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      Leadership and management in the undergraduate medical curriculum: a qualitative study of students’ attitudes and opinions at one UK medical school

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          Abstract

          Objective

          To explore undergraduate medical students’ attitudes towards and opinions about leadership and management education.

          Design

          Between 2009 and 2012 we conducted a qualitative study comprising five focus group discussions, each devoted to one of the five domains in the Medical Leadership Competency Framework, (Personal Qualities, Working with Others, Managing Services, Improving Services and Setting Direction). Each discussion examined what should be learnt, when should learning occur, what methods should be used, how should learning be assessed, what are the barriers to such education.

          Participants

          28 students from all three clinical years (4–6) of whom 10 were women.

          Results

          2 inter-related themes emerged: understanding the broad perspective of patients and other stakeholders involved in healthcare provision and the need to make leadership and management education relevant in the clinical context. Topics suggested by students included structure of the National Health Service (NHS), team working skills, decision-making and negotiating skills. Patient safety was seen as particularly important. Students preferred experiential learning, with placements seen as providing teaching opportunities. Structured observation, reflection, critical appraisal and analysis of mistakes at all levels were mentioned as existing opportunities for integrating leadership and management education. Students’ views about assessment and timing of such education were mixed. Student feedback figured prominently as a method of delivery and a means of assessment, while attitudes of medical professionals, students and of society in general were seen as barriers.

          Conclusions

          Medical students may be more open to leadership and management education than thought hitherto. These findings offer insights into how students view possible developments in leadership and management education and stress the importance of developing broad perspectives and clinical relevance in this context.

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          Most cited references8

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          Physician-leaders and hospital performance: is there an association?

          Although it has long been conjectured that having physicians in leadership positions is valuable for hospital performance, there is no published empirical work on the hypothesis. This cross-sectional study reports the first evidence. Data were collected on the top-100 U.S. hospitals in 2009, as identified by a widely-used media-generated ranking of quality, in three specialties: Cancer, Digestive Disorders, and Heart and Heart Surgery. The personal histories of the 300 chief executive officers of these hospitals were then traced by hand. The CEOs are classified into physicians and non-physician managers. The paper finds a strong positive association between the ranked quality of a hospital and whether the CEO is a physician or not (p < 0.001). This kind of cross-sectional evidence does not establish that physician-leaders outperform professional managers, but it is consistent with such claims and suggests that this area is now an important one for systematic future research. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Is management essential to improving the performance and sustainability of health care systems and organizations? A systematic review and a roadmap for future studies.

            Recent studies have highlighted the importance of management in the health care sector. Positive correlations have been found between clinical and economic performance. Although there is still controversy regarding what kind of management and which managers should lead health care organizations and health systems, we now have interesting evidence to analyze. Starting with a systematic review of the literature, this article presents and discusses the streams of knowledge regarding how management can influence the quality and sustainability of health systems and organizations. Through the analysis of 37 studies, we found that the performance of health care systems and organizations seems to be correlated with management practices, leadership, manager characteristics, and cultural attributes that are associated with managerial values and approaches. There is also evidence that health care organizations run by doctors perform better than others. Finally, we provide a roadmap that indicates how the relationship between the management and performance of health systems and organizations can be further and more effectively investigated.
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              Clinical leadership development requires system-wide interventions, not just courses.

              This is the third article in a series on clinical leadership and medical education. In the first two articles in this series we looked at the nature of leadership and examined professional outcomes, standards and competency frameworks from around the world that describe what it is we are trying to instil in medical students and doctors in postgraduate training. In this article we explore current trends in leadership development and describe broad approaches to clinical leadership development, highlighting those strategies that are likely to be more (or less) successful.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2014
                25 June 2014
                : 4
                : 6
                : e005353
                Affiliations
                [1 ]The Primary Care Unit, University of Cambridge , Cambridge, UK
                [2 ]Queen Edith Medical Practice , Cambridge, UK
                [3 ]Imperial College Healthcare NHS Trust, London, UK
                [4 ]West Suffolk Hospital NHS Trust , Bury St Edmunds, UK
                [5 ]Department of Medicine, Hinchingbrooke Health Care NHS Trust, Hinchingbrooke , Cambridgeshire, UK
                [6 ]School of Clinical Medicine, University of Cambridge , Cambridge, UK
                [7 ]General Practice Education Group, The Primary Care Unit, University of Cambridge , Cambridge, UK
                Author notes
                [Correspondence to ] Dr Thelma Quince; taq100@ 123456medschl.cam.ac.uk
                Article
                bmjopen-2014-005353
                10.1136/bmjopen-2014-005353
                4078777
                24965917
                d4fccb6c-2723-4521-8904-b07a8b562357
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 27 March 2014
                : 9 June 2014
                : 11 June 2014
                Categories
                Medical Education and Training
                Research
                1506
                1709
                1710

                Medicine
                medical education & training,qualitative research
                Medicine
                medical education & training, qualitative research

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