YPL 2015 Day 4

DAY 4: 12 October 2015 Berlin, Germany

Nineteen Young Physician Leaders (YPL) – the 2015 cohort of this five-year-old programme – were invited to Berlin to participate in a leadership training workshop.

One Day 1, they visited research centres in the Berlin area; on Day 2 they got down to business learning about different leadership models and practices; and on Day 3 much of the time was spent finalizing their own leadership improvement plan as well as group work to develop presentations aimed at participants of the World Health Summit itself.

Today, three groups of YPL presented their experiences and insights on leadership and the needs of the younger generation of ‘middle management leaders’ to an audience of about 50 WHS attendees.

Opening the session, with a focus on ‘Boss to mentor to partner’, Helene Rossinot (France) noted that, no matter what the country of origin of individuals in the YPL group (17 countries from five continents are represented) “we all face the same problems.”

She highlighted three main issues that her breakout group had identified: the fact that some much good information is now available freely on the internet, that there is no longer as much need to learn directly from a supervisor or boss, who can be less directly involved in providing training in a particular specialization; age discrimination, which can work two ways – against both younger and older people; and ghost writing, whereby a young physician may not be credited as an author in paper to which they have contributed, or delays in institutional approval systems that mean young leaders’ papers may not be published in a timely manner.

In Romania, another issue emerged – the fact that the previous generation of leaders has largely emigrated, leaving a gap between the old, traditional leaders and the emerging generation. As Csongor Toth put it: “If I deserve it, promote me. If I don’t deserve it, teach me. But don’t leave me in limbo.”

The ‘Boss to mentor to partner’ section then presented two positive case studies for potential replication. Andre Brunoni (Brazil) reported on the group’s visit to the Max Delbruck Centre a couple of days earlier, where they learned that laboratory space and research funding is made available to talented postdocs with good ideas. They can be appointed as junior leaders of research groups first for five years, with a possible extension for another four years. “After nine years,” reported Brunoni, “we heard that 95% of these junior group leaders get tenured positions, either at the MDC or elsewhere.”

Then Gergely Toldi (Hungary) reported on an initiative of the International Society for Advancing Cytometry. At one point, board members realized that their average age was approaching 70, so they established a programme to get younger people more involved.  As well as providing funds for travel and research grants, they provided space for young leaders to attend board meetings, work with the society’s journal editorial team, and help with organizing conferences, even taking the lead in designing and chairing sessions.

“Young people are admitted to the programme for five years,” explained Toldi, “and all the time are followed by a senior mentor. This is a simple but successful initiative that can easily be replicated in other medical fields.”

Najwan Abu Al-Saad (UK) and Venko Filipche (Macedonia) were elected by their group to present the session on ‘Contributing to health system strengthening through partnership’.

Venko highlighted a case study from his experience, inspired by the fact that he had undertaken an internship where he simply watched others performing surgical procedures without getting any hands-on experience himself.

“A group of us realised that this was not unusual and decided to do something about it,” he said. “We focused on Tanzania, where the government has built and equipped new hospitals, but they are almost empty and very few procedures are carried out. The reason is because the doctors, often trained abroad, do not have the confidence, once they return, to undertake the procedures themselves.”

Glavanising a group of colleagues, including senior experts from the USA and other countries, Filipche and his team visited Tanzania and spoke with officials at the Ministry of Health to learn of their needs and priorities.

“They were very welcoming and supportive,” affirmed Filipche. “They realized that such a scheme would show the importance of donated equipment, reduce the likelihood of trained physicians leaving the country in search of more meaningful work, and also eliminate some costs such as sending patients to India for certain procedures.”

With the support of a range of donors, including private companies, his team of experts focused on training the trainers. And training was hands-on. Tanzanian doctors carried out all procedures with their mentors standing behind keeping watch and providing advice when needed. In this way, the local doctors soon built up their confidence and ability to carry out even the most technical procedures on their own.

“Because we train the trainers,” said Filipche, “the project is sustainable and can easily be rolled out in other countries.”

In this case, it is clear that Filipche was a leader. But as his colleague, Al-Saad noted: “As young physicians, we work in different kinds of teams. Sometimes we lead, sometimes we follow, sometimes we partner. At this stage in our careers we can also empathise with younger colleagues and are more open to peer-to-peer networks. Although we are trained and have our specialisations, we are still open to new ideas, procedures and technologies. I hope we will retain this flexibility.”

The final YPL group presentation focused on ‘Training responsive physician leaders for tomorrow’.

“Although modern technology can be a boon,” explained Flavia Senkubuge (South Africa), “it can also cause problems. Anyone can go online and consult ‘Doctor Google’, and patients using social networks can quickly cause damage to someone’s professional reputation.”

“We also require continuing medical education,” she observed, citing the case that, with the current influx of migrants into Europe, cardiothoracic surgeons such as Martins Kalejs (Latvia) also need to know about infectious diseases.

“And then there is the work/life balance – when we must take time for ourselves and recharge our systems against a background of clinical duties, research and management obligations.”

“Leadership and communication must become part of our life-long training curriculum,” confirmed Kalejs, who related his experience in Switzerland working with a mentor on a six-month long programme where he learned not only new clinical skills, but also soft skills like managing a team or a research project.

In the discussion that followed, it was agreed that business administration and management skills should also be included, as these skills would help when dealing with administrators who have no knowledge of clinical practices, as is the case in many hospitals.

“This is certainly true in Bangladesh,” said Fazle Chowdhury, “where we work under the Ministry of Health and Family Welfare., which is run by bureaucrats who don’t understand, for example, the relative merits of a paper published in The Lancet, say, compared to one published in a local journal.”

Among the other questions the YPL had to field was the provocative one: “How do you know that, in 20 years’ time, you won’t be the same kind of boss in the same kind of system?”

Brunoni answered that although we have a generation of young leaders who have not received training to become leaders, there were some programmes available – the IAMP YPL programme fills such a niche for young medical professionals – and that by participating in such programmes, they can pass on their new knowledge also to their peers.

“This is certainly the situation in Sri Lanka,” said Veranja Liyanapathirana, “where our national academy has been nominating YPL for the past five years and we now have a network of alumni who have come together to replicate the YPL-type training in the country.”

“Similar alumni programmes are also taking shape in the Philippines and Brazil,” confirmed Jo Boufford.

Indeed, this is part of the long-term goal of the IAMP YPL programme – not just providing training to a group of up to 20 young physicians each year, but to try to work with the alumni to develop a support network for them, and to encourage them to use their training and peer support group to reach out to others like them in their home countries to spread the word on effective leadership. With good leadership, more effective and efficient institutions are built, and with better healthcare institutions around the world, we hope in some small way to contribute to improved global health.