In Reply to Khoo and Teo : Academic Medicine

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In Reply to Khoo and Teo

Myers, Christopher G. PhD; Pronovost, Peter J. MD, PhD

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Academic Medicine 93(4):p 517, April 2018. | DOI: 10.1097/ACM.0000000000002124
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We thank Drs. Khoo and Teo for amplifying our call for management skills in medical education and for recognizing that more than a single “Management 101” course is necessary to change the practice of medicine. We agree completely that an introductory management course cannot, and should not, constitute the totality of training in these critical skills but, rather, that exposure to these concepts should be ongoing, “beginning in medical school and continuing throughout physicians’ careers.”1 We further agree that education in management skills will require more than formal, rote learning; helping physicians become better leaders is a truly transformational learning endeavor. The question is, as Drs. Khoo and Teo ask, How?

Failures of leadership or management, as with those of clinical competency, can have significant consequences for patient care. Thus, waiting for physicians-in-training to experience a “disorienting dilemma” firsthand is likely both insufficient and undesirable for prompting this kind of learning (and also risks significant delays and variation in learning). Two strategies that we have explored in our own work for surfacing dilemmas and promoting reflection on critical management skills are (1) the review and discussion of leadership scenarios (as described by Drs. Khoo and Teo) and (2) the implementation of high-fidelity interpersonal simulations as part of ongoing physician training.

Developing context-specific leadership scenarios2 and engaging senior, junior, and future physicians in robust discussions about what could be done to address them provides a forum not only for exchanging ideas about how to apply management concepts but also for reinforcing the importance of these skills as an accepted responsibility of medical practice. Moreover, in-depth simulations involving the application of management skills (e.g., deploying effective interpersonal skills with colleagues) present a relatively consequence-free environment in which to experiment with different leadership strategies, whether among junior residents or even department chairs,3,4 and can provide physicians with the types of disorienting dilemmas Drs. Khoo and Teo highlight as the impetus for transformational learning.

Christopher G. Myers, PhD
Assistant professor of management and organization, Carey Business School, and core faculty, Armstrong Institute for Patient Safety and Quality, School of Medicine, Johns Hopkins University, Baltimore, Maryland; [email protected]; Twitter: @ChrisGMyers; ORCID:

Peter J. Pronovost, MD, PhD
Senior vice president for clinical strategy, UnitedHealthcare, Minnetonka, Minnesota.


1. Myers CG, Pronovost PJ. Making management skills a core component of medical education. Acad Med. 2017;92:582584.
2. Pronovost P, Myers C. How prepared are you to lead? AM Rounds. June 13, 2017. Accessed December 21, 2017.
3. Lu-Myers Y, Myers CG. Incorporating interpersonal skills into otolaryngology resident selection and training. Otolaryngol Head Neck Surg. 2018;158:2123.
4. Shapiro DE, Abbott LM, Wolpaw DR, Green MJ, Levi BH. Using a simulation of a frustrated faculty member during department chair searches: A proof of concept project. Acad Med. 2018;93:224228.
Copyright © 2018 by the Association of American Medical Colleges