The formation of future doctors’ managerial competence: experience in leading institutions of higher medical education in Ukraine

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Lviv Polytechnic National University

The formation of future doctors' managerial competence: experience in leading institutions of higher medical education in Ukraine

Maksym Myskiv

Abstract

The article deals with the problem of future doctor's managerial competence formation. The aim of the article is as follows: to analyze the educational programs of future doctor's training in the leading medical higher education institutions in Ukraine in the context of their managerial competence formation. The article highlights the results of scientific literature analysis. The author substantiates the criteria for selection of institutions of higher medical education of Ukraine, the experience of which is studied. The article presents the results of the analysis of educational programs for future doctors' training and determines its common features as well as compliance with the Standard of higher education for the second (master's) level of higher education in speciality 222 Medicine. It is proved that most institutions of higher medical education offer optional courses, which form separate components of the managerial competence of a future doctor in such professional domains as "cooperation", "services", and "the development of profession". The issues of forming managerial competence for the implementation of one's own professional activity and professional development of doctors, promoting the development of professional community, improving services, introducing changes, etc., remain outside the attention of educational programs' developers. The conclusion is made that there are gaps both in educational programs and in the knowledge of medical students regarding the need to master managerial knowledge, skills and abilities, as well as their application in professional activities. Such conclusions provide grounds for the development of scientific and methodical recommendations for solving this issue.

Key words: future doctor, managerial competence, educational program, Standard of higher education for the second (master's) level of higher education, speciality 222 Medicine, core courses, optional courses, knowledge, skills, abilities.

Анотація

managerial competence future doctor

Миськів Максим

Формування управлінської компетентності майбутніх лікарів: досвід провідних закладів вищої медичної освіти України

У статті розглядається проблема формування управлінської компетентності майбутнього лікаря. Мета статті полягає в наступному: проаналізувати освітні програми підготовки майбутніх лікарів у провідних закладах вищої медичної освіти України в контексті формування їхньої управлінської компетентності. У статті висвітлено результати аналізу наукової літератури. Автором обґрунтовано критерії відбору закладів вищої медичної освіти України, досвід роботи яких вивчається. У статті наведено результати аналізу освітніх програм підготовки майбутніх лікарів та визначено їхні спільні риси, а також відповідність Стандарту вищої освіти другого (магістерського) рівня за спеціальністю 222 Медицина. Доведено, що більшість закладів вищої медичної освіти пропонують вибіркові курси, які формують окремі компоненти управлінської компетентності майбутнього лікаря в таких професійних сферах, як «співпраця», «послуги», «розвиток професії». Поза увагою розробників освітніх програм залишаються питання формування управлінської компетентності для здійснення власної професійної діяльності та професійного розвитку лікарів, сприяння розвитку професійної спільноти, удосконалення послуг, впровадження змін тощо. Зроблено висновок про наявність прогалин як в освітніх програмах, так і в знаннях студентів-медиків щодо необхідності оволодіння управлінськими знаннями, уміннями та навичками, а також застосування їх у професійній діяльності. Такі висновки дають підстави для розробки науково-методичних рекомендацій щодо вирішення цього питання.

Ключові слова: майбутній лікар, управлінська компетентність, освітня програма, Стандарт вищої освіти другого (магістерського) рівня, спеціальність 222 Медицина, основні курси, вибіркові курси, знання, уміння, навички.

Introduction

The profession of a doctor fairly occupies one of the privileged places among other professions. Medical education has a special role in the higher education system, which is justified by the professional activity of doctors who work with people, which requires not only the mastery of general and professional competencies during initial professional training but also the formation of a humanistic worldview, patient-centeredness, the ability to continuous professional and personal development, etc.

Modern scientific and pedagogical studies highlight the organization of initial professional training of future doctors, the main goal of which is the formation of their professional competence (Мельничук, Мукан, Біда, & Пашко, 2022). Regarding management and its implementation in the health care system, scientists analyze its various aspects. We have analyzed those works that are directly related to the health care institution and the professional activity of modern doctors. Медяник та Липчанський (2016) investigate the effectiveness of the health care system institution, distinguishing its types as medical, social, and economic. Грабовський та Клименко (2014) study the specifics of applying a systemic approach to the management of a health care facility. Борщ (2019) characterizes the modern personnel management system of the health care institution. Generally, in scientific works, it is said that managerial competence, as a component of the professional competence of modern doctors, is important for the performance of professional functions in cooperation with colleagues, nurses, patients and their families, and managerial staff of the health care system. Understanding the role and importance of managerial competence in the professional activity of a doctor, it is logical to study the experience of institutions of higher medical education aimed at training future doctors for managerial activities.

The aim of the article is to analyze the educational programs of future doctor's training in the leading medical higher education institutions of Ukraine in the context of their managerial competence formation.

Research results

Taking into account the results of scientific investigations of domestic researchers, which highlight the specifics of doctors' professional activity, theoretical and methodological approaches, laid as a basis for the formation of future doctors' professional competence in institutions of higher medical education, considering the results of our study of managerial competence, its place in the structure of doctors' professional competence, we consider it necessary to investigate the practice of domestic institutions of higher medical education and find out whether it involves the formation of managerial competence during initial professional training.

It is logical to refer to regulatory documents, among which there is the Standard of higher education in speciality 222 Medicine for the second (master's) level of higher education. It was approved by Order №1197 of Ministry of education and science of Ukraine on 08.11.2021 (МОН України, 2021). It is worth noting that at the beginning of 2024, only the Standard for the second (master's) level of higher education was approved, and development of the Standard for the third (educational and scientific) level of higher education is still ongoing. The specificity of future doctors' training in Ukraine is that there are no programs of the first (bachelor's) level of higher education for speciality 222 Medicine since the training of future doctors is carried out according to an integrated master's program, which has 360 ECTS credits.

This Standard states that educational and professional or educational and scientific programs of the second (master's) level of higher education in the speciality 222 Medicine are aimed at the formation of integral competence (“the ability to solve complex problems, including research and innovation in the field of medicine; the ability to continue learning with a high degree of autonomy” (МОН України, 2021, p. 8), as well as several general and special (professional, subject) competencies (МОН України, 2021).

The results of the analysis of the Standard for speciality 222 Medicine for the second (master's) level of higher education show that managerial competence as a component of future doctors' professional competence is not distinguished as a separate competence, but managerial knowledge, abilities and skills are traced in a number of both general and special (professional, subject) competencies. For example, the general competences include “the ability to adapt and act in a new situation; the ability to make informed decisions; ability to work in a team; the ability for interpersonal interaction” (МОН України, 2021, p. 9); among special (professional, subject) competencies - “the ability to solve medical problems in new or unfamiliar environments in the presence of incomplete or limited information, taking into account the aspects of social and ethical responsibility; the ability to analyze the activities of a doctor, unit, health care institution, quality assurance medical care and increase the efficiency of the use of medical resources; the ability to organize and integrate the provision of medical care to the population and conduct marketing of medical services; to clearly and unambiguously convey one's own knowledge, conclusions and arguments on health care problems and related issues to specialists and non-specialists, in particular to learners; the ability to manage work processes in the field of health care, which are complex, unpredictable and require new strategic approaches; the ability to develop and implement scientific and applied projects in the field of health care” (МОН України, 2021, p. 10).

The system of higher medical education in Ukraine includes 15 institutions that train specialists with higher education for the health care system. According to the data provided on the information resource «Освіта.ua» (Осві-ra.ua), among the leading 5 institutions of higher medical education there are the following ones: Bogomolets National Medical University (Національний медичний університет імені О. О. Богомольця), Danylo Halytsky Lviv National Medical University (Львівський національний медичний університет імені Данила Галицького), I. Horbachevsky Ternopil National Medical University (Тернопільський національний медичний університет імені І.Я. Горбачевського), National Pirogov Memorial Medical University, Vinnytsya (Вінницький національний медичний університет імені М.І. Пирогова), Bukovinian State Medical University (Буковинський державний медичний університет).

Acquaintance with educational programs for training specialists in speciality 222 Medicine in these institutions of higher education shows that they have common characteristics. All the listed universities offer educational and professional training programs for future doctors. At the same time, it was found that there are no proposals for training in educational and scientific programs in speciality 222 Medicine. The training lasts about 6 years (360 ECTS credits), and its successful completion involves obtaining a master's degree in medicine with the professional qualification “Doctor”.

The educational and professional programs of selected institutions of higher medical education are offered in Ukrainian and English and have successfully passed accreditation. Analysis of the competencies declared in educational programs shows their compliance with the Standard of higher education in speciality 222 Medicine of the second (master's) level of higher education (МОН України, 2021), and their formation is ensured by educational components belonging to the cycle of general and professional training.

The results of the analysis of educational and professional programs of the five best institutions of higher medical education in Ukraine indicate that only I. Horbachevsky Ternopil National Medical University offers the academic discipline “Management and Economics of Health Care” (2 ECTS credits), which is studied during the 6th year of study (Тернопільський національний медичний університет імені І.Я. Горбачевського).

During the analysis of the syllabi, it was found that the studied institutions of higher medical education offer optional courses, each of which partially relates to the formation of future doctors' managerial competence in a certain domain.

For example, the optional courses in Bogomolets National Medical University presuppose:

“formation of the student's ethical and deontological qualities of a medical specialist and the ability to apply them in specific professional situations, which creates the necessary prerequisites for faster adaptation to further work in the clinic” within the scope of the “Professionalism and Medical Ethics” course (Національний медичний університет імені О.О. Богомольця, 2023a, p. 2), which is important for such a domain of professional activity as cooperation;

"interaction skills and interpersonal skills; the ability to act based on ethical considerations; the ability to plan and manage time; the ability to be critical and self-critical; ability to work in a team; the ability to identify, pose and solve problems; the ability to preserve and multiply moral, cultural, scientific values and achievements of society based on understanding the history and patterns of development of the subject area, its place in the general system of knowledge about nature and society and the development of society, technology, to use various types and forms of motor activity for active recreation and leading a healthy lifestyle” within "Professionalism and medical culture” course (Національний медичний університет імені О.О. Богомольця, 2023b, p. 2), etc.

Among the main tasks of the optional "Management in health care” course, which is offered for study to students of the 6th year in Danylo Halytsky Lviv National Medical University, the following are distinguished: "deepening knowledge of the foundations of social and humanitarian policy of the state and directions of reforming the health care sector of Ukraine; mastering the basic methods of management in the field of health care; mastering basic technologies and management styles; familiarization with the concepts of "neo-management”, "innovative management”, "evidence management”, electronic, "self-management”, "information management”, "timing management”; study of the main economic indicators of the health care system; mastering the SWOT analysis methodology and the ability to apply the results in decision-making in healthcare management; studying the peculiarities of the management of pharmacotherapy of socially significant diseases (myocardial infarction, stroke, arterial hypertension, diabetes, COVID-19); study of issues of management of drug-related problems and risk management of pharmacotherapy; mastering the basics of drug behavior management and its role in improving the quality of pharmacotherapy and the system of providing medical care in general; study of issues of information management and innovations in health care” (Львівський національний медичний університет імені Данила Галицького, 2023, р. 2).

Among the learning outcomes of the “Humanity and empathy in the work of a doctor” optional course, which is offered in I. Horbachevsky Ternopil National Medical University, the following are determined: “to build relationships with the patient based on trust; recognize the patient's emotions; communicate with the patient with respect for his values without stigma and discrimination; regulate personal boundaries and respect the boundaries of others; resolve conflicts; build partnerships with the patient and family; involve patients in shared decision-making about their health/treatment; communicate with patients in difficult situations; to communicate bad news with patients or their families with a demonstration of appropriate support; to be aware of and manage one's own emotions” (Тернопільський національний медичний університет імені І.Я. Горбачевського, 2023а, p. 2).

Within the frame of the “Fundamentals of Medical Communications” optional course the following skills are developed: “the ability to use theoretical knowledge and practical skills in humanitarian, medico-biological, and professionally oriented disciplines related to medical activity; to quickly collect medical information about the patient and analyze clinical data; to solve practical professional tasks in modern conditions of state formation and relevant social and political relations; to comply with the requirements of ethics, bioethics and deontology in their professional activities; to adhere to the doctor's code of ethics, which ensures the formation of a specialist with appropriate personal qualities, to raise the general educational and cultural level; to solve complex tasks and problems in professional communication with the patient” (Тернопільський національний медичний університет імені І.Я. Горбачевського, 2023b, p. 2).

The optional course “Conflictology” provides “the formation of systemic knowledge and understanding of the conceptual foundations of the general theory of conflicts; features of conflicts at different levels of existence of the social system; mastering the main styles of conducting the negotiation process; social conflict management mechanisms; analysis of conflicts in the professional activity of a medical worker; research on the technology of effective communication and rational behaviour in conflict” (Тернопільський національний медичний університет імені І.Я. Горбачевського, 2023с, p. 2).

The optional course “Marketing of medical services” deserves special attention as well. Its syllabus states that its successful mastery will enable students to “use economic methods and techniques during the planning, organization and evaluation of the activities of health care institutions in the conditions of public and private management; predict the negative and positive consequences of the influence of various factors on the activity of a health care institution; choose the most effective directions for the growth of health care institutions; organize and conduct marketing research; develop competitive marketing strategies” (Тернопільський національний медичний університет імені І.Я. Горбачевського, 2023d, p. 2).

At National Pirogov Memorial Medical University, Vinnytsya one can find the optional course "Communicative skills of a doctor”, aimed at mastering "means of psychological influence (psychological tools) in the process of professional dialogue with the patient (active listening skills, methods of calming, motivating, informing, showing empathy); criteria for successful communication (achievement of planned results, development of relations with patients, their relatives, colleagues, personal satisfaction); doctor's tactics and strategy during patient consultation - conducting a diagnosis - reporting a diagnosis” (Вінницький національний медичний університет імені М.І. Пирогова, 2023, p. 3).

According to the syllabus "Training of a doctor's communicative competence” at Bukovinian State Medical University, it is aimed at "developing the professional communication skills of a doctor; analysis of verbal and non-verbal means of communication; formation of adequate self-esteem, stress-resistant personal resources; constructive life skills and behavioural strategies; analysis of the cause of communication difficulties; development of empathic communication; development of emotional intelligence; constructive behaviour in conflict situations; communicative competence of cooperation in a team; introspection and reflection...” (Буковинський державний медичний університет, 2023, p. 1).

The performed analysis makes it possible to single out the characteristic features of the experience of the top five institutions of higher medical education in Ukraine regarding the formation of managerial competence of future doctors. First of all, we should note that the practice of introducing a separate educational component, aimed at forming the management competence of the future doctor, to the list of mandatory ones is rare. From the researched experience, this is available only in one institution of higher medical education. For most institutions of higher medical education, the experience of delivering optional courses, which form separate components of the managerial competence of a future doctor, is evidenced by the results of the analysis of their syllabi.

In the course of the analysis of educational programs for masters in the speciality 222 Medicine, presented on the websites of institutions of higher medical education, it was found that the proposed optional courses mainly involve the development of knowledge, skills and abilities that are necessary for a doctor to fully function in such domains of professional activity as:

“cooperation” (Bogomolets National Medical University, I. Horba- chevsky Ternopil National Medical University, National Pirogov Memorial Medical University, Vinnytsya, Bukovinian State Medical University);

“services” (Bogomolets National Medical University, Danylo Halytsky Lviv National Medical University, I. Horbachevsky Ternopil National Medical University, National Pirogov Memorial Medical University, Vinnytsya, Bukovinian State Medical University);

“the development of profession” (Bogomolets National Medical University, Danylo Halytsky Lviv National Medical University).

However, the results of syllabi analysis of the specified optional courses give grounds to claim that their content only partially reveals the specifics of the several domains of professional activity, and there is no proposal related to the professional development of a doctor and the formation of managerial competence in this domain.

Regarding the “cooperation” domain, the main emphasis is placed on the formation of skills and abilities to establish and maintain constructive professional relations with patients, and teamwork. Regarding the “services” domain, the optional courses are aimed at mastering knowledge about people management and activity management.

Regarding “the development of profession” domain only Danylo Halytsky Lviv National Medical University provides the development of knowledge about management in the health care system in general and the formation of skills and abilities in the use of technologies, and management styles, that have an impact on the development and introduction of innovations in health care, as well as making decisions based on knowledge and evidence, evaluating their impact.

The issues of forming managerial competence for the implementation of one's own professional activity and professional development of doctors, promoting the development of the professional community, improving services (ensuring patient safety, introducing innovations, promoting transformations), introducing changes, etc., remain outside the attention of educational programs developers. It seems logical to single out such a shortcoming as the selectivity of courses aimed at the formation of separate elements of managerial competence. This means, that if a student from the list of optional courses does not choose one of the analyzed educational disciplines, then in this case there is no possibility of forming even separate elements of the managerial competence of the future doctor.

Conclusions

So, based on the analysis of the experience of leading institutions of higher medical education in training future doctors, we conclude that there are gaps both in educational programs and in the knowledge of medical students regarding the need to master managerial knowledge, skills and abilities, as well as their application in professional activities. Such conclusions provide grounds for the development of scientific and methodical recommendations for solving this issue.

References

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11. Національний медичний університет імені О.О. Богомольця. (2023b). Силабус навчальної дисципліни «Професіоналізм і медична культура». Взято з: https://docs.google.com/document/d/1lc7Ub1n1DCM6nTgKyQNmK5Vqthsd7 XoZW9GcEQmrfo/edit (O.O. Bogomolets National Medical University. (2023b). Syllabus of the academic discipline "Professionalism and medical culture".

12. Retrieved from: https://docs.google.eom/document/d/1lc7Ub1n1DCM6nTgKyQNmK5Vqt_hsd7XoZW9GcEQmrfo/edit). Національний медичний університет імені О.О. Богомольця. (2023а). Силабус навчальної дисципліни «Професіоналізм та лікарська етика». Взято з: https://drive.google.com/drive/folders/1YAHlJfFx9O5CVrALOPbCZJVkIQs1FPZ (O.O. Bogomolets National Medical University. (2023a). Syllabus of the academic discipline "Professionalism and medical ethics". Retrieved from: https://drive.google.com/drive/folders/1YAH_lJfFx9O5CVrALOPbCZJVkIQs1FPZ).

13. Тернопільський національний медичний університет імені І.Я. Горбачевського. (2023а). Силабус навчальної дисципліни «Людяність та емпатія в роботі медика». Взято з: https://drive.google.com/file/d/1idkT-dk7oh6Sxs3oha8j1MDD9v9c57Q/view (Ternopil National Medical University named after I.Ya. Gorbachevsky. (2023a). Syllabus of the educational discipline "Humanity and empathy in the work of a doctor". Retrieved from: https://drive.google.com/file/d/1idkT-dk7oh6Sxs3oha8j1MDD_9v9c57Q/view) Тернопільський національний медичний університет імені І.Я. Горбачевського. (2023b). Силабус навчальної дисципліни «Основи медичних комунікацій». Взято з: https://drive.google.com/file/d/1Yc0DcB8goppLCi1IrOj2oGalLaBiUWvf/view (Ternopil National Medical University named after I.Ya. Gorbachevsky. (2023b). Syllabus of the educational discipline "Fundamentals of medical communications". Retrieved from: https://drive.google.com/file/d/1Yc0DcB8goppLCi1IrOj2oGalLaBiUWvf/view). Тернопільський національний медичний університет імені І.Я. Горбачевського.

14. (2023с). Силабус навчальної дисципліни «Конфліктологія». Взято з: https://drive.google.com/file/d/1tRXoAbomOPTdW7zR0YOC0IyINucBHPUw/view (Ternopil National Medical University named after I.Ya. Gorbachevsky. (2023c). Syllabus of the educational discipline "Conflictology". Retrieved from: https://drive.google.com/file/d/1tRXoAbomOPTdW7zR0YOC0IyINucBHPUw/view) Тернопільський національний медичний університет імені І.Я. Горбачевського.

15. (2023d). Силабус навчальної дисципліни «Маркетинг медичниг послуг». Взято з: https://drive.google.com/file/d/1jYR0aB77DnFyfe960eLjfstAKiwkJVV/view (Ternopil National Medical University named after I.Ya. Gorbachevsky. (2023d). Syllabus of the educational discipline "Marketing of medical services". Retrieved from: https://drive.google.com/file/d/1jYR0aB77DnF_yfe960eLjfstAKiwkJVV/view).

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