The RCPSC concept of Manager
As Managers, physicians are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system.
Physicians interact with their work environment as individuals, as members of teams or groups, and as participants in the health system locally, regionally or nationally. The balance in the emphasis among these three levels varies depending on the nature of the specialty, but all specialties have explicitly identified management responsibilities as a core requirement for the practice of medicine in their discipline. Physicians function as
Managers in their everyday practice activities involving co-workers, resources and organizational tasks, such as care processes, and policies as well as balancing their personal lives. Thus, physicians require the ability to prioritize, effectively execute tasks collaboratively with colleagues, and make systematic choices when allocating scarce healthcare resources. The CanMEDS Manager Role describes the active engagement of
all physicians as integral participants in decision-making in the operation of the healthcare system.
Dr. Glen Bandiera
Director, Postgraduate Medical Education
St. Michael’s Hospital
St. Michael's Hospital
30 Bond Street
Tel: (416) 864-5095
Fax: (416) 864-5341
|Ideas for teaching the Manager Role|
|In clinical rotations|
1. Direct questions/concerns about management issues to more senior residents. (For example, a nursing question about patient length of stay or a request to set up and conduct a family meeting.)
2. Allow residents to spend time with clinic/ward administrative staff to appreciate the nuances of scheduling patients and handling complaints. Ask them to summarize the three or four most important lessons.
3. Include explicit explanations of the impact of resource allocation on patient management into rounds and clinical teaching sessions.
4. Explicitly identify when Manager skills are demonstrated (both good and bad examples) by health care professionals in day to day practice. (For example, identifying lack of available equipment as a department resource management issue, or identifying a colleague as an outstanding manager of time).
5. Demonstrate and explain the effects of scheduling multiple professional responsibilities.
6. Involve residents in quality assurance measures such as: reviewing radiology and laboratory reports, routine follow-up procedures, drafting responses to letters of complaint.
Non-Clinical Teaching Options
1. Rotations specifically used to highlight the Manager Role. (For example, chief resident positions, clinic-based month with explicit Manager objectives, opportunities to shadow an administrator to meetings, retreats, practice management sessions)
2. Formal practice management sessions such as those run by the CMPA and MDManagement.
3. Formal courses on the administrative aspects of the specialty. (For example Emergency Medicine administration course: http://www.emergencymedicine.utoronto.ca/Faculty/Orientation/2005_Orientation.htm)
4. Themed workshop and dedicated academic half-days for Manager topics such as: Managing medico-legal risk, improving team dynamics, work-life balance.
Dr. Bandiera graduated from McMaster Medical School and completed his residency in Emergency Medicine at the University of Toronto and McMaster University. He subsequently completed subspecialty training in trauma and obtained a Master’s of Education degree from the Ontario Institute for Studies in Education. Dr. Bandiera is currently a staff Emergency Physician and trauma team leader at St. Michael’s Hospital, is the program director for the University of Toronto FRCP(EM) residency program, and is the Director of Postgraduate medical education at St. Michael’s Hospital. His research interests include measurement and evaluation, clinical teaching techniques, and curriculum development.
CanMEDS Resources and Best Practices for the Scholar Role
- Physicians as active participants in the healthcare system
- Physician roles and responsibilities in the healthcare system
- Collaborative decision-making
- Quality assurance and improvement
- Organization, structure and financing of the healthcare system
- Managing change
- Supervising others
- Consideration of justice, efficiency and effectiveness in the allocation of finite healthcare resources for optimal patient care
- Budgeting and finance
- Practice management to maintain a sustainable practice and physician health
- Health human resources
- Time management
- Physician remuneration options
- Career development
- Information technology for healthcare
- Effective meetings and committees
Physicians are able to...
- Participate in activities that contribute to the effectiveness of their healthcare organizations and systems
- Work collaboratively with others in their organizations
- Participate in systemic quality process evaluation and improvement, such as patient safety initiatives
- Describe the structure and function of the healthcare system as it relates to their specialty, including the roles of physicians
- Describe principles of healthcare financing, including physician remuneration, budgeting and organizational funding
- Manage their practice and career effectively
- Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life
- Manage a practice including finances and human resources
- Implement processes to ensure personal practice improvement
- Employ information technology appropriately for patient care
- Allocate finite healthcare resources appropriately
- Recognize the importance of just allocation of healthcare resources, balancing effectiveness, efficiency and access with optimal patient care
- Apply evidence and management processes for cost-appropriate care
- Serve in administration and leadership roles, as appropriate
- Chair or participate effectively in committees and meetings
- Lead or implement a change in health care
- Plan relevant elements of health care delivery (e.g., work schedules)
Evaluating the Manager Role
- Examinations: Include questions on resource allocation, principles of continuous quality improvement, or the use of various forms and procedures (Mental health act, Canadian Council on Health Services, hospital disaster plans).
- In-training Evaluation Reports (ITERS): Include descriptions of specific observable behaviours specific to the specialty.
- Resident Portfolios: Have residents write brief summaries of experiences that taught them Manager competencies. Mandate a minimum per year. Include minutes of key meetings identifying resident input. Solicit letters of input from chairs of committees that residents sit on. Have residents reflect on rotations during which Manager competencies were not well-taught. Include abstracts of research or quality assurance projects, or slides from M&M rounds presented.
- Faculty Observation: Have faculty complete a rating form for a workshop, seminar or retreat.
- Mandatory Academic work: Develop a scoring sheet for academic or QA projects. Mark assignments associated with an administration course.
- 360 Degree: Solicit specific input from multiple health professionals about resident performance on rotations. For example, nurses can comment on ability to organize a care plan and manage personal time, social workers can comment on performance in family meetings, clerical staff can comment on ability and professionalism around delegation of tasks.
Bartlett RC et al (1994) Evolving approaches to management of quality in clinical microbiology. Clinical Microbiology Reviews 7 (1):55-88.
Callahan M, Fein O, and Stocker M (2000) Educating residents about managed care: A Partnership between Academic Medical Center and Managed Care Organization. Acad Med 75 (5):487-493.
Callahan M, Fein O, and Battleman D (2002) A practice-profiling system for residents. Acad Med 77 (1):34-39.
Doezema D, McLaughlin S, and Sklar DP (2002) An approach to fulfilling the systems-based practice competency requirement. Acad Emerg Med 9 (11):1355-1359.
Dyne PL, Strauss RW, and Rinnert S (2002) Systems-based practice: the sixth core competency. Acad Emerg Med 9 (11):1270-1277.
Whitman,N., Bishop,F.M. (1991) Evaluating three years of a management skills course for chief residents. Academic Medicine. 66(4); 242.