Medical Education’s Seismic Shift: Implications for Recruiting New Leaders

In a recent article, Joyce De Leo shared her views on the seismic shift taking place in medical education. She pointed out that it is now time for change and that change is coming quickly as medical educators review the way classes are taught and what subjects are included in the curriculum, redefine who is best qualified to teach these classes, and identify who can best lead medical schools through this era of transformation. In this interview, Dr. De Leo follows up on those ideas, sharing her thoughts on how these changes impact leadership—and leadership searches—at medical schools.

The EvoLLLution (Evo): How could medical schools—and academic medical centers and universities as a whole—be impacted if they do not adapt to the shifts taking place?

Joyce De Leo (JDL): Medical schools and academic medical centers must anticipate the market shifts and respond in a proactive, informed way to improve the quality of medical education. Much of the change in medical education over the past decade has been driven by forces in graduate and postgraduate education. The ACGME (Accreditation Council on Graduate Medical Education) was the first accrediting organization to adopt competencies on which residents in all 9,000 residency programs in the U.S. would be assessed.

These competencies included new domains such as practice-based learning and improvement, systems-based practice, interpersonal and communication skills, and professionalism, in addition to the traditional domains of medical knowledge and patient care. This shift in what resident physicians must be able to demonstrate in terms of their knowledge, skills and attitudes has caused residency programs to redesign their educational approaches.

The ABMS (American Board of Medical Specialties) has adopted very similar competencies on which physicians in practice will be assessed for their board certification. These changes have led to the adoption of programs for maintenance of certification for practicing physicians in all fields of medical practice. This new landscape for physicians graduating from medical school requires that medical schools not only keep pace with these changes, but excel in the preparation of physicians who will be able to thrive in this new environment.

Those medical schools that are adopting innovations in medical education delivery and content can improve their national reputations and enrollment.  If their reputation declines, this may impact the ability to secure federal and private research funding, as well as the opportunity to procure philanthropic gifts to support budget increases and decreasing indirect cost recoveries. The Liaison Committee on Medical Education (LCME) provides significant oversight of medical education, and probationary status, even if temporary, can significantly damage reputation. This can greatly impact the quality of prospective students and the ability to attract outstanding faculty and researchers.

Evo: Is the pressure for new leadership and new directions coming from the schools themselves, or from healthcare organizations and the marketplace?

JDL: The demands for new directions and new leadership come from both internal and external factors. As noted above, one key stakeholder that has enormous clout and power is the ACGME. The ACGME is a private, non-profit council that evaluates and accredits more than 9,000 residency programs across 135 specialties and subspecialties in the United States. The ACGME establishes educational standards and program requirements for all training programs. ACGME accreditation signifies a program’s commitment to maintaining quality education for residents and the safe care for patients. A program must be ACGME-accredited in order to receive federal graduate medical education (GME) funds.

The ACGME competencies noted above have been an important driver of educational change in medicine. In order to align with these residency requirements, medical schools have taken on the charge of integrating specific curriculum throughout the four years to begin to address these competencies after graduation. This implementation has impacted course and contact hours, as well as the faculty that are now needed to teach in the four-year curriculum. And these changes are not static. Medical education content continues to evolve as health care organizations and medical schools recognize the emerging importance of population health, precision science, bioinformatics, data analytics, and the role of inter-professional teams.

An additional external force impacting the medical educational mission is the role of integrated health systems as they merge with or even acquire academic medical centers and medical schools. New legislation such as the Affordable Care Act is shaping reform of payment for health care as well as driving shifts in the organization of care. One such shift is the creation of accountable care organizations (ACOs).  As hospitals, ambulatory practices, payers, and communities reshape their systems and move toward collaborative partnerships, the landscape of health care is changing drastically and requires leaders with new skills. As the focus of these partnerships shifts to improving health care delivery and achieving better outcomes for the same or lower costs, the educational mission is often overlooked by senior leadership.

Evo: Is there a typical career path for medical school leaders? Besides credentials and experience as physicians and/or researchers, what other qualifications are needed?

JDL: The typical career path for medical school leaders is being challenged. The usual step-wise progression from resident or post-doctoral fellow to junior faculty as an assistant professor and then promotion through the ranks until a leadership role is obtained may not yield the type of innovator required to navigate and succeed in these demanding times. Leaders were often chosen to be department chairs or deans based on their successful research career. Managing a research laboratory or having a successful clinical practice does not ensure or even predict success in a leadership role. Progressive administrative leadership and both internal and external professional development should be sought out throughout one’s career.

For leadership in medical education, additional training in education, the science of learning and the use of technology to deliver hybrid and distance learning will be highly valued. Attending regional and national meetings and being members of education, digital and learning societies, especially those that integrate neuroscience and learning will broaden one’s perspectives, knowledge and approaches. Other examples of leadership training in academic medicine that would be highly relevant for medical school leaders of the future include: the Executive Leadership in Academic Medicine (ELAM) program,  the American Association of Medical Colleges (AAMC) Leadership Development series, several offerings by the Harvard Macy Institute, the Stanford Leadership Development Program, and even advanced degree programs such as the Masters in Health Care Delivery Science offered at Dartmouth.

Another qualification that should be considered for medical school leaders of the future is the complexity of roles that one has held previously and quantifiable metrics of success within those roles. For example, the number of faculty recruitments, increases in federal and private funding, ability to fundraise and develop philanthropic support can all be measured.  An often difficult to measure, but critical qualification, is the social and emotional intelligence of the candidate.  Strong emotional and social intelligence and a proven ability to connect with others in a meaningful way at all levels of an organization is a major indicator of future success.

Evo: What does it take to find the ideal leader for a medical school? What are some best practices in recruiting in this area?

JDL: One of the best practices for leadership recruitment is for the current leadership team to first understand and assess the organization’s culture, opportunities, challenges, and appetite for change. Honesty and self-reflection during this assessment phase will lead to better outcomes for selection of the right candidate. The leader possessing the right cultural fit, previous experience and expertise, and emotional intelligence will excel in the organization.

It is imperative to expand the network of contacts from a diverse pool of candidates. This diversity of gender, ethnicity, geography, perspectives, experience and skill sets results in greater depth and breadth for leadership vision, innovation and transformation. Remember to cast a wide net and encourage applications from those that come from different organizations and backgrounds. Having more minds with diverse creative solutions will position medical schools to respond to the current challenges and emerge as stronger organizations.