A Transformative Learning Approach to Teaching Management Skills in Medical Education.

Abstract

To the Editor: Drs. Myers and Pronovost1 have drawn attention to the need for management skills in medical education; however, as they admit, instituting “Management 101” into a medical school curriculum is no panacea to the challenges faced by physicians in an increasingly complex health care landscape. The intricate interplay between medicine and management, coupled with changes in technology and health care policy along with their attendant implications for practice, requires more than the basic serving of first-year business school topics indicated in their Commentary. Medical students will have a tough time comprehending how management concepts are relevant, given their selection of the medical vocation. We therefore advocate that a formal management curriculum be integrated with immersive learning experiences that enable the transition from informational learning, which increases one’s knowledge and skill base, to transformative learning, which changes the way people see themselves and their world. Transformative learning begins with experiencing a disorienting dilemma, leading the learner to reevaluate underlying assumptions and worldviews. Critical reflection upon the dilemma leads to a renewed understanding of the learner’s limitations and areas for improvement. This engagement in reflective discourse and the acquisition of new capabilities to address limitations transform the learner by providing new perspectives. Not just seeing but actually living the new perspective is a critical pillar of transformative learning.2 What may a curriculum inculcating management skills in medical education, undergirded by transformative learning theory, look like? Two important aspects are key: (1) A disorienting dilemma may take the form of a narrative about failed leadership and management leading to negative consequences in patient care; and (2) critical reflection that highlights the paucity of the learner’s leadership and management skills, coupled with implications at the personal or system levels, may prompt the learner to fill these gaps. The transformative learning approach to management skills will be even more relevant to residents who, in post-medical-school years, have real-world opportunities to adapt and transfer management lessons to daily practice. Drs. Myers and Pronovost highlight the challenge of working in an environment where management skills are treated with cynicism and tokenism. To ensure that junior clinicians are exposed to balanced perspectives while learning from senior clinician role models, we propose pairing learners with senior clinicians working in concert with business school faculty to contextualize and interpret management capabilities within a health care milieu. Hwee Sing Khoo, MComm, PhDResearch analyst, Health Outcomes and Medical Education (HOMER), National Healthcare Group, Singapore; ORCID: http://orcid.org/0000-0002-8880-3494. Winnie L. Teo, PhDManager, Group Education, National Healthcare Group, Singapore; [email protected]; ORCID: http://orcid.org/0000-0003-4592-6344.