Management & Leadership Pathway - Internal Medicine Residency Program ::

The ever-changing field of medicine demands that future leaders not only excel in the clinical arts but also in the complex management settings that now dominate healthcare. Identifying talented individuals early in their careers and providing clinical and management training - as well as focused mentoring - will be critical to develop future generations of physican executives capable of leading healthcare organizations and influencing the transformation of healthcare. The Management and Leadership Pathway for Residents (MLP-R) provides residents with the knowledge and skills essential to bridge clinical practice and managment and become skillful and effective physican executives.

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Format

The MLP-R is an 18-month rotational experience that gives trainees the opportunity to work on high priority initiatives across the Duke University Health System and the Schools of Medicine and Nursing in multiple disciplies including health system management and operations; financial management and planning; quality improvement and safety; informatics; technology transfer; global strategy and business development; research enterprise management; clinical service enterprise management; and supply chain management.

To accommodate the above, MLP-R trainees would add a PGY-4 year to a three-year residency program, or re-purpose built-in elective or research time within longer programs. The 18 months of structured management experiences (modules) can be intermingled with traditional clinical rotations in six-month blocks. These management modules will be project-based, with a clear work product that can be produced in 3-6 months. The resident will also engage in regular didactic sessions and structured learning programs, including the option to take courses at Fuqua School fo Business, Duke School of Law, and Terry Sanford Institute of Public Policy.

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Curriculum

The goals of the MLP-R are best achieved through thoughtful collaboration among existing post-graduate training programs and the management structure of Duke Medicine to allow trainees to (a) complete requirements for clinical practice and ABMS board eligibility (and where applicable, specialty board certification), and (b) participate in project-driven modules designed to achieve applicable solutions to high priority issues within their clinical Department and Duke Medicine. Throughout the combined training program, clinical rotations and management modules will be aligned to the extent possible. For example, a trainee may participate in a clinical rotation in nephrology and then complete a management rotation aimed at increasing outpatient dialysis services in the Triangle, North Carolina.

Core Curriculum

Health System Management and Operations

One of the keys to successfully managing complex organizations is to understand the way in which individual components interact with each other. Focusing on the multifaceted relationships between various parts of Duke Medicine will build greater insight into future needs of the organization and the best approaches to address system-wide needs. This rotation will impart trainees with the know-how to create efficiency on an organizational level by properly aligning multiple elements within the system.

Financial Management and Planning*

Physician executives must be able to use the latest quantitative techniques and strategies to measure and improve a health system’s value and performance. Trainees may chose to focus on a specific financial function such as investments (Duke Management Company) or clinical revenue management (Patient Revenue Management Organization). This rotation will impart the knowledge, behaviors and confidence to meet the challenges of today’s real-world and real-time healthcare economy.

Quality Improvement and Safety*

Local and national trends place tremendous emphasis on continuous quality improvement. The combined business and clinical skill sets expected of trainees provide excellent tools to address this crucial topic. After completing this rotation, trainees will be able to focus on developing innovative and rapidly deployable ideas to improve the quality of clinical care within a healthcare system and disseminating these ideas across other healthcare organizations.

Selective Curriculum

Information Technology/Informatics*

Properly developing and deploying information technology and informatics capabilities plays an integral role in the success of major healthcare organizations. Developing fundamental knowledge about the role of information technology and potential innovations within academic healthcare will help provide the basis for future strategic planning. This rotation will teach trainees how to use the tools of information technology to advance clinical care and health system management.

Hospital Operations

In patient care continues to represent a large part of a health system’s operational and financial foci. The hospital setting is an ideal one for trainees to learn the symphonic interplay among such diverse entities such as environmental services, food preparation, perioperative services, and others. This rotation will give resident the opportunity to participate in the daily activity of one or more of Duke Medicine’s hospitals.

Technology Transfer and Licensing

Developing efficient infrastructure for maximizing technology transfer and improving skill sets in assessment of technology for commercial potential are key components of adding value within an academic medical center. Multiple organizations at Duke, including the Office of Licensing and Ventures, the Office of Corporate and Venture Development, and the Center for Entrepreneurship and Research Commercialization, would provide fertile laboratories for trainees to gain experience in this critical arena.

Global Strategy and Program Development*

Academic healthcare organizations, including Duke Medicine, are expanding their global presence. Future leaders must comprehend the changing global landscape for academic medicine and its potential impact to the organization. This rotation will educate trainees on how to generate synergies among global initiatives to further the mission of Duke Medicine. The ongoing developments in Singapore and furthering the concept of Duke Medicine Global would provide fertile opportunities to develop a project within this rotation.

Research Enterprise Management

Leaders in academic healthcare organizations must have a thorough understanding of the structure and management of the research enterprises associated with these organizations. This rotation will focus on developing a deeper comprehension of the interplay between the clinical and research functions of major academic healthcare organizations such as Duke. The Duke Translational Medicine Institute provides an ideal venue for developing a project within this rotation.

Clinical Service Enterprise Management*

Recognizing opportunities to expand services to meet demand is crucial to the viability of a healthcare organization. This rotation will impart an understanding of how to grow and modify services in the midst of changing demographics, competitive reimbursement environments, and fluid institutional priorities. Trainees may choose to focus on a specific service line such as the Cancer Center or Heart Center.

Supply Chain Management

Understanding how supply chain activities, including management and negotiation of contracts for goods and services, logistics and materials distribution, and reduction of non-labor spend impact the functioning of a health system is vital to a physician executive’s repertoire of skills. This rotation will focus on the key aspects related to the acquisition of goods and services, supplier relationships, and cost reduction.

(*denotes a rotation that may be coordinated from within the trainee’s primary ACGME Department)

Trainees will also have the opportunity to interact informally with thought leaders throughout Duke Medicine through a regular luncheon/seminar series.

The MLP-R addresses the six ACGME general competencies as follows:

Patient care	Residents will continue to provide supervised care on the inpatient wards and in the outpatient clinic per their individual residency program requirements. The resident will demonstrate caring and respectful behavior in all patient interactions; make informed decisions about diagnostic and therapeutic interventions with an improved understanding of the resource limitations of the practice setting; demonstrate creative and effective use of information technology in patient care; serve as a model for effective inter-departmental communication and collaboration within the institution; demonstrate an active awareness of relevant continuous quality improvement initiatives that are achievable in this setting; demonstrate a commitment to patient safety and autonomy in all endeavors; advocate for quality of patient care at all times; demonstrate the appropriate application of health system knowledge and methodology when implementing patient care plans.
Medical knowledge	Residents participating in the RMLP will acquire expanded knowledge of the administrative, financial, and management issues related to the diagnosis and treatment of disease at individual, system, community, and population level.
Practice-based learning and improvement	Practice-based learning is a key focal point of the RMLP and will take place during all modules. Residents/fellows will participate in rotational modules throughout Duke Medicine managing the interface between clinical care and the business of medicine.
Interpersonal and communication skills	Residents will continue to develop their written and oral presentation skills. They will learn to build coalitions and partnerships while navigating the complexities of a major medical center.
Professionalism	Residents will have added opportunity to demonstrate professionalism by working with non-clinical team members and both leading and taking direction from them. The resident will endorse the ethical principles that are most important in health care delivery from a systems perspective.
Systems-based practice	Systems-based practice is the cornerstone competency of this program. Residents will gain understanding of how the clinical enterprise functions within a framework of financial, managerial, regulatory, and entrepreneurial forces.

The MLP-R addresses two additional program competencies as follows:

Research and scholarly activity

The resident will develop a working understanding of management and research needs of the health system in which the resident is working; develop a practical understanding of the existing research programs and institutional review protocols already in place; understand the historical, economic, and cultural issues that may have an effect on research initiation and implementation in the relevant health care facilities and communities; and lead a final project that is relevant and involves one or more management disciplines.

Personal growth

The resident will demonstrate a commitment to continuing education; identify areas for personal and practice improvement; demonstrate receptiveness to instruction by non physicians and other managers; facilitate the education of learners within the system by serving as a teacher and role model to medical students, other residents, and others; demonstrate the ability to discuss medical errors from a systems perspective and a willingness to learn from these errors; begin a process of self-analysis that will foster an awareness of the additional stress that can be encountered when combining management with clinical practice; and develop a personal system for stress reduction and coping mechanisms for the inevitable management errors one will encounter in this setting.

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Sample Curriculum

To ensure synergy across training, clinical rotations and management modules will be aligned to the extent possible. For example, a trainee may participate in a clinical month in nephrology and then complete a managment rotation aimed at increasing outpatient dialysis services in surrounding counties. Additionally, residents will participate in management modules within the Department of Medicine, further ensuring integration of clinical and management skills.

This graphic represents a potential schedule for a trainee interested in operations. In each case modules and projects will be tailored to match the resident's priorities and interests. For example, a trainee interested in global initiatives may find modules aligned with Duke's initiatives in Asia and Singapore (e.g. global business and strategy, technology transfer) more suited for his/her career goals.

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Sample Projects

Outlined below is a sampling of projects that program leadership envision for MLP-R participants:

MLP-R Module	Project
Health System Management	Re-evaluate current plans for expansion in setting of current economy
Performance, Quality and Safety	Develop aligned metrics for Internal Medicine Quality Improvement
Hospital Operations	Design an effective patient flow management process
Finance	Compare and contrast overhead expenses across outpatient clinics
Clinical Service Management	Analyze and propose changes to better align incentives among clerical, administrative, and clinical staff
Strategy	Identify targeted areas for growth in surrounding counties