examined to keep current with quickly changing issues related to health policy.

Over the past two years, several collaborative projects emerging from the MLT residents have affected the residency program itself as well as the trajectory of individual residents' careers. Projects examined the role of residents in the discharge planning and coordination process in the hospital, spearheaded department and hospital efforts to incorporate patient reported outcome measures, and addressed inpatient ward regionalization efforts in the hospital. The MLT projects tackle challenging issues at the nexus of health care and management that are both important on a national level and highly applicable to the daily clinical work performed by residents in the program.

Looking ahead

The long-term success of the MLT program will be assessed by the career trajectories of its graduates and the impact they have on health care delivery, and alumni have already begun to make their mark as health care leaders. Among recent graduates of the MLT are the current director of Medicaid for Massachusetts; an incoming White House Fellow; a practicing clinician and health care venture capitalist at Google Ventures; the chief medical information and innovation officer at Merck; several clinical fellows; and a number of faculty members at academic medical centers around the nation, including BWH itself and the University of California at San Francisco.

The MLT program engages in a form of continuous process improvement, looking for areas of enhancement by continuously soliciting feedback. Active quality improvement efforts include redesigning the didactic sessions in the curriculum each year; inviting new speakers for the leadership seminars; and scheduling visits to new clinical sites. We hope the MLT may be used as a model to guide other residency programs and departments as they seek to design similar offerings for their residents in the future. The MLT is showcased in the informational material provided to final year medical students who interview at BWH as a means of demonstrating a firm commitment to and vision for cultivating future leaders. The MLT is truly a manifestation of the high priority placed by the residency program on developing the myriad skills that will be needed by future health care leaders who strive to enhance the delivery of health care in the 21st century.

Acknowledgements: We gratefully acknowledge the essential role that the BWH residents have played in the initial design and frequent improvements that keep the program useful and accessible. Productive contributors to the initial design of the program include, but are not limited to, former residents Krishna Yeshwant, MD, MBA; Julian Harris, MD, MBA; and Sachin Jain, MD, MBA.

References

(1.) Lee TH. Puffing the value framework to work. N Engl J Med., 363 (26): 248-3, Dec. 23, 2010.

(2.) Brindis RG, Spertus J. The role of academic medicine in improving health care quality. Acrid Med. 81 (9): 802-6, Sept. 2006.

(3.) Larson DB, Chandler M, Forman HP. MD/MBA programs in the United States: evidence of a change in health care leadership. Acad Med. 78 (3): 335-41, Mar. 2003.

(4.) Bohmer RM, Lee TH. The shifting mission of health care delivery organizations. N Engl J Med. 361 (6): 551-3, Aug. 6, 3009.

By Vinod E. Nambudiri, MD, MBA; Dale S. Adler, MD; Stephen C. Wright, MD; Thomas H. Lee Jr., MD, MSc; Joseph Loscalzo, MD, PhD; & Joel T. Katz, MD
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Author:Nambudiri, Vinod E.; Adler, Dale S.; Wright, Stephen C.; Lee, Thomas H., Jr.; Loscalzo, Joseph; Katz
Publication:Physician Executive
Geographic Code:1USA
Date:May 1, 2013
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