"Just do it": program to train MD executives gathers steam

After some lean recruiting years within the medical profession, a fellowship program designed to bring evidence-informed management practices to the health care workplace attracted a record number of physician participants in 2008.

And that's music to the ears of Dr. Chris Carruthers, past president of the Canadian Society of Physician Executives (CSPE).

"The CMA and CSPE consider EXTRA a tremendous tool for promoting the use of evidence-based administrative tools in managing health care," says Carruthers, who retired in 2008 as chief of staff at the Ottawa Hospital. "The fact that nine physicians were accepted into the 2008 EXTRA cohort, which is almost twice as many as we've had in any other year, is very good news."

EXTRA - the Executive Training for Research Application program - is funded by Health Canada, with participating health care organizations paying a one-time fee of $7,000 to sponsor each fellow. The program was launched in 2004 to encourage the use of research in the day-to-day management of Canada's health care system, and is managed by the Canadian Health Services Research Foundation. The CMA is one of the partner organizations supporting it.

"EXTRA is tailor-made for physicians who want to apply research findings directly in their workplace," Dr. Ruth Collins-Nakai, a past president of the CMA, said shortly after EXTRA's launch.

During each EXTRA two-year cycle, physician and nurse managers and health care administrators attend six weeks of residency sessions and complete an intervention project at their health care facility.

Carruthers says the training cycle is ideal for practising physicians, since the residency training is spread over four sessions and the intervention project is conducted within their home organizations. (All participants complete a project designed to improve practices within their home organization.)

The fact that more physicians are participating in EXTRA this year may be due to the team concept that was introduced two years ago to "spread the workload" among participants. This year four of the nine physician fellows are participating in teams, a development lauded by Dr. Penny Sutcliffe.

"The team approach has already allowed us to develop ideas and solutions together that we would not have come up with on our own," says Sutcliffe, medical officer of health and CEO at the Sudbury & District Health Unit in Ontario.

She is working with Dr. Susan Snelling, the unit's manager of research and evaluation, and Sandra Laclé, the director of health promotion, to apply evidence more consistently in developing healthy public policy and creating interventions to reduce health inequities.

"I would recommend a team approach," says Sutcliffe. "During the [first] two-week residency session we were able to capitalize on our numbers, consult with more people, and then compare notes." [More...]

Physicians have many reasons for applying to EXTRA.

"Many executive decisions seem to be based on inadequate research," explains Dr. Todd Webster, a urologist who serves as deputy chief of staff at Grey Bruce Health Services (GBHS) in Owen Sound, Ont. "I was excited to see a program like EXTRA that focused on increasing the capacity for research within executive decision-making."

Webster's intervention project involves the implementation of electronic medical records (EMRs), including computerized physician order entry, at GBHS. "As a clinician I try to demand solid evidence before changing my clinical practice," he says. "More and more physicians are demanding the same type of evidence before accepting administrative changes such as EMRs." [More...]

Webster says the program is meeting all his expectations. "The thing I value most is the incredible network of people I have met and will meet."

Internist Catherine Morris, who has been chief of staff at the Cambridge Memorial Hospital (CMH) in Cambridge, Ont., for three years, said her decision to apply to EXTRA was driven in large part by McMaster University's decision to establish an off-site campus of its medical school in the Cambridge area.

"The arrival of the medical school means that local hospitals have been asked to take on a teaching role, and that means the role of the people working within these hospitals has changed too, even if they are not accustomed to playing a role in education."

Morris and Beatrice Mudge, the chief nursing executive at Cambridge Memorial, are pursuing an EXTRA project that is attempting to transform their community hospital into a learning organization. "We want to position CMH as a Centre for Learning Excellence that supports staff, learners and teachers in the broadest sense," says Morris. [More...]

Her enthusiasm is shared by Dr. Megan Ward, associate medical officer of health for Ontario's Peel Region. Her project involves identifying and testing tools for applying research within the public health context.

"I am only a couple of months into the program and I have already learned a great deal," she says. "For me, EXTRA is a very useful type of CME." [More...]

Meanwhile, Todd Webster has simple advice for physicians considering applying to the program: "Just do it."

The deadline for 2009 EXTRA applicants is Mar. 3, 2009.
Application details
Profiles of physicians who have participated or are still in the program