Fellowships in ED Administration: Suggestions for a Standardized, Domain Based Curriculum
OPERATIONS MANAGEMENT COMMITTEE
Erin Muckey, MD MBA, Akiva Dym, MD, Kraftin Schreyer, MD MBA FAAEM, and Anthony Rosania, MD MHA FAAEM
development. This has led to the independent development of administrative fellowships, thus contributing to the significant variability which exists within the curriculums, structure, and duration of the varying administrative fellowships.
I
ntroduction
As health systems grow ever larger and more complex, it has become readily apparent that there is a critical need for skilled physician leadership at all levels of hospital and clinical administration. In particular, this assessment has spurred the development and growth of Emergency Medicine (EM) Administrative Fellowships around the country.1 The breadth of health care experience of an EM physician makes them uniquely positioned for leadership roles both within their own departments and the entire health care system. While other fellowships such as Observation Medicine, Toxicology, Telehealth, EMS and Event Medicine, Critical Care, and Sports Medicine have all offered Emergency Medicine the ability to expand the footprint of EM beyond providing “traditional”
LEADERSHIP & CHANGE MANAGEMENT
CLINICAL OPERATIONS
FINANCIAL OPERATIONS
LEGAL & POLICY ISSUES
The Seven Domains
PATIENT SAFETY & QUALITY
PROFESSIONAL & ACADEMIC DEVELOPMENT
While a variety of curricular approaches have been developed by the individual administrative fellowship programs themselves, there has been little done thus far to standardize these approaches. In the subsequent paragraphs, we will attempt to outline a standardized domain-oriented model for health care administration fellowship programs. While this outline of a seven-domain model is far from exhaustive, we hope that this will serve to help foster further discussion and deliberation within the EM community and serve as a starting point for further development of a standardized approach to the administrative fellowship.
DATA & INFORMATICS
emergency medicine care, administrative roles may allow for EM physicians to continue to expand into another important area which had previously been underutilized. Furthermore, as the EM SIT AMET workforce continues to expand, it will become increasingly important for EM physicians to also continue to expand the careers and opportunities which exist outside of the “four walls” of the emergency department (ED).2 There are over 40 current administrative-related fellowships to which residents can apply for formally structured training.3 These fellowships are presented under a variety of titles, such as administration, administration and leadership, administration and patient safety, operations and administration, quality improvement, and so forth. Many, but not all, are included in the Society for Academic Emergency Medicine Fellowship Directory.4 Currently, the Accreditation Council for Graduate Medical Education (ACGME) website outlines suggested program requirements for a “Health Care Administration, Leadership, and Management Fellowship” (HCALM).5 However, no current certifying board exists as of yet, and the program accreditation process remains under
The first step in any curriculum development is to identify the key domains which must be addressed within the educational model, and then determining the knowledge required within each domain. Mapping the required body of knowledge to specific domains is consistent with the work done for other EM fellowship programs and with what others have done for administrative fellowships. By starting at the domain level, one can define the specific body of knowledge required. The necessary crosswalks and mapping of individual topics to the best learning modality can then be performed. The lecture format may not always be the ideal modality for all learning, and some skills and knowledge may be best imparted via other formats such as readings, case studies, and experiential settings. We have placed the seven domains in a pyramid structure: as one moves up the pyramid, the domains begin to become increasingly focused and “hard skill” oriented, with the domains at the bottom of the pyramid forming the foundational skills required for the upper tiers of the pyramid.
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COMMON SENSE MAY/JUNE 2022
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