Conceptual Competencies for Naturopathic Medical Education Leaders

David Schleich, PhD

Naturopathic education program deans have been described more than once as probably the profession’s most enduring visionaries. So many of our profession’s leaders have had or currently have such roles at some point in their careers (Sensenig, Zeff, Pizzorno, Raskin, Mittman, Snyder, Khalsa, Smith, De Groote, Warren, Smith, Wolf and others). Over the years in our various colleges, frequently described as “learning organizations,” those leaders have started and sustained our educational programs, shaping the professional formation of naturopathic medicine in very direct ways. They continuously assess goals, set new ones, and attempt to motivate their colleagues and students to push ahead toward the larger picture. Among their many duties, they have had to focus for long periods of time on converting goals into specifics and more than once watched programs contract or cash flows converge uncomfortably close to risky spots along the Department of Education’s composite ratio continuum. Through tough times and good, nevertheless, they have found and led staff to maintain the necessary flow of processes, whether it is the creation of curriculum, the paying of bills, the creation of library collections, making sure the doors get opened in the morning, or launching new methodologies to deliver slowly metamorphosing curriculum. And, they have done these things using a particular set of competencies. The questions we are considering this month are what competencies do our leaders need today, and are they different than what we have needed all along?

Conceptual Competencies

Whatever approach to academic management our college deans or academic administrators adopted over the years, they knew that the naturopathic medical education machine must keep chugging along. Many had no choice but to learn on the job, either emerging into teaching via residency or through the adjunct faculty pathway. Some chose to shift into teaching and administration after time in clinical practice. Some came to us from the public sector, bringing career experience from higher education and inevitably molding our own programs into that framework. Within the naturopathic college environment, in any case, the need for strong academic leadership competencies, derived from whatever source, has never been stronger. The need for a systematic approach among our colleges to develop an apprenticeship pathway for such leaders grows stronger. John Levin, a higher education scholar, explains that “the shifting college environment” can often prove to be daunting or confusing for any new manager, whatever his or her background.

So, it may be helpful to describe certain conceptual competencies that scholars in the academic leadership field consider useful. Underpinning the conception of a managerial culture (in our naturopathic programs and colleges) are the assumptions that the colleges can be directed, and that change can be managed (Deegan et al., 1985; Levin and Dennison, 1989). Without doubt, because change is ever present in our colleges, the pace of which is unlikely to abate as the first decade of a new century winds down and we cross to the next, and because there are those who would cherry pick from what we do, the need for strong academic leaders is huge.

The transforming naturopathic college is a complex landscape where many factors continuously influence the competencies the leader needs to be able to steer safely along the road ahead. For one thing, our colleges are not publicly assisted nor publicly governed, but are nevertheless subject to government-linked accreditation, which assumes very specialized knowledge about the higher education sector, its standards and its processes. Secondly, the stakeholders in our colleges historically have not taken kindly to autocratic processes and top-down decision-making, inside or outside the profession. Thus, as Dennison has pointed out, “a strictly managerial approach is unlikely to be compatible with a collegial environment” (Baldrige et al., 1977; Cohen, 1990; Raisman, 1990). Our leaders push back when they feel the college’s primary mission might be challenged or misunderstood. Finally, our colleges are places of not only classroom learning, but also where precious and critical clinical skills are developed. Thus, there are very real “professional preparation” and “public safety” dimensions to the “product” of our programming, naturopathic physicians ready to treat patients.

Operating, then, as a kind of defining gestalt in this environment, there are general characteristics impacting on our naturopathic college leaders, whatever their level of experience and confidence. Those leaders must not only develop and have handy very specific competencies, but those competencies are also shifting and sometimes are even reeling as we absorb the riptides of public policy and the gyrations of the economy. Omnipresent too are recurrent issues such as governance (Dennison, 1994; Dennison and Gallagher, 1996; Baldridge et al., 1986); funding (Hough, 1992); responsibility and accountability (Hufner, 1991), currency and effective visioning (Tierney, 1993).

Some say that rapid transformation within such a landscape has from time to time encouraged habits of short-term crisis management in the colleges, stimulating the development and refining of certain competencies over others. That pattern has been affected across the past five decades by respectable bursts of growth in our seven programs. Periods of growth require competencies that are different from those needed to navigate through periods of contraction. Along with the growth phases, for example, come all the challenges of staff recruitment, capital investment and branding, not to mention the parallel challenge of state and provincial licensing for our graduates as a goal the colleges themselves have shared. Whatever the climate, though, as the reach of our colleges expands, their ability to respond in agile ways can tighten up if our leaders are not ready for both realities. Certain “flashpoints of controversy” as Michael Skolnik describes them (1987) are going to come up in both scenarios.

An example of such a flashpoint is the need whether a program is growing or shrinking for professional level competency in curriculum design, measurement and evaluation and finance function, including fundraising. Indeed, questions of funding limitations have been gnawing at the energy and focus of our academic leaders all along. Such pressures exacerbate the need for competencies to be crisp, practiced and reliable among our deans and chairs whose shoulders are expected to carry whatever immutable ill is blowing in the next fiscal period.

Key Competencies

Over the years, whatever the economic climate, our leaders have been generally autonomous within the higher education sector, enjoying a kind of exclusivity in accredited naturopathic medical education theory and practice. At the gates, though, they detect more often usurping providers, most recently in the form of a growing consortium of American universities boasting “integrated medicine” electives and programming. There are noises, too, about “bridge programs” of interest to the chiropractic profession and, of course, unaccredited “naturopathy” programs all over the place that confuse the public and potential students from the real thing. In this terrain, running a collegial ship to maximize resources and to embrace a future replete with constant, unforgiving change are daily realities.

The competencies our educational leaders need are influenced by the following factors:

  • the impact of public governance, especially in the form of accreditation standards and our challenge of sustaining them
  • the implications of shared governance pressures and aspirations toward collegiality
  • the vagaries of funding and understanding post-secondary financing
  • the dual edged sword of responsibility and accountability
  • the imperative of understanding the needs of naturopathic medical students as learners, but also as consumers of a growingly disparate patchwork of so-called “alternative healing careers”

The impact of thoughtful governance is an enduring characteristic of the naturopathic medical education environment inasmuch as our colleges and programs seek CNME, state degree and regional institutional confirmation of standards, quality and track record. In earlier manifestations of our college programs, NDs did the bulk of the governance work. That has changed over time as more public members join our boards from the worlds of higher education, finance, law, insurance, other non-profits, business and industry. Understanding the basic documents of each of our colleges and each program within other institutions more than ever must be accompanied by a deepening and broadening of that foundation with an analysis of subsequent governance variables, such as the emergence of rival programming in previously uninterested universities or the need for ambitious capital campaigns. Extrapolating from Birnbaum’s analysis in How Colleges Work(1988), it becomes clear that this competency also includes an understanding of the political history and current political reality of non-university post-secondary institutions (NUPSI) on both sides of the border. Being clear about how to navigate through the necessary change of edging the colleges away from the historically necessary and important influence of the profession’s own members is something our college academic leaders may struggle with. The roles of government-endorsed entities such as accreditation bodies or offices of degree authorization, whose impact on “accountability” and on “student funding” is immediate and demanding, are very central to our leaders’ skill base.

Linked, as well, because of being more known in the higher education sector, is a wider understanding of the nature of the college-university relationship in America and Canada. Added to this recipe is the American imperative (often identified with California) of shared governance (Owen, 1995). American naturopathic colleges and programs, as well their Canadian counterparts, have not yet been strongly affected by this factor. Of note, though, is that the history of labor relations in the Ontario higher education system has frequently been sour with conflict and projection (Skolnik, 1988), but CCNM, like its American colleague institutions, separated from what can be a confusing history of faculty unionization, has long enjoyed amicable management/staff/faculty relations.

The origins, current manifestations of such faculty associations, unions and collective agreements are very much part of the history lesson that moves about in the higher education sector and with which our naturopathic educational need to be familiar as we grow, and as new programs emerge within existing higher education institutions where such arrangements already operate. Thus, the leader in search of conceptual competencies to tool up for a march through a decade or two of managing in the colleges may also want to know about negotiation techniques (Ury, 1981, 1991), how organizational models can best be deployed to bring about success with college goals despite the defining limitations of collective agreements and the persistent amnesia of some colleges in the public sector as similar tensions about workload arrangements and job security recur season after season (Cohen et al., 1994).

That same leader will want to flesh out his or her growing familiarity with possible organizational models by studying ethics and jurisprudence as they relate to higher education, by reviewing government policy related to employment standards, and by being intimately familiar with medical ethics ideas and principles impacting on teaching and learning, particularly as these translate out into the doctor/patient relationship. The leader will want to tie all of these into a disciplined, ongoing review of best human resources practices. As well, understanding how to choreograph effective non-profit boards to support ethical, compliant policies and practices in the changing higher education sector is another key competency for the leader in the naturopathic medical education world (Carver, 1997; Piland, 1994; Andrews, 1994). Non-profit boards have an enormous policy impact on the operational detail of human resource deployment and management, on advancement, and on the degree of deference paid to government policy related to employment standards and institutional development. Learning organizations depend on a foundation of clear, integrated policy in order for practices to be helpful in achieving the college’s mission.

Learning organizations are, though, as Senge and DePree often point out, dependent on participation as the basis for that learning. Thus, skills such as consensus and team-building acumen are important competencies for the effective leader. The development of staff is intentional in colleges that seek to thrive. That development, however, needs to be aligned with mission and goals, which in turn are synchronized with available resources. Thus, the leader will want to know a great deal about human resource development in terms of how to operationalize a development plan within particular time frames. Further, identifying priorities in development can issue smoothly from operational reviews, which should be intrinsic to the college’s multi-year plans. Experience with the design, implementation and full evaluation of an operational review process is a key competency for the college leader.

Another key competency area is related to funding. The financing of higher education since the 1980s has been affected by a societal trend on both sides of the 49th parallel, which would see the user bear more of the cost (Hough, 1992; Rhoades, 1998). In the world of naturopathic medical education, the academic leader has quite a different perspective. He or she wants to reduce the pressure that comes from disproportionate tuition dependence. The college leader needs to understand not only the funding formula for his or her respective program or college, for example, but also to understand the share his or her program has and why of the total post-secondary pie in that institution. Being savvy about the political and fiscal priorities of the institution in which that program lives is essential.

Further, understanding the wider range of financing variables has to be part of this particular competency about finances, embracing an awareness of how student financial assistance works in practice as well as an awareness of costing models for successfully mounting single programs, program clusters and entire campuses. The sophistication of the knowledge needed about finance function cannot be emphasized enough, since strategic decisions are best made when the leader understands weighting formulas, projected revenues, fixed and variable costs, discretionary expenditure ratios, and confident grounding in the sound fiscal management of one-off projects. Aspects of this competency include a precise understanding of how elements work, such as revenue, operating income, cash flow and asset utilization.

The strong college leader will also seek conceptual competence in accountability (Hufner, 1991) and responsibility paradigms, as these manifest in higher education. In addition to seeing clearly the way the wind is blowing with respect to accountability instruments such as key performance indicators, the leader will want to generate exceptional competence in reporting outcomes to key stakeholders (advisory committees, boards of directors, central government agencies and so on). Rapid, reliable and focused communication with funding authorities, program approval teams, local governance groups such as advisory committees and standing committees of the board of directors implies a political sensitivity to what needs to be reported as well as a strong commitment to accuracy and documentation. The leader must know which categories are relevant and timely, and which need to be quantified and to what extent (Price-Waterhouse, 1995).

Choosing process performance measures (and not just results measures) is an important skill for the leader’s backpack, too. As well, good process performance measures build enthusiasm. In the end, the effective leader will have a conceptual competence in using performance measures to link what people do well daily to what the college’s overall objectives are. The difficulty of measuring performance is well known in the higher education sector, largely because most public sector institutions pay attention to a cost line, which does not reflect the accruing hard-to-measure equity of successful graduates and community goodwill. All too true in our colleges, eager attention to allocated budget amounts often does not reward entrepreneurial leaders who may well have a business plan for new activity that spans more than a single fiscal period.

Further, the college leader will want to develop conceptual competencies as a change agent (Price-Waterhouse, 1995). The transformation of post-secondary education proceeds at an unrelenting pace. At one extreme there are those who would proclaim that discontinuous thinking that would keep outdated rules and fundamental assumptions driving the agenda is impossible to dislodge. At the other extreme are those fearing the college’s mission can be relegated to dusting furniture in Pompeii (to awkwardly cite Hammer and Champy from their 1993 work on re-engineering corporations) … there are those who would have the leader move rapidly in an all-or-nothing mode, which could perpetuate ineffective, outdated ways of producing learning. The leader must, then, assimilate competencies for initiating, conducting and making sure that transformative practices are understood, implemented and fine-tuned. This complex competency involves the transforming of processes, which rapidly evolve new responsibilities and tasks, from narrow and task-oriented activity to more multidimensional work, particularly in the delivery of education and training. Our schools can be conservative places, otherwise, where “we always have done it this way” becomes a rationale for avoiding risk and reward approaches.

Unlike public sector institutions, our colleges, in the general sense of running a “going concern” (a phrase widely used in the corporate world), seem to have a greater degree of flexibility with an operations approach to strategic planning. The “policy and entitlement orientation” that affects so much of the public sector college’s operational framework, while present in our schools, is less entrenched. We don’t have operational instruments such as collective agreements or the need to seek central approval from a government body for funding for new programs. The functional rivalries, operational redundancies and contrary imperatives frequently present in state systems are less likely to daunt the leader who becomes increasingly skilled in transformative practices.

Finally, the effective college leader will want to master numerous competencies under the “learner-centered” umbrella (McCombs, 1992; O’Banion, 1997; Tinto et al., 1994) often talked about in higher education. He or she will need to have skill in curriculum and program design, measurement and evaluation, and information technology applications to teaching and learning. Becoming familiar with how adult learners learn and focusing on what are the most effective designs for value-added learning will greatly enhance the competency portfolio of that leader. Coupled with these pragmatic competencies must be a deeper understanding of theories of knowledge. Gathering awareness from approaches such as constructivism (Cherryholmes, 1994) will act as a catalyst for the leader because learning itself is transformational rather than additive. Building on developmentalist and constructivist approaches, the college leader will want to be sure to have a grasp of the dominant learning theory of the day. Further, the leader will want to understand the metamorphosing nature of the learners turning to his or her college for help. Those learners are, for example, younger than they were even a decade ago, and demanding of quick, electronically mediated, high-quality delivery and currency. Thus, our deans and chairs will want to be committed to keeping abreast of higher education theory and practice. If they choose to stay in an administrative role, they will make it a priority to stay on top of theories of knowledge and the related theories about how contemporary students learn. The old notion of time-place bound learning, supervised by a “sage on the stage” will not endure, despite many of our program accreditation standards being predicated on that model. The leader cannot simply stir students and teachers in a classroom bowl randomly. The timing, measure and ingredients are all important for the cake to come out right.

Garnering Information

Parallel with all these competencies must be the constant gathering and utilization of factual information. The leader must know how to find reliable community demographics with windows on diversity, access and futurism. Further, student demographic data and profiles are essential for the leader to plan. Stored in the larder, too, should be information about the history and evolution of naturopathic medicine as a heterodox medical system, labor market trends and inter-institutional relationships. Understanding conceptually, for example, differentiation and diversity among post-secondary institutions can greatly assist in the leader’s being able to build a more ideal system for the achievement of academic balance and diversity, as well as sustainability.

There are ever more areas about higher education (concepts, theories, facts, models) that the naturopathic medical academic who chooses to be a leader will want to understand better, and all of which loosely fit into the broad categories mentioned. It may be useful to articulate them here in the form of specific questions to round off this catalog of conceptual competencies. These questions may find solutions within the conceptual competencies itemized above.

The naturopathic medical education leader will want to know more about the structure of higher education in jurisdictions other than his or her own, so that he or she can compare and contrast what we have evolved in our particular state or province with what has developed elsewhere, with a view to improving our own designs. As well, understanding the origin and impact of government policy on higher education with the goal of spotting quickly what is trendy and what is enduring is a worthy competence toward which to strive. Further, digging more deeply into the essential differences between the mainstream university and the naturopathic college or university college could resolve in part the impulse of our colleges to revere the small, regional comprehensive university model. The original purpose of our colleges has been blurring for a long, long time. That purpose itself is shifting, and now includes, for example, strong commitments to research and to inter-institutional partnerships. There are, too, important competencies linked to developing the best ways to partner with mainstream primary care delivery systems without violating or compromising the educational mission of the naturopathic colleges.

The naturopathic college leaders, holding on to their guardians, conceptual competencies, have a daunting task. The influencing factors outlined here, the impact of public governancewherein as many lay persons are part of a board of directors as licensed NDs; the implications of shared governance pressures; the vicissitudes of funding; the pressures of accountability;and the imperative of understanding what a learner-centered institution looks likeare in many ways the tip of a very large iceberg. Glen Jones’ “decade of flurry” at the front end of the half century history of the CAATs has, perhaps, given way to an approaching “decade of renewal” in our North American sea. The value to society of naturopathic medical education has never been greater. The pressure on naturopathic college leaders to develop and manifest competencies to meet the challenge has also never been greater.

David Schleich, PhD is president and CEO of NCNM, former president of Truestar Health, and former CEO and president of CCNM, where he served from 1996 to 2003. Other previous posts have included appointments as vice president academic of Niagara College, and administrative and teaching positions at St. Lawrence College, Swinburne University (Australia) and the University of Alberta. His academic credentials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s University (BEd) and the University of Toronto (PhD).

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