In this study we investigated whether the perceived deficiencies and needs among Dutch residents were similar to those of their peers in other countries and if a longer incorporation of the CanMEDS framework and management training had an influence on the residents’ perceptions of their management competency.
We used a questionnaire that measured the perceived management competencies of residents from Denmark, Canada, the Netherlands and Australia and found out that on the average, residents from Canada scored lowest in their perceived competencies. In addition, the Canadian residents had lesser number of years of clinical experience post graduation than their Danish and Dutch counterparts and multiple regression analysis showed that this factor significantly influenced the average perception of their management competencies. This finding was remarkable however, since the CanMEDS framework emerged from Canada and had been implemented in their postgraduate training program about 10 years prior to its implementation in the other countries included in our survey. The Canadian respondents scored especially low, in comparison to the residents from the other countries, on the items in the factors Career Planning and Professional Ethics. Our assumption is that this may be due to the fact that the general guidelines for postgraduate training programs set up by the RCPSC are subject to the interpretation of the different program directors and how they subsequently translate these guidelines into specific educational activities. It is possible for example, that residents do not receive any training in these areas, because some program directors may feel that residents will learn this on the job, or that they may get more training in their senior years. Why the Dutch residents gave higher ratings than their colleagues in Canada is not completely clear, since they too do not receive any mandatory management training during medical school as well as during the postgraduate training. An explanation for the higher ratings from the Australian junior doctors could be that in some universities a number of hours are spent on topics such as health services management and health economics [personal communication: S. Ahern, Medical Director of Postgraduate Medical Council of Victoria, Australia].
The residents from Denmark gave themselves on average the highest scores, which could be due to the mandatory management training, which all residents in Denmark receive. We saw in our results that the more training they received, the higher their average score was (mean no training 3.40 (SD 0.38), mean one training 3.55 (SD 0.37), mean two training courses 3.57 (SD 0.38) mean three training courses 3.83 (SD 0.27)). Moreover the medical students in Denmark also receive a three-week course on Medical Sociology where topics such as “knowledge of how the healthcare system is organized and financed”, “management technologies”, “quality development” and “health policies” are being addressed .
The item “negotiating working conditions” was in the top three of lowest perceived competencies in all four countries. “Knowledge of how their respective specialist department is organized and financed” was in the top three of lowest scored items in Canada, Australia and the Netherlands while the other items in the respective top three category differed per country. These differences can, for example, be attributed to the structure of the health care systems the residents were working in, or to the education they received in (medical) school. These differences should be accounted for when developing and designing a management training in the different countries.
The same can be said about the residents preferred topics for a future management course. The topics differed per country except for “negotiation skills” which was in the top three of preferred topics in all of the countries. Since the majority of the residents from all four countries rated their negotiation skills lowly and chose it as a preferred topic for a management course, it suggests that this topic is a subject residents want to know more about and that it is a need which is felt in all participating countries.
Most importantly, the majority of the residents from all four countries felt a need for (more) management training. In Denmark, despite the extra attention that was given to the managers’ role during the postgraduate training, the average need for additional management training remained high. The different subcategories showed that the percentage of Danish residents who had not received any training yet and had a need for management training was 84.6%. The percentages of residents who had an additional management training need and received one, two or all three training courses was 87.0%, 81.2% and 78.9% respectively. An explanation for the increase in percentage after the first training could be that their interest in the subject is being raised after their first management course and that awareness arises of their knowledge gap in this area.
The favorite method of instruction was the same for Canada, Australia and the Netherlands, namely a workshop. The residents from Denmark preferred a case based method. The majority of all residents chose “physicians” as the preferred instructor for a management-training program. The preferred length of each training differed between Denmark, Canada and Australia from one hour to a half day. The preferred frequency of sessions among the respondents from those three countries was once every month or every half year.
We acknowledge that there is little room left for additional content in most postgraduate medical curricula and that including yet another element, namely medical management, into these busy programs may be difficult. However we think that since the managers role has been identified as a key competency in the four participating countries, the training programs in those countries need to design courses to develop this competency. Also, the extent to which these skills would need to be taught may differ for instance by the resident’s number of years in training or their personal interest. Nevertheless, our research showed that the majority of the residents felt a need for a basic understanding of medical management.
As we mentioned earlier in our methods section, there were constraints e.g. logistical and time that influenced our approach and choice for convenience sampling. As this could have resulted in our survey population being biased, we need to interpret our findings with caution. For example, the response rate was not as high as we had hoped for in all four countries and particularly low in Australia, despite the two reminders we sent. We assume that the low response rates could have been due to the increasing amount of emails and questionnaires that residents receive, which may have resulted in a lack of time and interest in the residents to respond. We know this to be especially true for the Australian residents, as they regularly receive surveys from their own health services. Furthermore, our use of convenience sampling in the Netherlands, Australia and Canada may have resulted in a selection of samples that were not fully representative of the situation among all the residents at a national level in the respective countries. In other words, our findings in the district of Victoria may not necessarily be representative of a national view or of the view of residents in other districts. However, we do expect some degree of generalizability in the results since all countries have similar frameworks (CanMEDS) in their national health services, which have been used to develop their respective professional training programs. Finally, caution should be exercised when interpreting these results as we measured the perceived management competencies of the residents in our survey, and it is possible that the scores could have been different if objective assessment methods had been used.