I recently shared my thoughts on Internal Medicine and my time on CTU (long story short - not a fan). The experience got me thinking about an older post of mine on CanMEDS roles and how the Manager role is an often-neglected yet vitally important aspect to being a physician.
Clerkship has dramatically changed some of my views on medicine, but this is one that couldn't have been reinforced more. The CTU is very much a team and the attending physician - as much as us clerks and the residents rely on them for their substantial medical knowledge - their main responsibility is to manage a rather large team of learners. I found I had the best experience - and patients seemed to have the best outcomes - not when the best medical expert was in charge of the CTU, but when the best manager was in charge.
The thing is, in medicine there aren't many people who aren't exceptionally knowledgeable. I like to think I'm a fairly intelligent, hard-working person, but truth be told I'm a pretty average medical student. I'm perfectly fine with that though and haven't focused my efforts on improving my standing relative to my class. The reason for this is that when I think of the physicians who have done the most capable job, in terms of what colleagues and patients think of them as well as what I've seen of their ability to do provide meaningful help for their patients, they're rarely the walking textbooks other physicians seem to be. Rather they incorporate all those other CanMEDS competencies, including the manager role, along with a high level of knowledge that is near-universal in medicine.
So, as long as my knowledge base can be reasonably described as average or better relative to my peers, I try to focus on other things, like being a good manager, or a good communicator, or a good advocate. In the long run, I believe that's what will make me the best physician I can be for my patients.
Showing posts with label CanMEDS. Show all posts
Showing posts with label CanMEDS. Show all posts
Saturday, 27 February 2016
Saturday, 11 July 2015
CanMEDS Competencies and Being a Manager
The CanMEDS competencies are a set of roles of current and aspiring physicians considered integral to being a capable doctor. While they are typically groan-inducing if mentioned to a group of physicians or med students after they get over that "OMG I'm in Med School" feel (typically takes 2 months), they do serve as a reasonably useful framework.
The reason I find them useful is that deficiencies in any one of them by a physician tends to lead to problems for patients, though not always in obvious, easily identifiable ways. As such, they're qualities every well-rounded physician should be working on improving and maintaining.
Yet every single physician has a weakness in at least one of those roles (full disclosure - for me, I believe it's "Collaborator" and to a lesser extent, "Health Advocate"). That's not a terrible thing - we all have strengths and weaknesses, interests and areas where we struggle. Being less-than-stellar in these areas does lead to sub-optimal care, but doctors are humans and no human is perfect, so a degree of sub-optimal care is unavoidable. More importantly, there's a bit of a diminishing return on improving in many of these roles. Being merely competent at all roles gets a physician most of the way to providing good-quality care.
Where trouble can arise is when physicians are exceptionally strong in one area and almost completely deficient in another. The stereotypical example is the physician who is a strong Medical Expert and Scholar, but a horrible Communicator - I can think of several physicians off the top of my head that fit that description. Being great in one role doesn't compensate for being inadequate in another, because physicians have to jump between these roles frequently.
Another point of trouble is when physicians as a group collectively struggle in any one role. Medicine is ultimately a team sport, so mild deficiencies from an individual perspective can be overcome by strength from a group perspective. The "Scholar" role fits that description well - there are certainly many physicians who are not the strongest Scholars, but because the medical field places such an emphasis on scholarly work, the profession overall does pretty well on that front.
There are certainly some of the CanMEDS roles where physicians, as a group, are lacking. We do well on the "Medical Expert" side of things and, as I said, are pretty good from the "Scholar" perspective. Everything else is a bit of a mixed bag. I'd like to briefly focus on one role that I find often gets neglected: "Manager".
When thinking about management, a lot of physicians immediately think of the administrative tasks that we all hate to do, or the administrators whose primary function sometimes seems to be making practicing medicine more difficult. (As an aside, those administrative tasks and administrators are often quite necessary or helpful, but often in a long-term, big-picture way that's hard to appreciate day-to-day). Yet management, at a fundamental level, really just involves organizing groups of people (including yourself) to accomplish a task efficiently and effectively. Physicians do this all the time, whether it's managing other physicians or members of a larger healthcare team. Knowing how to do this effectively is critical to coordinating care.
The basics of this are not that difficult - for the most part, as long as every member of the team knows what they're supposed to do, by when, and who to check in with when it's completed. Yet, it's amazing how often this basic structure does not get followed and how easily teamwork on a project - or a patient - falls apart without it.
Being a good manager also involves knowing how to be managed. Physicians are no longer the automatic leader of any group, for good reason. Being a good team-member is vital to being a good leader. By following, you learn how certain leadership strategies work and how some of them fail, where they can be adapted or improved upon. Following is a skill that physicians don't work enough on and as a consequence, we could be a lot better at the Manager role.
The reason I find them useful is that deficiencies in any one of them by a physician tends to lead to problems for patients, though not always in obvious, easily identifiable ways. As such, they're qualities every well-rounded physician should be working on improving and maintaining.
Yet every single physician has a weakness in at least one of those roles (full disclosure - for me, I believe it's "Collaborator" and to a lesser extent, "Health Advocate"). That's not a terrible thing - we all have strengths and weaknesses, interests and areas where we struggle. Being less-than-stellar in these areas does lead to sub-optimal care, but doctors are humans and no human is perfect, so a degree of sub-optimal care is unavoidable. More importantly, there's a bit of a diminishing return on improving in many of these roles. Being merely competent at all roles gets a physician most of the way to providing good-quality care.
Where trouble can arise is when physicians are exceptionally strong in one area and almost completely deficient in another. The stereotypical example is the physician who is a strong Medical Expert and Scholar, but a horrible Communicator - I can think of several physicians off the top of my head that fit that description. Being great in one role doesn't compensate for being inadequate in another, because physicians have to jump between these roles frequently.
Another point of trouble is when physicians as a group collectively struggle in any one role. Medicine is ultimately a team sport, so mild deficiencies from an individual perspective can be overcome by strength from a group perspective. The "Scholar" role fits that description well - there are certainly many physicians who are not the strongest Scholars, but because the medical field places such an emphasis on scholarly work, the profession overall does pretty well on that front.
There are certainly some of the CanMEDS roles where physicians, as a group, are lacking. We do well on the "Medical Expert" side of things and, as I said, are pretty good from the "Scholar" perspective. Everything else is a bit of a mixed bag. I'd like to briefly focus on one role that I find often gets neglected: "Manager".
When thinking about management, a lot of physicians immediately think of the administrative tasks that we all hate to do, or the administrators whose primary function sometimes seems to be making practicing medicine more difficult. (As an aside, those administrative tasks and administrators are often quite necessary or helpful, but often in a long-term, big-picture way that's hard to appreciate day-to-day). Yet management, at a fundamental level, really just involves organizing groups of people (including yourself) to accomplish a task efficiently and effectively. Physicians do this all the time, whether it's managing other physicians or members of a larger healthcare team. Knowing how to do this effectively is critical to coordinating care.
The basics of this are not that difficult - for the most part, as long as every member of the team knows what they're supposed to do, by when, and who to check in with when it's completed. Yet, it's amazing how often this basic structure does not get followed and how easily teamwork on a project - or a patient - falls apart without it.
Being a good manager also involves knowing how to be managed. Physicians are no longer the automatic leader of any group, for good reason. Being a good team-member is vital to being a good leader. By following, you learn how certain leadership strategies work and how some of them fail, where they can be adapted or improved upon. Following is a skill that physicians don't work enough on and as a consequence, we could be a lot better at the Manager role.
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