Are we preparing for collaboration, advocacy and leadership? Targeted multi-site analysis of collaborative intrinsic roles implementation in medical undergraduate curricula

BACKGROUND: The Collaborator, Health Advocate and Leader/Manager roles are highly relevant for safe patient management and optimization of healthcare system in rehabilitation and prevention. They are defined in competency-based frameworks and incorporate competencies empowering physicians to master typical daily tasks in interdisciplinary, interprofessional and institutional collaboration. However, appropriate implementation of roles remains difficult in undergraduate medical education (UME) and needs to be closely monitored. The aim of this cross-institutional mapping study was to examine for the roles of Collaborator, Health Advocate and Leader/Manager: (1) To what extent do German UME programs explicitly meet the given standards after 5 years of study? (2) Which information may be obtained from multi-site mapping data for evidence-based reflection on curricula and framework? METHODS: In a joint project of eight German UME programs, 80 to 100% of courses were mapped from teachers’ perspective against given national standards: (sub-)competency coverage, competency level attainment and assessment. All faculties used a common tool and consented procedures for data collection and processing. The roles’ representation was characterized by the curricular weighting of each role content expressed by the percentage of courses referring to it (citations). Data were visualized in a benchmarking approach related to a general mean of the intrinsic roles as reference line. RESULTS: (Sub-)competencies of the Health Advocate are consistently well-integrated in curricula with a wide range of generally high curricular weightings. The Collaborator reveals average curricular representation, but also signs of ongoing curricular development in relevant parts and clear weaknesses regarding assessment and achieved outcomes. The Leader/Manager displays consistently lowest curricular weightings with several substantial deficiencies in curricular representation, constructive alignment and/or outcome level. Our data allow identifying challenges to be considered by local curriculum developers or framework reviewers (e.g. non-achievement of competency levels, potential underrepresentation, lacking constructive alignment). CONCLUSION: Our non-normative, process-related benchmarking approach provides a differentiated crosscut snapshot to compare programs in the field of others, thus revealing shortcomings in role implementation, especially for Leader/Manager and Collaborator. The synopsis of multi-site data may serve as an external reference for program self-assessment and goal-oriented curriculum development. It may also provide practical data for framework review.