doctors and managers

Published: 27/03/2003, Volume II3, No. 5848 Page 44

If clinicians are to become involved in management, they need to acquire awareness of operational issues early in their careers. David Pearson and colleagues report

The need for doctors to be involved in management is well accepted. But what sort of training do they need to enable them to fulfil this role?

Ideally, it should be cumulative so that medical students and senior house officers acquire awareness of operational issues early in their careers and develop more strategic skills at a later stage.

1But this approach conflicts with traditional ones, in which doctors are taught to be autonomous and selfdriven in order to maximise levels of patient care.

Traditionally, management training for doctors in the UK has been episodic and remedial. Generally doctors have been reluctant to enter senior management positions in contrast to Denmark, where structured management training is compulsory and medical directors' posts carry more status than in the UK.

2In October 2001, the division of medicine at Stockport trust devised a pilot scheme to contribute to the management development of specialist registrars. It was aimed at those who would shortly be applying for consultant posts.

The scheme centred on shadowing sessions. The division tried to give each specialist registrar an opportunity to shadow managers and clinicians in meetings at a variety of levels within and outside the organisation. Participants had the chance to attend a primary care trust board meeting as well as divisional meetings within the trust.

Participants shadowed the trust medical director, clinical directors, divisional and assistant divisional managers, management trainees, clinical governance facilitators, PCT project managers and the assistant director of service development. Participants had the opportunity to attend meetings on capacity modelling, developing services, clinical governance, targets and options appraisal.

As the pilot evolved, several of the participants expressed an interest in completing psychometric tests to help them understand their management styles and identify areas for development.These sessions were facilitated by the trust's training manager, who subsequently provided feedback on the results.The training department offered learning lunches presented by a management development specialist.

Seven specialist registrars started the scheme and five completed it. It was rated excellent or good by those who finished it. Some wanted more emphasis on one-to-one tutorials and others wanted more shadowing sessions with a greater variety of managers and clinicians.One said it would have been helpful to have an outline of the trust's management structure and how it worked. It was a surprise to the division that specialist registrars with 10 years' experience of working in acute trusts did not already know this.

One of the unexpected benefits of the scheme was that it fostered a closer relationship between managers and specialist registrars.One manager said he felt easier about approaching specialist registrars to discuss service development, having gained a greater understanding of the pressures on them.

The division concluded that the scheme had developed participants'management competencies and understanding of the organisation and fostered new relationships between doctors and managers. It had also contributed to the development of the division as a whole. The training is now being offered to specialist registrars in other divisions of the trust.

Similar schemes could easily be replicated in other NHS organisations with little financial cost.The major resource required is management time to organise the shadowing sessions.The principal recommendation to trusts wanting to start such a scheme is to ensure the support of a senior clinical director, or the trust's medical director.


1Palmer R, Sprugeon P and Clark J. Doctors in management: Career view mirror, Health Service Journal. 2001; 111 (5783) 2627.

2Clark J. 2002 Clinical management and leadership - an international perspective.HSMC Newsletter Vol. 8. , No 3.

David Pearson is a management trainee at Cheshire and Merseyside Strategic Health Authority.Dr Lisa Rees is assistant divisional manager, division of medicine, Stockport trust.Nicola Marsden, is assistant general manager, Heart and Lung Division South Manchester University Hospitals trust.