Beyond the dual degree: development of a five-year program in leadership for medical undergraduates

The current state of physician leadership education consists mainly of executive degree programs designed for midcareer physicians. In 2004, the authors proposed that, by educating medical students in physician leadership and integrating this with a business management or public health degree program, graduates, health care organizations, and communities would benefit sooner. Given the lack of program models to guide program integration and development, the authors began a one-year inquiry to build a model leadership curriculum and integrate leadership education across degree programs. The qualitative inquiry resulted in several linked tasks. First, the authors identified a feasible method for concurrently delivering all three program components (MD degree, Leadership Curriculum, and MBA or MPH degree) during a five-year plan. Second, the authors chose a competency-based educational framework for leadership and then identified, adapted, and validated existing leadership competencies to their context. Third, the authors performed an extensive program alignment to identify existing overlaps and opportunities for integration within and across program components. Fourth, the authors performed a needs analysis to identify educational gaps, subsequently leading to redesigning two courses and to designing three new courses. A description of the Leadership Curriculum is also provided. This inquiry has led to the development of the Boonshoft Physician Leadership Development Program, which provides physician leadership education integrated with medical education and education in business management or public heath. Future program initiatives include developing leadership student assessment tools and testing the link between program activities and short- and long-term outcome measures of program success.

Is a management degree worth the investment for physicians? A survey of members of the American College of Physician Executives

In a survey of 568 physician members of the American College of Physician Executives (ACPE), most of whom had advanced management degrees (MBA, MMM, MPH), approximately 90% of respondents reported that their investment in the education was "worth it." The return on investment was independent of the quality of the academic institution, although primary care physicians stood to gain more relative to specialists. Salary comparisons showed that female physicians had approximately 20% lower incomes than male physicians, confirming the presence of a "glass ceiling" for female physician executives as seen in other medical specialties. These findings have implications for early and mid-career physicians and physician recruiters.

Developing physician-leaders: key competencies and available programs

Because effective leadership is critical to organizational success, frontrunner organizations cultivate leaders for bench depth and pipeline development. The many challenges in healthcare today create a special need for great leadership. This paper reviews the leadership competencies needed by physician-leaders and current experience with developing physician-leaders in healthcare institution-sponsored programs. On the basis of this review, six key leadership competency domains are proposed: 1. technical skills and knowledge (regarding operational, financial, and information systems, human resources, and strategic planning), 2. industry knowledge (e.g., regarding clinical processes, regulation, and healthcare trends), 3. problem-solving skills, 4. emotional intelligence, 5. communication, and 6. a commitment to lifelong learning. Review of current experience indicates that, in addition to leadership training through degree and certificate-granting programs (e.g., by universities and/or official medical societies), healthcare institutions themselves are developing intramural programs to cultivate physician-leaders. Greater attention is needed to assessing the impact and effectiveness of such programs in developing leaders and benefiting organizational outcomes.

Multisource feedback: 360-degree assessment of professional skills of clinical directors

For measuring behaviour of National Health Service (NHS) staff, 360-degree assessment is a valuable tool. The important role of a clinical director as a medical leader is increasingly recognized, and attributes of a good clinical director can be defined. Set against these attributes, a 360-degree assessment tool has been designed. The job description for clinical directors has been used to develop a questionnaire sent to senior hospital staff. The views of staff within the hospital are similar irrespective of gender, post held or length of time in post. Analysis has shown that three independent factors can be distilled, namely operational management, interpersonal skills and creative/strategic thinking. A simple validated questionnaire has been developed and successfully introduced for the 360-degree assessment of clinical directors.

Public health decision-makers' informational needs and preferences for receiving research evidence

OBJECTIVES

The purpose of this study was to identify decision-makers' preferences for the transfer and exchange of research knowledge. This article is focused on how the participants define evidence-based decision-making and their preferences for receiving research evidence to integrate into the decision-making process.

METHODS

Semistructured interviews were conducted with a purposive sample of 16 Ontario public health decision-makers from six Ontario public health units in this fundamental qualitative descriptive study. The sample included nine program managers, six directors, and one Medical Officer of Health. Participants were asked to define the term evidence-based decision-making and identify preferred research dissemination strategies. The interviews were audio-taped, transcribed verbatim, and coded for emerging concepts.

RESULTS

Participants defined evidence-based decision-making as a process whereby multiple sources of information were consulted before making a decision concerning the provision of services. To facilitate integration of research evidence into the decision-making process, public health administrators appreciate receiving, in both electronic and hard copy, systematic reviews, executive summaries of research, and clear statements of implications for practice from health service researchers.

CONCLUSIONS

Although consensus exists among participants concerning the definition of evidence based public health decision-making, ongoing efforts are required to continue to promote the use of research evidence in program planning and public health policy. It is also important to continue to improve the ease with which public health decision-makers access systematic reviews, as well as to ensure the relevance and applicability of the results to the practice setting.

Survey: Most ED staff victimized by violence never report incident

Staff members who are victims of violence and fail to report the incident may remain traumatized and unable to perform at their normal level of proficiency; some may not even be able to return to the ED. As a manager, there are steps you can take: Have reporting processes available, and regularly update your staff on what they are and how they are to be used. Be a role model for your staff. Take every event seriously, and follow up with the victim to make sure they receive the help they seek. Be sure to include staff-on-staff verbal abuse as part of your violence-reporting policies and procedures.

Preparing physicians to lead

The University of St. Thomas' Physician Leadership College is an 18-month program that trains physicians in leadership and management. It was started in 1999 in response to calls from within the health care industry for more training of physician leaders to guide reform efforts. This article makes the case that physicians need to not only participate in but also to lead change in health care. It also describes the program and reports findings from participants' evaluations.

Enhancing the effectiveness of the psychiatric chief resident

OBJECTIVE

Despite its importance in psychiatry residency training, there is little written about the role of chief resident. Invoking principles of credibility, continuity, and inclusion, and the establishment of two roles, as legislative and representative leader, this article offers a model for how a residency program can empower its chief resident to act decisively, make meaningful contributions to training, and ultimately enhance his or her effectiveness.

METHOD

The authors review the literature on the psychiatry chief resident and identify ambiguity as a common and powerful impediment to effective leadership.

RESULTS

The authors present a model for psychiatry residency programs to enhance chief resident effectiveness based on the three components of credibility, continuity, and inclusion, and elucidate how each improves chief resident leadership. The authors identify two integral leadership roles of the chief resident, those of the legislative and representative leader, and discuss how each empowers the chief resident to act decisively.

CONCLUSIONS

The authors assert that if psychiatry residency programs elect the chief resident by involving both faculty and residents, grant a year-long term and include him or her in all major decisions that involve the residency, the chief resident is far more likely to make meaningful contributions to the training program.

Current perspectives on chief residents in psychiatry

OBJECTIVE

The authors examine qualitative data from outgoing chief residents in psychiatry from the 2004-2005 academic year to 1) determine common characteristics between programs, 2) examine the residents' perspectives on their experiences, and 3) determine their common leadership qualities.

METHOD

The authors sent out self-report surveys via e-mail to 89 outgoing chief residents who attended the APA/Lilly Chief Resident Executive Leadership Program.

RESULTS

Fifty-three (60%) chief residents responded. Although most chief residents are senior residents, over 20% are in their third postgraduate year. Two-thirds of programs have more than one chief resident each year. Most chief residents believe that their "participating" leadership style, existing leadership skills, and interpersonal skills contributed to their overall positive experiences.

CONCLUSIONS

Successfully performing duties as a chief resident entails functioning in a variety of roles and demands attention to leadership qualities of the individual. Developing existing leadership skills, clarifying expectations, and providing mentorship to chief residents will ensure successful transition into practice, and the advancement of the field of psychiatry.

Physicians as managers: psychiatry residents' perceived gaps in knowledge and skills in administrative psychiatry

OBJECTIVE

The authors determine psychiatry residents' perceived needs and educational preferences for a physician-manager curriculum.

METHOD

The authors surveyed 102 psychiatry residents at the University of Toronto for their perceived current and desired knowledge and skills in specific administrative areas, and their educational preferences for learning more about administration. Gap scores expressed the difference between residents' perceived current and desired knowledge or skill ratings.

RESULTS

Forty-nine residents completed the survey and identified greater gap scores in physician compensation, program planning, self and career development and innovation, and leading change topic areas. More than 60% of respondents preferred learning through workshops, small groups, and mentorship.

CONCLUSIONS

Residents identified specific gaps in their current knowledge and skill levels in several administrative areas. The questionnaire results, including residents' educational preferences, will inform curriculum development efforts.

Leadership and Management Training for Residents and Fellows: A Curriculum for Future Medical Directors

Context.—Management of laboratories and pathology practices is increasingly complex. Residents and fellows in laboratory medicine and pathology need more structured curricula in leadership and management (L&M) training to function as medical and laboratory directors.

Objective.—To define a curriculum that provides basic competency in L&M for residents and fellows in pathology.

Design.—A year-long formal L&M course included didactic lectures, interactive sessions, case scenarios, team-building exercises, formal team presentations (capstone project), and precourse and postcourse assessment of L&M knowledge. The curriculum meets requirements of American College of Graduate Medical Education and supports goals for leadership training of the College of American Pathologists. Participants evaluated (5-point scale) the content and speakers of all sessions. Trainees were evaluated after considering postcourse examination results, quality of the capstone presentation, and a global assessment.

Results.—The 5 non-capstone sessions received evaluation scores ranging from 4.4 (informatics) to 5 (L&M basics). Postcourse test scores showed significant improvement when compared with the pretest scores for the 2003– 2004 and 2004–2005 trainee cohorts.

Conclusions.—Short-term results indicate that the course described improves trainee knowledge of L&M issues.

The Patient Safety Leadership Academy at the University of Pennsylvania

BACKGROUND

We based the Patient Safety Leadership Academy (PSLA) on the premise that improving management skills could improve patient safety and employee satisfaction.

STUDY DESIGN

Fellows completed baseline surveys on leadership skills knowledge, patient safety knowledge, and program goals. They completed the same surveys 7 months later at the final PSLA session. The fellows also completed a survey assessing how PSLA improved expertise and comparing PSLA to other patient safety learning opportunities. Matched pairs t tests were used to compare baseline and postprogram results.

RESULTS

Baseline scores indicated appropriateness of focusing on leadership, with average leadership knowledge (2.48) significantly lower than patient safety knowledge (3.22). For patient safety, postprogram results were significant for 8 of 10 questions. All results were significant for leadership. Fellows also rated skills covered by the curriculum on a scale of 1 to 10. For all areas, the median score for knowledge gained was 7. When compared with other patient safety learning experiences, participants rated PSLA as 4 or 5, where 1 indicated the other experience much more valuable and 5 much more valuable.

CONCLUSIONS

PSLA demonstrates that leadership skills are perceived as important by physicians and managers in surgical areas. This study demonstrated that a leadership skills approach to patient safety training could improve knowledge in specific leadership areas and general patient safety.