Who owns responsibility? An administrator's take on implementing time-variable medical training in teaching hospitals

Area of Science:

• Medical Education
• Healthcare Management
• Organizational Studies

Background:

• Outcome-based medical education has driven the adoption of time-variable medical training (TVMT).
• TVMT, a paradigm shift towards individualized learning, impacts teaching hospital organization.
• Implementation of TVMT faces considerable organizational and financial hurdles.

Purpose of the Study:

• To explore how hospital administrators manage the implementation of time-variable medical training.
• To identify challenges and coping strategies in integrating TVMT into postgraduate programs.

Main Methods:

• An exploratory qualitative study was conducted.
• Interviews were held with hospital administrators actively implementing TVMT in postgraduate programs.

Main Results:

• Existing governance structures were inadequate for TVMT's financial and organizational demands.
• Administrators employed strategies such as departmental delegation, task reallocation, inter-hospital learning, and facility expansion.
• Initial control strategies, including budget cuts and a wait-and-see approach, proved ineffective.

Conclusions:

• Hospital administrators find TVMT implementation difficult, disrupting the balance between education and clinical services.
• Adaptive strategies are necessary as traditional management approaches and delegation to departments are insufficient.
• Further research is needed on effective governance and support mechanisms for TVMT.