NOVEMBER / DECEMBER 2003

HARVARD MACY INSTITUTE

Harvard Macy course model customized to meet an institution’s needs

Each June the Harvard Macy Institute convenes its popular Program for Leaders in Medical Education. This program helps leaders of academic medical centers identify the most effective strategies for fostering innovation in their institutions. Generally the participants come from many different countries, but in September the Institute answered the call of the University of Western Ontario (UWO) to deliver a leadership program designed specifically to help UWO’s leadership better manage an exciting new initiative aimed at ensuring high-quality health care in underserved regions of Canada.

Dr. Elizabeth Armstrong, director of the Harvard Macy Institute, and Dr. Tom Aretz, HMI director of international education, led a multi-disciplinary group of 40 faculty, chairs, and deans in London, Ontario through a series of exercises tailored to the curriculum reform challenges at UWO.

The University of Western Ontario became interested in hosting the program after a number of its faculty attended the Program for Leaders in Medical Education in Boston. “They came back raving about the quality of the program,” says Dr. James Silcox, Vice Dean for Education in the Faculty of Medicine and Dentistry at UWO. “There was a feeling at UWO that we had a lot of new faculty, deans, and chairs, and would benefit from this approach to leadership training. We anticipated that managing the SWOMEN initiative would be a challenge.”

Dr. Jim Silcox, Vice Dean of Education

SWOMEN—which stands for Southwestern Ontario Medical Education Network—is a partnership of communities throughout Southwest Ontario designed to encourage doctors to practice in underserved areas. London, the site of UWO, is 200 miles from Toronto, which Silcox says is a magnet for new doctors who graduate from UWO and other institutions in the region. SWOMEN is part of a curriculum reform mandate, part of which requires increased class sizes. “There just weren’t enough places to serve the residencies and clerkships in London, so we looked to other areas,” said Silcox.

Because so many people in so many different departments were involved in the SWOMEN effort, Armstrong says, it made sense to take the course to Western Ontario. “Originally, UWO inquired about sending a large group to Boston for our Leaders program, but because we could not accommodate the number, after discussion, we concluded with the dean at UWO that this would be a great opportunity to customize the program to meet the specific challenges of UWO.”

For three days in September, 40 academic deans and department chairs, plus other medical educators and leaders—all in some way stakeholders in UWO’s curriculum reform initiative—worked with Armstrong and Aretz to bring down the barriers between them and develop a plan of action for enhancing the value of SWOMEN. The group had three main objectives for the workshop: develop negotiation skills that would enable them to work together, learn how to overcome resistance to change, and learn how to build a task force to get the work done. The reform efforts at UWO involve a number of disparate groups that simply aren’t accustomed to working together: clinical faculty at both London and at the rural sites, and the policymakers in government who have an interest in the program’s success.

One exercise placed the participants in a mock situation which required that they use negotiation techniques to come to an agreement. As Armstrong put it, “They had an opportunity to practice skills of negotiation in a risk-free setting, and then step back and reflect on what works or does not work for them in that setting.”

Silcox saw it from the point of view of a participant. “We were able to put ourselves in the shoes of others. This was the big highlight: to have the opportunity to negotiate and see how others view us.”

Armstrong explained that although the program was guided by a formal curriculum—a set of activities, a collection of readings, specific exercises designed to meet UWO’s objectives—the “informal curriculum, that unscripted set of conversations that take place over coffee or during a break, helped the participants realize that they benefit from hearing the perspectives or approaches of people in other departments, other clinical sites, and within different layers of the organization.”

This demolition of communication barriers that enables people not only to collaborate, but to begin to develop strategies for navigating an array of related but competing agendas, raises an interesting question: why is it difficult for a group of educated, well intentioned people with the same goal to work together?

“ We are all creatures of habit,” says Armstrong. “Faculty and leaders have succeeded in their academic lives by performing work in a pattern that promotes their outstanding efforts and their departments individually. But now organizations like UWO are requiring work to be done across departments by multi-disciplinary teams, and some find themselves unfamiliar working in that venue.”

When asked to assess the Harvard Macy model, Armstrong explains that she measures a program’s success by the readiness of the participants to “leave the program with a new action plan and the tools to move forward with it effectively.”

Silcox said that UWO is taking the lessons of the program and devising its next steps, including taking a close look at the SWOMEN project and identifying ways to improve it. There is work to be done, but in his view, the program has already had a positive effect. “The program essentially turned us on our ear,” he said. “The buzz around UWO is significant.”

Although elements of the Institute’s programs have been delivered in other parts of the world, this was the first time that one of the two annual programs of the Institute has been customized for one institution’s needs. Armstrong and Aretz are currently exploring other opportunities to replicate the Western Ontario experience for other institutions, and several schools have already shown interest in hosting the program in the future.

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