gms | German Medical Science

It is a viable assumption that general medicine departments at German universities are going to increase their relative importance in medical research and education over the next years. Within the field of general medicine, however, considerable variations in structure are prevalent. About half of the general medicine departments at German universities are led by a full professor (C4/W3 or C3/W2 position) who is surrounded by a group of scientific and non-scientific employees [1]. These departments are usually equipped with a sound budget, and find themselves represented as an autonomous working unit in relevant organizational committees. In contrast, the other half of general medicine departments at German universities rely upon the services of external lecturers, usually with an applied professional background, and have only rare access to organizational budgets or structures at all. Allowance for respective lectureship varies considerably, ranging up to no payment at all for some lecturers. Furthermore, involvement of these general medicine departments in organizational committees is relatively low.

The General Medicine Department at LMU Munich does not exhibit the structures of an autonomous working unit. The department’s arrays of teaching include lectures, seminars, teaching in practice settings, as well as e-learning (e.g., guidelines of the German Society of General Practice and Family Medicine), seminars during the practical year, and several compulsory courses with a focus on general medicine. However, a core group of external lecturers at the LMU General Medicine Department has organized itself in order to systematically handle administrative and coordination duties. Members of this core group are full-time general practitioners and therefore run their individual practices. The department itself is not equipped with full academic positions or an autonomous budget. A part-time secretary has been employed based on overall clinic resources. Moreover, the internist clinic and general research and teaching budgets serve to finance 40% of a position for a scientific employee at the LMU General Medicine Department. With very few exceptions, lecturers at the department are engaged on a voluntary and unpaid basis.

The General Medicine Department at LMU Munich is led and coordinated by two heads (director and coordinator) both of whom are general practitioners. Due to the department’s specific working structure as described above, tasks of department director and coordinator are shaped by several distinct features and challenges which can be grouped into three categories:

1. Communication

Communication among department leaders and members usually takes place via telephone, or even more often, in written form via e-mail. Everyday work in their own practices, including stressful patient care, results in a spatial distance between department members and exacerbates attempts to arrange regular face-to-face communication. Holding meetings on a weekly or monthly basis is rendered impossible. Both forms of communication, as described above, require high-level leadership skills. For instance, leadership challenges arise such as how to transfer negative feedback in a sensitive way or how to lead controversial discussions with all team members.

2. Heterogeneity

All core team members at the LMU General Medicine Department are full-time general practitioners running their individual practices. Their commitment to the department is voluntary and unpaid. Neither of the two department heads is officially authorized to instruct team members as is the case in regular academic institutes. Therefore, the level of cohesion in this group of general practitioners without financial incentive or labor-law provisions connecting them to the department depends mostly upon intrinsic motivation, open communication, and a constructive culture of conflict solution.

3. Leadership

The department director frequently acts in the role of a “Primus inter Pares” who conveys numerous projects and aims by means of his communication and leadership skills. Moreover, the department coordinator is faced with the problem of being the youngest group member. Therefore, his authority may be in question when assigning necessary tasks to other team members.

Systematic development of leadership and teamwork is a topic of high relevance for academic contexts. However, to date, most German universities have neglected this area of organizational strategy [2]. The LMU Center for Leadership and People Management was established with its main task being the professionalization of leadership and teamwork at LMU Munich [3]. The project “cooperation culture” is an integral part of the Center’s portfolio. Specifically, this project serves to: (a) analyze strengths and potential for development in university teams; and (b) to derive specific, evidence-based recommendations for subsequent development.

The analyses that follow are based on a written survey conducted at two points of measurement. At the LMU General Medicine Department, two department leaders, 13 lecturers, and the department’s secretary were surveyed (14 male, 2 female). Response rates were at a good level for both points of measurement with 87.5% (survey part 1) and 75.0% (survey part 2).

Procedure: The survey was conducted in five steps (cf. Figure 1 [Fig. 1]):

1.

Information and adjustment (i.e., initial meeting with department coordinator, questionnaire adaptation)

2.

Online survey

3.

Data analysis

4.

Presentation and discussion of results with department leaders and members

5.

Recommendations for development

1. Transformational and transactional leadership

The leadership styles of department director and coordinator were assessed via the German version [4] of the Multifactor Leadership Questionnaire [5]. Items were grouped into six dimensions: Management by exception active (4 items, α=.78); contingent reward (3 items, α=.96); intellectual stimulation (4 items, α=.95); individualized consideration (4 items, α=.97); inspirational motivation (4 items, α=.94); and idealized influence (3 items, α=.92).

2. Cooperation climate

With respect to decision-making and communication [6] at the department, participants evaluated trust, fairness, mutual appreciation, open communication, and constructive criticism (5 items, α=.97).

3. Motivation

Team members’ work motivation [7] was assessed with regard to four different forms: external, introjected, identified, and intrinsic motivation (4 items, α=.80).

4. Job satisfaction

Satisfaction items [8] referred to department leaders, tasks, colleagues, working conditions, professional development, and general job satisfaction (6 items, α=.83).

All ratings were conducted on a Likert-scale ranging from 1 (very low) to 5 or 7 (very high), respectively.

Data were analyzed with the statistical software package SPSS® 17. Data analysis included descriptive statistics calculated for the above described scales. Average evaluations (Median: Mdn, Mean: M) and standard deviation (SD) as an indicator of variability are displayed subsequently.

An overview of results is displayed in Table 1 [Tab. 1].

1. Transformational and transactional leadership

Transactional leadership constitutes the necessary basis of professional leadership through goal setting and rewarding behavior. However, challenging working environments require transformational leadership which focuses on critical questioning of common assumptions and procedures, consideration of followers’ individual needs, and a strong value-orientation [9]. As compared to a sample of leaders from business and administrative contexts (cf. Figure 2 [Fig. 2], [4]), department heads received excellent evaluations with regard to transformational leadership. Variability in these evaluations is relatively low. Therefore, department heads appear to display highly effective leadership behavior.

2. Cooperation climate

Outstanding results were obtained for trust, fairness, mutual appreciation, are open communication at the department. However, constructive criticism was evaluated marginally less positive.

3. Motivation

In general, for external (e.g., payment, rules, authority) and introjected motivation (e.g., negative feeling in case of insufficient task fulfillment) rather low levels are expected. The opposite is true for identified (e.g., strong connections among tasks and values) and intrinsic motivation (e.g., perceived meaning of tasks). Results for the department are very satisfying: external motivation and introjected motivation are relatively low. Identified motivation and intrinsic motivation are clearly at above-average levels. That is, department members ascribe high meaning to their tasks, enjoy their job at the department, and perceive strong connections among their tasks and individual values.

4. Job satisfaction

Department members express very high evaluations of their satisfaction with department leaders, tasks, and colleagues. General job satisfaction is at a good to average level. Lower evaluations are found for working conditions and professional development. High levels of variability in all satisfaction ratings suggest a prevalent disagreement among team members with regard to their satisfaction.

Overall, the displayed results convey a markedly positive picture of leadership and teamwork at the LMU General Medicine Department. Particularly, evaluations of leadership behavior and of team members’ motivation create an outstandingly positive impression. Improvement was suggested in the facilitation of constructive criticism within the team and to team members’ satisfaction with working conditions and professional development.

Despite the positive results for the LMU General Medicine Department, collaboration of smaller general medicine departments with established academic units at their respective university remains a challenge.

Based on the project as introduced in this article, other general medicine departments or smaller institutes striving for higher impact within their university, the following management aspects can be regarded as exemplary:

1.

Systematically using internal offers to develop professional structures

2.

Gaining insights into individual strengths and potential for development

3.

Optimizing internal communication and cooperation structures

4.

Involving all team members in the development process

5.

Improving visibility at the university through project results

Additionally, it is necessary to reflect on the unique characteristics of teaching conducted by full-time practitioners. No doubt, further professionalization is required. Via participating in the project “cooperation culture”, the LMU General Medicine Department has faced up to such challenges. When confronted with lacking support or even exclusion from medical departments, certain levels of discontent arise as would be expected. Specific improvement holds the potential of counteracting such shortcomings. Moreover, regular communication to the teaching faculty of student achievements and of positive course evaluations should take place. For instance, evaluations of general medicine courses are among the highest at the entire medical department at LMU Munich. However, current and future high-quality education in general medicine clearly depends upon external lecturers. With the aim of improving the discipline’s internal and external reputation and impact on the education of young physicians, less-established departments are required to improve their structure though similar projects as the one described here. An improvement in professional structure is clearly obtainable – even if based on short resources!

The authors declare that they have no competing interests.