And while medical student curricula have changed considerably over the last 30 years, graduating students still feel insecure about the future of medicine, and most relate they had little to no management and leadership training in medical school.
In a survey that the University of South Florida College of Medicine is just completing, 60% of physicians practicing three years or less feel that despite being more than $100,000 in debt, they did not learn what they most needed in practice. They learned biochemistry, anatomy, cardiology and obstetrics-gynecology. But many did not learn how to creatively embrace change, collaboratively negotiate or effectively communicate. They learned how to “be a doctor” but not necessarily how to be an individual in an organization, be a leader (or a follower for that matter), run an effective meeting or even make patients happy.
In a paper I co-wrote many years ago with one of my professors from the Wharton School at the University of Pennsylvania, we spoke about the selection and educational biases that have held physicians back from effectively embracing and leading change; in essence, that we had joined a “cult” around autonomy, competitive and hierarchical biases that affected our ability to lead healthcare transformation
At USF College of Medicine, we had been wrestling with these issues and have successfully implemented changes toward achieving these goals through a more holistic approach to admissions as well as implementing “areas of scholarly concentration” in which medical students have the opportunity to take a “minor” in business and entrepreneurship, health disparities, health systems engineering, international medicine, law, medical education, medical humanities, public health or research. But to go to the next level, we needed a hospital partner who embraced the same values of interprofessional education, leadership development, emotional intelligence and embracing of quality and safety in their educational efforts.
Traditionally, you could limit that search by getting out a map and drawing a circle around your campus to see which teaching hospitals might be available to partner. But now, when more people meet on Match.com than the local tavern, we decided that philosophical agreement may be more important than geographic congruity. We found our ideal partner, Lehigh Valley Health Network, a mere 1,094 miles away in Allentown, Pa.
Lehigh Valley is one of the great community academic centers, has been recognized by U.S. News & World Report for 13 consecutive years as one of America's Best Hospitals, has consistently been among the “most wired” health systems (important when you are working more than 1,000 miles away) and has the same set of core values necessary to make this program successful—namely, interdisciplinary, patient-centered care; a laser focus on quality and safety; and a willingness to be forward-thinking and creative in their educational approach.
And so the SELECT (Scholarly Excellence, Leadership Experiences and Collaborative Training) program was born. On the surface, the concept is simple. Students will enter USF College of Medicine, spend two years in the main campus in Tampa, Fla., and their entire clinical experience at Lehigh Valley in Allentown. There will be cross-fertilization of faculty and programs, and Lehigh Valley becomes the northern academic campus for USF Health.
But, just as the vinyl record giving way to MP3 files is more than just a change in how music is played, this program is more than a change of venue for medical students. The Josiah Macy Jr. Foundation report of 2009 stated that “medical education has not kept pace with the growing demands of an increasingly complex healthcare system. As a consequence, medical students too often graduate without all the knowledge and skills that 21st century physicians need and without fully appreciating the role that professional values, leadership competencies and attitudes play.” Our SELECT program has embraced these challenges in a number of ways.
In order to pre-select the most likely candidates to succeed in this environment, we have supplemented our admissions criteria and are working with the Teleos Leadership Institute, founded by two Wharton professors, to actively search for characteristics of students—such as self-awareness, empathy, and the ability to be a change catalyst—that make it likely for them to be successful in a leadership role. We will be using a behavioral experience interview, a well-known “emotional intelligence” tool in the business world, but seldom used in healthcare. We have also added questions to the secondary application that search for specific leadership experiences and traits. The overall goal is to rely less on science GPA and MCATs and more on parameters that will create physicians less prone to the “biases” of the past.
The curriculum will include traditional components of medical education side-by-side with three new broad categories of education: leadership education, values and ethics, and health systems and policy. SELECT students will need to demonstrate competency in each of these areas similar to the more traditional medical topics. For example, while all medical students will be taught healthcare policy and reform, the SELECT students will immerse themselves at a higher level through small group policy analysis and synthesis, giving presentations to policy groups and “hands-on” training.
Another unique aspect of the program will be the emphasis on mentoring and coaching. Each student will have two mentors—one each from USF and Lehigh Valley—and will be expected to meet weekly. There will be a summer leadership internship between years one and two in which students will be expected to follow and interact with a leader of their choosing. This can be a physician entrepreneur, the state's surgeon general or a health network chief medical officer, to name some examples. The student will choose based on their goals and leadership views and will report on their experiences. The students will be brought together in a fourth year capstone course—an intense, two-month amalgamation of personal and class experiences—leading to the conclusion of their medical and leadership training.
This is a beginning, but we believe that the SELECT program will break traditional geographic barriers as well as begin a dialogue of what we should (and shouldn't) be teaching medical students as they move to a very different healthcare system than the one that created most of their faculty and deans.
Dr. Stephen Klasko is dean of the University of South Florida's College of Medicine and senior vice president of USF Health, Tampa.
