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      Simulating the physician as healthcare manager: An innovative course to train for the manager role Translated title: Simulation Gesundheitsmanagement – der Arzt als Gesundheitsmanager: Ein innovativer Kurs zur Ausbildung der Managerrolle

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          Abstract

          Introduction: During their formal studies medical students acquire extensive medical expertise. However, the medical profession demands additional competencies, such as those involved in efficient resource allocation, business administration, development, organization, and process management in the healthcare system. At present students are not sufficiently prepared for the physician’s role as manager. In response, we designed the seminar course, MeCuM-SiGma, to impart basic knowledge about healthcare policy and management to students of medicine. This project report describes our teaching strategies and the initial evaluation of this educational project.

          Project description: In this semester-long, seminar course introduced in 2010, medical students gather experience with the competencies mentioned above as well as learn basic management skills. The course is offered each winter semester, and students sign up to attend voluntarily; course coordination and organization is done on a voluntary basis by physicians and employees of the Mentoring Office (MeCuM-Mentor) at the Medical School of the Ludwig Maximilian University (LMU) in Munich, Germany. The course is open to all students enrolled at the two medical schools in Munich.

          During the first part of this elective, students learn about the basic principles of the German political and healthcare systems in case-based, problem-based tutorials led by trained tutors and in lectures held by experts.

          In the second part of the course students take on the roles of the University Hospital’s executive board of directors and supervisory board to work on an existing hospital project as a group within the scope of a simulation. This phase of the course is accompanied by workshops conducted in cooperation with university-based and off-campus partners that address the procedural learning objectives (teamwork, project management, negotiation strategies, etc.).

          A suitable, authentic issue currently facing the hospital is selected in advance by the course organizers in coordination with the hospital’s executive board. Students then work on this issue in the third and final phase of the course under the supervision of tutors and with assistance from hospital employees. At the end of the course the students formally present the results of their work to the hospital’s executive and supervisory boards.

          Results: The course undergoes written student evaluation, a round of oral feedback, evaluation of the final projects, and feedback from the hospital’s executive and supervisory boards. All attendees to date have reported a substantial gain in general knowledge and increased knowledge about the healthcare system, and rate the relevance of the course as being high. The majority felt the content was important for their future practice of medicine. Overall, students evaluated the course very positively [overall rating on a six-point grading scale (1=excellent; 6=unsatisfactory): 1.28 (mean)±0.45 (standard deviation)].

          Discussion: The importance of the physician’s role as manager in medical organizations and as a guiding force in the healthcare system is neglected in medical degree programs. Our seminar course attempts to address this shortcoming, is the object of great interest and receives positive evaluations from seminar participants, our cooperative partners and the executive and supervisory boards of the University Hospital in Munich.

          Zusammenfassung

          Einleitung: Medizinstudierende erlangen durch ihre Ausbildung ein umfassendes medizinisches Fachwissen. Allerdings erfordert der Arztberuf zusätzliche Fähigkeiten wie Ressourcenallokation, Wirtschaftlichkeit, Konzeption, Organisation und Prozessmanagement im Gesundheitssystem. Auf die Rolle des Arztes als Manager werden die Studierenden nicht ausreichend vorbereitet. Deshalb entwickelten wir den Kurs MeCuM-SiGma, welcher Medizinstudierenden die Grundlagen von Gesundheitspolitik und -management vermittelt. In diesem Projektbericht stellen wir das didaktische Konzept und erste Ergebnisse der Evaluation des Lehrprojekts vor.

          Projektbeschreibung: Der seit 2010 bestehende, einsemestrige Kurs vermittelt Medizinstudierenden neben den oben bereits erwähnten Kenntnissen grundlegende Managementkompetenzen. Das immer im Wintersemester stattfindende, freiwillige Lehrprojekt wird ehrenamtlich von Ärzten und Mitarbeitern des Mentoring-Büros (MeCuM-Mentor) der medizinischen Fakultät der LMU München koordiniert sowie organisiert und steht allen Medizinstudierenden der beiden medizinischen Fakultäten in München zur Teilnahme offen.

          In der ersten Phase dieses Zusatzangebots lernen die Studierenden in fallbasierten, problem-orientierten Tutorials unter Anleitung von geschulten Tutoren und in Expertenvorträgen u.a. die Grundlagen des politischen Systems und des Gesundheitssystems in Deutschland kennen.

          In der zweiten Phase nehmen die Teilnehmer die Rollen der Mitglieder des Vorstandes sowie des Aufsichtsrates des Klinikums der Universität München ein und bearbeiten in Teamarbeit im Rahmen einer Simulation ein bereits bestehendes Projekt des Klinikums. Begleitet wird diese Phase von Workshops zu den prozeduralen Lernzielen (u.a. zu Teamarbeit, Projektmanagement und Verhandlungsstrategien), die in Kooperation mit inner- und außeruniversitären Kooperationspartnern durchgeführt werden.

          In enger Zusammenarbeit mit dem Vorstand des Klinikums wird von den Kursverantwortlichen im Vorfeld eine geeignete reale Problemstellung ausgewählt, mit der sich der Klinikumsvorstand aktuell befasst. Dieses bearbeiten die Studierenden in der dritten und letzten Phase unseres Kurses unter Supervision von Tutoren und unter Mithilfe von Klinikumsmitarbeitern. Zum Abschluss stellen die Teilnehmer ihre Ergebnisse dem realen Vorstand und Aufsichtsrat in einer Abschlusspräsentation vor.

          Ergebnisse: Der Kurs wird mittels einer schriftlichen Evaluation der Teilnehmer, einer mündlichen Feedbackrunde, einer Evaluation der Abschlussprojekte und eines Feedbacks von Vorstand und Aufsichtsrat des Klinikums evaluiert. Alle bisherigen Teilnehmer maßen dem Kurs einen großen inhaltlichen Informationsgewinn zu, bekundeten einen Zuwachs an Wissen zum Gesundheitswesen und schätzten die Relevanz der Kursziele hoch ein. Die Mehrheit fand die Inhalte wichtig für ihre spätere ärztliche Tätigkeit. Insgesamt wurde der Kurs von den Teilnehmern sehr gut [Gesamtnote auf sechsstufiger Notenskala (1=sehr gut; 6=ungenügend): 1,28 (Mittelwert)±0,45 (Standardabweichung)] bewertet.

          Diskussion: Die Bedeutung der Rolle des Arztes als Manager sowohl in medizinischen Organisationeinheiten als auch als Weichensteller im Gesundheitssystem wird in der medizinischen Ausbildung vernachlässigt. Unser Kursangebot beginnt diese Lücke zu schließen und wird mit großem Interesse und hervorragender Evaluation von Teilnehmern, Kooperationspartnern, Vorstand und Aufsichtsrat unserer Universitätsklinik angenommen.

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          Most cited references34

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          General competencies and accreditation in graduate medical education.

          Many have recommended changing the professional development of physicians. Concluding that further educational process specification was inadequate, the Accreditation Council for Graduate Medical Education (ACGME) decided to specify six general competencies of graduate medical education (GME): patient care; medical knowledge; practice-based learning and improvement; professionalism; interpersonal skills and communication; and systems-based practice. Coupling them with a developmental view of professional knowledge and skill acquisition, the ACGME invited further specification and development of desired learning from the extended medical specialty community, including the specialty boards. This collaborative process offers a model of the role accrediting agencies can play in fostering workforce developmental change.
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            Medical student perceptions of education in health care systems.

            Undergraduate medical education has been criticized for not keeping pace with the increasing complexity of the U.S. health care system. The authors assessed medical students' perceptions of training in clinical decision making, clinical care, and the practice of medicine, and the degree to which the intensity of education in health care systems can affect perceptions. The authors studied data from 58,294 U.S. medical graduates who completed the Association of American Medical Colleges annual Medical School Graduation Questionnaire (2003-2007). In a second analysis, they compared responses of 1,045 medical school graduates (2003-2007) from two similar medical schools with curricula of different intensity in health care systems. The percentage of students reporting "appropriate" training was 90% to 92% for clinical decision making, 80% to 82% for clinical care, and 40% to 50% for the practice of medicine. Students from the school with a higher-intensity curriculum in health care systems reported higher satisfaction than students from the school with a lower-intensity curriculum for training in four of five practice of medicine components: medical economics, health care systems, managed care, and practice management. Importantly, the high commitment to education in health care systems in the higher-intensity curriculum did not lead to lower perceived levels of adequate training in other domains of instruction. Nationally, students consistently reported that inadequate instructional time was devoted to the practice of medicine, specifically medical economics. A higher-intensity curriculum in health care systems may hold substantial potential to overcome these perceptions of training inadequacy.
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              The CanMEDS 2005 physician competency framework. Better standards - better physicians - better care

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                Author and article information

                Journal
                GMS J Med Educ
                GMS J Med Educ
                GMS J Med Educ
                GMS Journal for Medical Education
                German Medical Science GMS Publishing House
                2366-5017
                17 May 2016
                2016
                : 33
                : 3
                : Doc41
                Affiliations
                [1 ]LMU Munich, Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
                [2 ]Universityhospital Munich, Medzinische Klinik und Poliklinik IV, Munich, Germany
                [3 ]LMU Munich, Neurologische Klinik und Poliklinik, Munich, Germany
                Author notes
                *To whom correspondence should be addressed: Maximilian Gradel, LMU Munich, Institut für Didaktik und Ausbildungsforschung in der Medizin, Ziemssenstraße 1, D-80336 Munich, Germany, E-mail: masimilian.gradel@ 123456med.uni-muenchen.de
                Article
                zma001040 Doc41 urn:nbn:de:0183-zma0010400
                10.3205/zma001040
                4894355
                27275506
                632fe6b6-ad71-49a4-9347-2ec063226f9b
                Copyright © 2016 Gradel et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.

                History
                : 15 April 2015
                : 25 February 2016
                : 16 February 2016
                Categories
                Article

                manager role,physician as manager,healthcare management,medical curriculum,simulation,gaming simulation

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