The Emergency Physician as Medical School Leader
In this issue of Academic Emergency Medicine, Cole et al.1 have developed a conceptual model to serve as a guide to emergency physicians who wish to pursue leadership roles in the medical school dean's office. The skill set required for success as an emergency physician and leader within the discipline may represent an ideal background for the integrative leadership needed at the helm of a medical school.2 Successful leaders in the dean's office share common attributes of vision, administrative acumen, financial savvy, integrity, scholarship, communication, interpretative ability, and excellent group dynamics with an ability to work with a team (member or leader).3 Emotional intelligence is widely believed to be a core value for successful practice as a clinician, educator, and leader.4 It may be one of the most critical traits for the future medical school leader.5
Emergency physicians typically oversee multidisciplinary teams and must have an intuitive sense and a broad background of knowledge with expertise in the acute diagnosis and management of life-threatening conditions. They must be able to engage with a variety of individuals (patients and their families, trainees, colleagues, consultants, emergency medical services [EMS] personnel, nurses, support staff, etc.) and be able to solve problems in creative ways. Although this skill set is robust, each EM candidate will likely require some professional development to complete their qualification portfolio for a deanship.
Emergency medicine representation in the dean's office is critical for the advancement of the specialty. The Liaison Committee for Medical Education mandates that medical students should be able to evaluate the undifferentiated patient (Standards ED-13, ED-17).6 The emergency department is the ideal place for this requirement to be met; however, EM is not universally a required clerkship, nor are all EM faculty members situated within dedicated academic departments of EM. Substantial funding is generally allocated within an institution for required EM (and other) clerkships along with dedicated administrative support. On the other hand, elective clerkships, including subinternships in EM, may suffer from a lack of institutional funding.
Within the dean's office are numerous roles, and although different institutions will group responsibilities and assign titles accordingly, there are some common themes7 that are outlined in Table 1. The pragmatic approach recommended by Cole et al. can be applied to one's interest in an assistant/associate dean role to service as the overall medical school dean.
| Type of Deana | Common Duties | Desirable Traits |
|---|---|---|
| Overall dean |
School vision Coordination of leadership team External communication Development of revenue streams Accreditation Talent recruitment |
Balance of vision and management skills Large portfolio of emotional competencies (manages complexity, manages conflict, business insight, courage, customer focus, interpersonal savvy, strategic, resourceful) |
| Clinical affairs |
Manage clinical service mission Support department chairs, health system leadership, and dean's team Compensation plan oversight Practice plan operations |
Operationally savvy Fiscal acumen Outcomes focused Customer service Team and network development Resourceful and strategic |
|
Academic affairs Undergraduate education Faculty affairs |
Coordinate educational mission for different levels of learners Monitor and anticipate changing accreditation mandates Maintain accreditation standards Acquire resources for educational mission and develop educational synergy working with dean's team and department chairs Support faculty development Manage curricular assessment |
Outcomes focused Customer service Team and network development Resourceful and strategic Fiscal acumen Organizational savvy Persuasive and resilient Innovative |
| Business administration & operations | Manage operations and overall fiscal/administrative infrastructure of school in support of department chairs, health system leadership, and dean's team |
Fiscal acumen Organizational savvy Persuasive and resilient Innovative Resourceful and strategic Customer service |
| Research | Manage research infrastructure, operations and strategy of school in support of department chairs, health system leadership, and dean's team |
Innovative Resourceful and strategic Fiscal acumen Customer service Team and network development Outcomes focused |
| Student affairs |
Manage student well-being and success during medical school training Provide career counseling and coordinate personal counseling and stress management Coordinate student financial aid program |
Outcomes focused Customer service Innovative and flexible Develops talent Manages conflict Communicates effectively |
| Admissions |
Coordinates medical school admissions process Recruits admissions team members Advocates for diversity Supports equitable and holistic process |
Outcomes focused Team and network development Customer service Develops talent Manages conflict Communicates effectively |
| Graduate medical education |
Coordinate educational mission for residents/fellows Monitor and anticipate changing GME accreditation mandates Maintain GME accreditation standards Acquire resources for GME mission and develop synergy working with dean's team and department chairs |
Outcomes focused Customer service Team and network development Resourceful and strategic Organizational savvy Persuasive and resilient Innovative |
| Continuing medical education |
Coordinate educational mission for faculty and community-based professionals Monitor and anticipate changing CME accreditation mandates Maintain CME accreditation standards Acquire resources for CME mission and develop synergy working with dean's team and department chairs |
Outcomes focused Customer service Team and network development Resourceful and strategic Organizational savvy Persuasive and resilient Innovative Plans and aligns activities with customer base |
| Graduate education |
Coordinate educational mission for graduate students in MS/PhD programs Monitor and anticipate changing graduate education accreditation mandates Acquire resources for graduate education mission and develop synergy working with dean's team and department chairs Support graduate student well-being |
Outcomes focused Team and network development Resourceful and strategic Organizational savvy Persuasive and resilient Innovative Operationally savvy Fiscal acumen Customer service |
- a This table represents a broad range of duties and desirable traits for various deanship roles. Individual institutions may have different roles and expectations. Readers are encouraged to consult with local leaders and refer to organizational charts for the most relevant information.
It is important to take a step back and emphasize that work in the dean's office differs from work within the academic department as the former is primarily discipline-focused and the latter is primarily institution-focused. The skills needed in the dean's office use less discipline-related knowledge and are less operationally tied to specific disciplines. The more valuable skills include vision setting, clear and consistent communication, trust and relationship building, listening and information integrating, and team building that will help the institution (or school) overcome fiscal and personnel changes, public perception, and other internal and external forces. Yet one does not generally lead in the dean's office without an understanding of the end product (physician, scientist, faculty member), the educational/training/accreditation process, the interplay of the missions of the medical school, and the role of the institution in the larger community.
In the assistant/associate dean roles, there are content knowledge needs related to specific mission-based responsibilities that must be mastered. Prior experience in these areas during one's leadership development while within a departmental faculty role is generally expected prior to a broader leadership role within the dean's office. In the overall dean role, the team of assistant/associate deans themselves must be guided. The dean must respond to internal and external stakeholders; each stakeholder has its own set of expectations. Medical schools will always be highly matrixed and the dean must champion the school's vision and lead a team of leaders (assistant/associate deans and department chairs). Understanding the transition from operational unit (e.g., department) leadership to institutional leadership with its more strategic, interdisciplinary, and multimission responsibilities is essential to succeed in the dean's office.
The value of the present article by Cole et al. extends beyond the stated guide for emergency physician leaders who wish to work within the dean's office. EM and other physicians can apply the advice and strategies suggested in this conceptual model to advance career development, especially with respect to advancement to leadership roles.
