Physicians as Managers of Health Care Delivery and the Implications for Postgraduate Medical Training: A Literature Review

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Abstract
Background: As increasing demands on health care services are posing new challenges to practicing physicians worldwide, physicians have to extend existing and develop new competencies in various domains of their profession. Management and leadership is one of these domains, and relevant competencies have been incorporated in many new competency-based (postgraduate) training programs. Among trainee physicians and clinical educators, however, good understanding remains scant in relation to the definition and content of the physician's competency as manager. Summary: One objective of this article is to identify the specific knowledge, skills, and attitudes required for the development of managerial competencies in physicians. The article also establishes both the extent to which competency-based curricula are successful in equipping medical trainees with managerial competencies and the availability of programs specifically designed to develop these competencies. We reviewed publications retrieved through a PubMed search using relevant keywords, combined with the “related articles” function and a manual search of the references of the retrieved articles. Forty relevant articles were selected. They addressed residents’ needs for management education and described the design, implementation, and evaluation of management education curricula. Most of the studies were conducted in North America and within the family medicine specialty. The most commonly taught topics were financial and management concepts and quality assurance. In all studies, training resulted in improved knowledge about management issues. All curricula were evaluated positively despite the use of different educational methods. Conclusions: Management education in health care appears to be generally considered essential and necessary. There is, however, no clear consensus as to when in the medical education continuum, how, and for how long management education should be provided.

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