Innovative Program Fills Leadership Gap for Medical Students

Medical students who want to be physician leaders often lack appropriate exposure to resources and training to allow them to develop the necessary skills. An innovative program addresses this void.

ABSTRACT: Beyond being at the forefront of clinical innovation, physician leaders provide operational guidance to advance patient care. But medical students with such a career interest often lack appropriate exposure to resources and training to allow them to develop the necessary skill set. An innovative program at Weill Cornell Medicine specifically addresses this critical void for medical students interested in health care leadership.

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There is a growing emphasis on education and training of physicians in business and management skills, as demand for clinical leaders in administrative positions increases throughout the health care industry.1 The marriage of high-quality care and economic stewardship is upon us. The challenge is how, and to which medical students, and at what point within a physician’s training, to target such teaching and knowledge transfer.

The existing methods to achieve this outcome typically require either additional years of schooling or training, or make the current years of schooling more taxing as students fit in additional coursework. Thus developed our question of how to impart leadership, management and business-oriented skills to interested students in the most efficient and effective manner early in medical school so that the experience can be transformative in future career-guiding decisions.

There are currently several options in business and management education for medical students. Some medical schools have made management skills a core component by integrating such courses into their general curriculum.2 There certainly is value in education around management techniques for all involved in medicine. This, however, might not identify future health care leaders.

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Another approach integrates a medical doctorate with an MBA, in either the traditional amount of time for a medical doctorate alone or, more typically, with an additional year of schooling. The number of joint MD/MBA programs in the United States increased from six in 1993 to 65 in 2015.3 But for many students, the question about pursuing an additional degree is fraught with concerns about time and finances. An immersive experience early in medical school might make that decision more palatable and feasible.

After medical students obtain their doctorate and begin the training process in their chosen specialty, there are graduate medical education residency programs that incorporate structured management experiences with traditional clinical rotations.4 Likewise, administrative fellowships in academic institutions and private group practices provide leadership and management training to board-eligible or board-certified physicians after residency.5

Despite these options, relatively few institutions focus on fully immersive early leadership and management experiences for medical students during the summer between their first and second academic years. This is the final summer of their educational journey available for an intensive extracurricular experience to guide individual career decisions.6 Thus, our goal in developing the Healthcare Leadership and Management Scholars Program at Weill Cornell Medicine in New York was to expose interested medical students to multidisciplinary aspects of health care administration as a primer for developing a career as a physician leader within the health care industry.

We aimed to do this in a unique fashion — by fostering close relationships between the scholars and senior leaders across our health system, delivery of an operationally based project and immersing them in meetings with administration, strategic initiatives, clinical quality and patient safety, policymaking and clinical operations management.

Program Design

Participants: Two to three Weill Cornell Medical students between their first and second years of medical school, who have an interest in health care-associated business practices and are interested in pursuing a hybrid career.

Selection process: Each applicant submits an application including cover letter, curriculum vitae, personal statement about their interest in the program, and a one-page summary of a project they would like to pursue. Interviews are granted to the qualified applicants, and, from those interviewed, scholars are selected by the program’s core faculty. No preference is given for gender or minority status.

Oversight: The core HLM faculty is composed of the chief of emergency medicine and two EM faculty members with an interest and experience in health care management. The program’s advisory board consists of several members from Weill Cornell Medicine’s board of overseers.

Curriculum: The eight-week program includes individual meetings with top hospital executives and leadership, departmental and hospital working-group meetings, didactics, shadowing clinical shifts in the emergency department, as well as participating in a weekly journal club and completing a scholarly project (see Figure 1). The scholars are fully immersed in health care administration, observing the decision-making process for various aspects. They are introduced to tools essential for gaining a well-rounded education with the business side of health care, including ongoing mentorship should they choose to pursue an advanced degree, such as an MBA, MHA or MPH.

Project: The scholars identify a project of current operational importance, whether as part of a strategic initiative or quality assurance and patient safety, developing their own timeline and deliverables, and being prepared for interval meetings with stakeholders and a final presentation at the end of eight weeks. They must identify an individual piece of a larger project that weaves together into one product for senior level management. For example, three scholars recently chose to study a new telehealth initiative in different ways: feasibility of scaling it up in volume, cost and capacity; using it for intrahospital consults to expedite emergency department patient length of stay while being a tool for supervision and resident education; and a demographic analysis of the telehealth population captured during the first year of business with marketing suggestions for where the target audience lies for chief complaints.

Program measurements: Scholars return a survey (see Table 1) after each individual executive meeting, highlighting expectations for, content of and reflections upon the event. These surveys are reviewed periodically and in aggregate at the end of the program to evaluate whether any changes need to be made in the structure or the leaders with whom the scholars spend time. The scholars complete a comprehensive survey about all other aspects of the program at the end to provide feedback for improvements. Specifically, they are asked to rate meetings, journal club topics and delivery, and clinical shadowing on a Likert Scale and with open-ended questions. Scholars receive feedback from the core HLM program faculty at the conclusion of their final presentation to the emergency medicine faculty and project stakeholders at the end of their eight weeks. Additional evaluation is conducted by surveying the senior executives in the meetings, asking them about their experience, whether they would like to continue as part of the program, suggestions for improvement and more (see Table 2).

Funding: The program was supported by the Department of Emergency Medicine in its inaugural year, 2016. Costs include contribution to the student work/study program, purchasing educational materials, faculty administrative time, and student membership to the American Association for Physician Leadership. Given the success of the program, it is now endowed by a private donation.

Outcomes

The program has completed two summer sessions with a total of five students — two in the first year and three in the second year. Of the five scholars, four were female and one was male. Three were of Asian descent, one Latino and one Caucasian.

Student feedback has been highly positive, with the first summer’s participants instrumental in recruiting candidates for the second. As one wrote: “In an era of medical education that does not include significant training in hospital management or administration, the HLM fellowship provided a unique venue to escape from the bench or clinical research that most students undertake in the summer after their first year. For me, as a student interested in working to improve medical care on an immediate and tangible level, this program was a perfect fit, as it allowed for direct participation in the day-to-day life of a hospital administrator. It exposed me to the obstacles to implementing new protocols and the rewards of seeing patient satisfaction improve.”

The senior executive leaders of the institution likewise had positive remarks. They appreciated meeting with small groups of scholars, because it allowed for more direct interaction and questions in an intimate environment. When asked if they recommended this experience to other senior leaders and/or medical schools to implement, one leader noted: “Leadership learning should take place throughout one's life. The HLM program gives students a chance to experience health care leadership early in their medical careers. Mentoring students, especially ones as talented as these, pushes us to answer the hard questions they pose. I think of it as having to be at the top of my game.”

Discussion

After having completed two sessions of this program, several factors that were central to the vision of this program have shown to be of value.

• Why offer a short, immersive program rather than a longitudinal course? This intensive, full-time program over eight weeks allows scholars to be actively involved in current hospital initiatives as they are developed, implemented and modified in real time, akin to seeing a live case study. It provides insight into the daily challenges of launching and maintaining initiatives. The current pace of health care change provides all these phases of opportunity in this time span, and without a full-time experience, the scholars would miss steps along the way.

• Why offer this program to so few medical students? This program currently targets a subset of medical students with an interest in pursuing careers as physician leaders. By limiting the number of fellows to two or three students, we anticipated a greater opportunity for individual mentoring and personalized conversations with senior management, which has borne true, based on feedback. It also allows for more individual attention on their project and access to limited resources. The curriculum could be expanded, as has been done elsewhere,2 but we would anticipate a different experience for all involved.

• Why offer this program early in medical education? Its placement after the first preclinical year is a formative experience. The first two participants subsequently have chosen to devote their future required research time during medical school to quality-assurance projects within the institution. None of the entering scholars had definitive plans for obtaining an MBA; by the end, several had decided to pursue the business school application process.

Future Outcome Measures and Steps

Over the next several years, the HLM faculty will remain in close contact with those participants who complete the program. We will continue to survey them for their educational, training and career choices, and incorporate feedback to the evolution of the curriculum. To date, the program has not experienced any negativity as might arise when questioning professional identity in exploring or promoting two traditionally diametrically opposed career paths.

EXPERT'S THOUGHTS

Thomas L. Higgins, MD, MBA, CPE, a member of the Physician Leadership Journal editorial board and AAPL board of directors, comments on this article. Click here.

While concerns exist that physicians with MD/MBAs preferentially will leave clinical practice over time,7,8 there is a need for multi-institutional, longitudinal studies to investigate the trajectory of MD/MBA candidates compared to those on a traditional MD pathway.

Limitations

This program was designed and implemented in a large academic medical center (New York-Presbyterian Hospital/Weill Cornell Medicine) with an affiliated medical school and thus might not correlate to other institutions. The medical students involved are self-selecting and leadership-oriented, and thus such a curriculum might not be as successful with an entire class.

The sample size of surveys returned thus far is intentional, but it presents a challenge in tools used for analysis and interpretation of the results. Longitudinal evaluation of the scholars and chosen career paths, as well as having additional scholars join the program in coming years, will provide additional information to understand the strengths and weaknesses of our program design.

Conclusion

The first two years of the Healthcare Leadership and Management Scholars Program have been a preliminary success as measured by the feedback from the students, mentors and faculty alike. With the lessons learned over time, we hope to be a model and resource for other institutions that want to implement a similar experience for medical students.

Mary R. Mulcare, MD, is an assistant professor of clinical medicine in the Division of Emergency Medicine at New York-Presbyterian Hospital/Weill Cornell Medicine in New York.

Robert Tanouye, MD, MBA, is an assistant professor of clinical medicine in the Division of Emergency Medicine at New York-Presbyterian Hospital/Weill Cornell Medicine in New York.

Rahul Sharma, MD, MBA, CPE, is the emergency physician-in-chief in the Division of Emergency Medicine at New York-Presbyterian Hospital/Weill Cornell Medicine in New York.

Sapir Nachum, BS, is a student at Weill Cornell Medical College in New York.

Shokhi Goel, BS, is a student at Weill Cornell Medical College in New York.

Jane Torres-Lavoro is the program coordinator in the Department of Emergency Medicine at New York-Presbyterian Hospital/Weill Cornell Medicine in New York.

Acknowledgements and disclosures: The authors appreciate the support of Weill Cornell Medicine, New York-Presbyterian Hospital and the Department of Emergency Medicine. Private funding was provided by the Istel-Begala Family Healthcare Leadership and Management Fund at Weill Cornell Medicine.

REFERENCES

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3. Goyal R, Aung KK, Oh B, et al. “Survey of MD/MBA programs: opportunities for physician management education.” Acad Med. 2015;90:121.

4. Ackerly DC, Sangvai DG, Udayakumar K, et al. “Training the next generation of physician-executives: an innovative residency pathway in management and leadership.” Acad Med. 2011;86:575-9.

5. Society of Academic Emergency Medicine Fellowship Directory. org/resources/directories/fellowship-directory . Accessed Oct. 11, 2017.

6. Gottlieb MW, E. Wagner, A. Chan, T. “Applying Design Thinking Principles to Curriculum Development in Medical Education.” AEM Education and Training. 2017;1:21-6.

7. Patel MiS, Arora V, Patel MaS, et al. “The Role of MD and MBA Training in the Professional Development of a Physician: A Survey of 30 Years of Graduates from the Wharton Health Care Management Program.” Acad Med. 2014;89:1282-1286.

8. Krupat E, Dienstag JL, Kester WC, Finkelstein SN. “Medical Students Who Pursue a Joint MD/MBA Degree: Who Are They and Where Are They Heading?” Eval Health Prof. 2016;40(2):203-218.