A first step toward understanding best practices in leadership training in undergraduate medical education: a systematic review

Medical Student Leader Performance in an Applied Medical Field Practicum

INTRODUCTION

Many medical schools in the United States are introducing leader and leadership curricula. However, there is a large gap regarding how to assess leader performance during undergraduate medical education. With the guidance of a conceptual framework, leadership assessment measures can be developed, learners can make expected improvements in performance over time, and assessment measures can be used in relevant, applied, medical teaching settings. Uniformed Services University (USU) medical students are educated to become healthcare leaders who can perform effectively in various settings. Medical students are assessed on multiple occasions for elements of leader performance during "Operation Bushmaster" - the capstone military medical field practicum event for fourth year medical students - by experienced faculty. A conceptual framework guides the assessment approach for leader performance during Bushmaster. The USU Leader and Leadership Education and Development program developed an assessment tool to measure student leader performance used in a military medical field practicum. The present paper examines whether: (1) leader performance can be measured at Bushmaster; (2) leader performance changed during Bushmaster; (3) leader performance elements are related to each other; and (4) overall leader performance is related to other medical academic performance.

MATERIALS AND METHODS

Trained faculty assessed students' leader performance. Data from three cohorts of USU medical students (N = 509) were collected. All data were collected, compiled, deidentified, and analyzed with approval from the USU Institutional Review Board (Protocol number: KM83XV). Descriptive statistics, repeated measures t-tests, trend analyses, and correlation analyses were performed.

RESULTS

Data were available from 483/509 [95%] students. Results revealed that: (1) average leader performance was satisfactory; (2) overall leader performance and performance on each of the major elements of leader performance significantly improved over the course of Bushmaster; (3) major elements of leader performance were significantly correlated with each other and with overall leader performance; (4) leader performance was not correlated with students' performance on the MCAT total score or USMLE Step exam scores.

CONCLUSION

With the guidance of a conceptual framework, the assessment tool was used to assess leader performance in a relevant, applied, medical teaching setting. The findings of this study indicate that leader performance can be measured. Additionally, leader performance appears to be a separate skillset from medical academic performance and both types of performance can be taught and developed. This was a retrospective correlation study and was conducted during a military medical field practicum at a single institution. Gathering additional validity evidence of the assessment tool is needed. With additional validity evidence, the assessment tool could be applied to other medical exercises in different settings and help with the assessment of leader performance beyond medical school.

Development of a national medical leadership competency framework: the Dutch approach

BACKGROUND

The concept of medical leadership (ML) can enhance physicians' inclusion in efforts for higher quality healthcare. Despite ML's spiking popularity, only a few countries have built a national taxonomy to facilitate ML competency education and training. In this paper we discuss the development of the Dutch ML competency framework with two objectives: to account for the framework's making and to complement to known approaches of developing such frameworks.

METHODS

We designed a research approach and analyzed data from multiple sources based on Grounded Theory. Facilitated by the Royal Dutch Medical Association, a group of 14 volunteer researchers met over a period of 2.5 years to perform: 1) literature review; 2) individual interviews; 3) focus groups; 4) online surveys; 5) international framework comparison; and 6) comprehensive data synthesis.

RESULTS

The developmental processes that led to the framework provided a taxonomic depiction of ML in Dutch perspective. It can be seen as a canonical 'knowledge artefact' created by a community of practice and comprises of a contemporary definition of ML and 12 domains, each entailing four distinct ML competencies.

CONCLUSIONS

This paper demonstrates how a new language for ML can be created in a healthcare system. The success of our approach to capture insights, expectations and demands relating leadership by Dutch physicians depended on close involvement of the Dutch national medical associations and a nationally active community of practice; voluntary work of diverse researchers and medical practitioners and an appropriate research design that used multiple methods and strategies to circumvent reverberation of established opinions and conventionalisms.

IMPLICATIONS

The experiences reported here may provide inspiration and guidance for those anticipating similar work in other countries to develop a tailored approach to create a ML framework.

Medical Student Consulting: Providing Students Leadership and Business Opportunities While Positively Impacting the Community

INTRODUCTION

Medical schools are increasingly attempting to prepare future physicians for diverse new leadership roles in the health care system. Many schools have implemented didactic leadership curricula, with varying levels of structure and success. Project-based learning via completion of real-world projects using a team-based approach remains an underutilized approach to developing student leadership skills.

METHODS

We designed and implemented the Medical Educational Consulting Group (Med ECG)-a student-run consulting program that provides medical students with opportunities to develop leadership skills by completing consulting projects with local clients. We provide an overview of the Med ECG model, including a combination of didactic training sessions and project-based learning via both simulation and real-world projects. Surveys were used to evaluate the value of Med ECG to clients, the community, and students.

RESULTS

Fourteen medical students (eight first-years, two second-years, three third-years, and one fourth-year, including five dual-degree candidates) completed the Med ECG program. Client feedback pointed to the value of Med ECG's projects and their impact on the community through partner organizations. Finally, linear regression analysis showed a strong positive correlation (R² = .61) between the amount of effort devoted to various leadership attributes and the perceived improvement while working with Med ECG.

DISCUSSION

Med ECG's experiences show that a medical student-led project-based learning program is a novel way to develop leadership skills for future physician leaders. Efforts to replicate these types of programs will help additional students develop their leadership and business skills, making a positive impact outside of the classroom.

Engaging Medical Students in Leadership Development

Leadership development plays a critical role in preparing collaborative, systems-based physicians. Medical schools across the globe have dedicated significant effort towards programming for medical student leadership development. Students report a variety of existing leadership opportunities, ranging from formal didactics to leadership positions within the community. Students identify lack of time, funding, and the hierarchy of medicine as significant barriers for engaging in leadership opportunities. Students favor a formal leadership curriculum coupled with hands-on opportunities to practice leadership skills. In order to train medical students to be engaged physician leaders, it is imperative to foster practical opportunities for leadership development.

Engaging Medical Students in Leadership Development

Leadership development plays a critical role in preparing collaborative, systems-based physicians. Medical schools across the globe have dedicated significant effort towards programming for medical student leadership development. Students report a variety of existing leadership opportunities, ranging from formal didactics to leadership positions within the community. Students identify lack of time, funding, and the hierarchy of medicine as significant barriers for engaging in leadership opportunities. Students favor a formal leadership curriculum coupled with hands-on opportunities to practice leadership skills. In order to train medical students to be engaged physician leaders, it is imperative to foster practical opportunities for leadership development.

A leadership education framework addressing relationship management, burnout, and team trust

Despite the collaborative nature of medicine, most medical professionals are not taught or trained to lead collaboratively. Even when leadership skills and content are incorporated into the curriculum, rarely is the content focused on relationship management and trust, both of which are imperative to collaborative and team leadership in medicine. Resonant leadership is a leadership framework centered on emotional and social intelligence. Emotional intelligence, a concept involving skills that can be taught and improved, has proven to be important in leadership. Resonant leaders, or leaders with social and emotional intelligence, develop positive relationships and environments, engaging team members to work toward a common goal through mindfulness, hope, and compassion. This article examines the current state of leadership education and development and proposes resonant leadership as a viable framework for education. A leadership framework heavy on emotional and social intelligence is ideal for the team environment of medicine, and there is literature to back up the positive outcomes of leading with this framework in a clinical setting, including reduction of burnout, building team trust, and better relationship management.

A first-year leadership programme for medical students

BACKGROUND

The established medical hierarchy, dramatic expansion of scientific knowledge and emphasis on value-based health care means that graduating physicians need to know how to manage and lead positive change. There is a critical gap in the teaching of these skills in undergraduate medical education.

METHODS

Our medical school developed a first-year medical student competency-based leadership curriculum that focused on: leading yourself; teams and teamwork; influence and communication; problem solving; and systems thinking. The course used four methods of teaching leadership: experiential learning; targeted development; reflection; and feedback. The formal curriculum included topics such as developing a leadership agenda, challenging conversations and negotiations. The informal curriculum (learning outside of the structured curriculum) included applying leadership in co-curricular and extracurricular activities (e.g. in a student-run free clinic). Students recorded leadership experiences using a novel reflective assessment tool, obtained multi-source feedback and then articulated a plan for improvement.

RESULTS

Course evaluations noted that only one-third of first-year students responded that the curriculum developed skills in communication, and the ability to problem-solve, apply systems thinking and build teams. Students self-reported that they were often building, leading and managing productive teams, and applying influence and communication. The multi-source feedback assessment revealed that students, on average, were rated as competent to proficient.

DISCUSSION

Creating a robust curriculum for medical students in the first year is challenging. Student reactions ranged from affirming to critical. The next steps will focus on increasing interactive teaching and on helping students understand why, where and how leadership is important.

Leadership Development in Postgraduate Medical Education: A Systematic Review of the Literature

PURPOSE

To evaluate and interpret evidence relevant to leadership curricula in postgraduate medical education (PGME) to better understand leadership development in residency training.

METHOD

The authors conducted a systematic review of peer-reviewed, English-language articles from four databases published between 1980 and May 2, 2017 that describe specific interventions aimed at leadership development. They characterized the educational setting, curricular format, learner level, instructor type, pedagogical methods, conceptual leadership framework (including intervention domain), and evaluation outcomes. They used Kirkpatrick effectiveness scores and Best Evidence in Medical Education (BEME) Quality of Evidence scores to assess the quality of the interventions.

RESULTS

Twenty-one articles met inclusion criteria. The classroom setting was the most common educational setting (described in 17 articles). Most curricula (described in 13 articles) were isolated, with all curricula ranging from three hours to five years. The most common instructor type was clinical faculty (13 articles). The most commonly used pedagogical method was small group/discussion, followed by didactic teaching (described in, respectively, 15 and 14 articles). Study authors evaluated both pre/post surveys of participant perceptions (n = 7) and just postintervention surveys (n = 10). The average Kirkpatrick Effectiveness score was 1.0. The average BEME Quality of Evidence score was 2.

CONCLUSIONS

The results revealed that interventions for developing leadership during PGME lack grounding conceptual leadership frameworks, provide poor evaluation outcomes, and focus primarily on cognitive leadership domains. Medical educators should design future leadership interventions grounded in established conceptual frameworks and pursue a comprehensive approach that includes character development and emotional intelligence.

Why we need to teach leadership skills to medical students: a call to action

Health system reform models since the early 1990s have recommended leadership training for medical students, graduates and health workers. Clinicians often have leadership roles thrust on them early in their postgraduate career. Those who are not well trained in leadership and the knowledge that comes with leadership skills may struggle with the role, which can impact patient safety and create unhealthy working environments. While there is some literature published in this area, there appears to be little formal evaluation of the teaching of leadership, with scarcely any discussion about the need to do so in the future. There are clear gaps in the research evidence of how to teach and assess medical leadership teaching. In this paper, three leadership frameworks from Australia, Canada and the UK are compared in terms of leadership capabilities for a global view of medical leadership training opportunities. A literature review of the teaching, assessment and evaluation of leadership education in medical schools in Australia, the UK and America is also discussed and gaps are identified. This paper calls for an education shift to consider practical health system challenges, citing the mounting evidence that health system reform will require the teaching and rigorous evaluation of leadership methods. Opportunities for teaching leadership in the curricula are identified, as well as how to transform leadership education to include knowledge and practice so that students have leadership skills they can use from the time they graduate.

Twelve tips for integrating leadership development into undergraduate medical education

Healthcare systems need effective leadership. All healthcare professionals can and should "learn to lead" and this requires a clear focus on leadership development from the earliest stages of a career. Within medicine, undergraduate students should be provided with opportunities to thrive and develop their skills in terms of leadership, management and followership. Drawing from the existing evidence base, the authors' expertise and the latest "thought leadership", these 12 tips provide practical guidance to universities and associated provider organizations, and to academic and clinical faculty, on how to integrate leadership development into their undergraduate medical programs. These 12 tips will help educators provide medical education that incorporates leadership as a core part of a professional's identity, and help students gain a deeper understanding of themselves and the teams, organizations and system they work within.

Assessment of medical students' leadership traits in a problem/case-based learning program

BACKGROUND

Healthcare delivery is shifting to team-based care and physicians are increasingly relied upon to lead and participate in healthcare teams. Educational programs to foster the development of leadership qualities in medical students are needed to prepare future physicians for these roles.

OBJECTIVE

Evaluate the development of leadership attributes in medical students during their first 2 years of medical school while participating in leadership training integrated into a problem/case-based learning program utilizing the Leadership Traits Questionnaire assessment tool.

DESIGN

Ninety-eight students enrolled at Zucker School of Medicine participated in Patient-Centered Explorations in Active Reasoning, Learning and Synthesis (PEARLS), a hybrid problem/case-based learning program, during the first and second years of medical school. The Leadership Traits Questionnaire, designed to measure 14 distinct leadership traits, was utilized. It was administered to students, peers in students' PEARLS groups and their faculty facilitators. Participants completed questionnaires at three-time points during the study. Likert scale data obtained from the questionnaire was analyzed using a two-level Hierarchal Linear Model.

RESULTS

Complete data sets were available for 84 students. Four traits, including self-assured, persistent, determined, and outgoing, significantly increased over time by measurements of both peer and facilitator-rated assessments. Six additional traits significantly increased over time by measurement of facilitator-rated assessment. By contrast, a majority of student self-rated assessments trended downward during the study.

CONCLUSIONS

Medical students demonstrated development of several important leadership traits during the first 2 years of medical school. This was accomplished while participating in the PEARLS program and without the addition of curricular time. Future work will examine the impact of third year clerkships on leadership traits.

Preparing health professions students to lead change

PURPOSE

Health care systems increasingly demand health professionals who can lead interdisciplinary teams. While physicians recognize the importance of leadership skills, few receive formal instruction in this area. This paper aims to describe how the Student Leadership Committee (SLC) at the Harvard Medical School Center for Primary Care responded to this need by creating a leadership curriculum for health professions students.

DESIGN/METHODOLOGY/APPROACH

The SLC designed an applied longitudinal leadership curriculum and taught it to medical, dentistry, nursing, public health and business students during monthly meetings over two academic years. The perceptions of the curriculum were assessed via a retrospective survey and an assessment of team functioning.

FINDINGS

Most teams met their project goals and students felt that their teams were effective. The participants reported increased confidence that they could create change in healthcare and an enhanced desire to hold leadership positions. The sessions that focused on operational skills were especially valued by the students.

PRACTICAL IMPLICATIONS

This case study presents an effective approach to delivering leadership training to health professions students, which can be replicated by other institutions.

SOCIAL IMPLICATIONS

Applied leadership training empowers health professions students to improve the health-care system and prepares them to be more effective leaders of the future health-care teams. The potential benefits of improved health-care leadership are numerous, including better patient care and improved job satisfaction among health-care workers.

ORIGINALITY/VALUE

Leadership skills are often taught as abstract didactics. In contrast, the approach described here is applied to ongoing projects in an interdisciplinary setting, thereby preparing students for real-world leadership positions.

A Qualitative Analysis of Narrative Preclerkship Assessment Data to Evaluate Teamwork Skills

Construct: Students entering the health professions require competency in teamwork. Background: Although many teamwork curricula and assessments exist, studies have not demonstrated robust longitudinal assessment of preclerkship students' teamwork skills and attitudes. Assessment portfolios may serve to fill this gap, but it is unknown how narrative comments within portfolios describe student teamwork behaviors. Approach: We performed a qualitative analysis of narrative data in 15 assessment portfolios. Student portfolios were randomly selected from 3 groups stratified by quantitative ratings of teamwork performance gathered from small-group and clinical preceptor assessment forms. Narrative data included peer and faculty feedback from these same forms. Data were coded for teamwork-related behaviors using a constant comparative approach combined with an identification of the valence of the coded statements as either "positive observation" or "suggestion for improvement." Results: Eight codes related to teamwork emerged: attitude and demeanor, information facilitation, leadership, preparation and dependability, professionalism, team orientation, values team member contributions, and nonspecific teamwork comments. The frequency of codes and valence varied across the 3 performance groups, with students in the low-performing group receiving more suggestions for improvement across all teamwork codes. Conclusions: Narrative data from assessment portfolios included specific descriptions of teamwork behavior, with important contributions provided by both faculty and peers. A variety of teamwork domains were represented. Such feedback as collected in an assessment portfolio can be used for longitudinal assessment of preclerkship student teamwork skills and attitudes.

Incorporating medical leadership into undergraduate curricula: a proposal for a spiral curriculum

PURPOSE

There is increasing recognition of the importance of incorporating medical leadership training into undergraduate medical curricula and this is now advocated by the General Medical Council (GMC) and supported through the development of the Undergraduate Medical Leadership Competency Framework (MLCF). However to date, few medical schools have done so in a systematic way and training/experience in medical leadership at undergraduate level is sporadic and often based on local enthusiasm. The purpose of this paper is to outline a theoretical curriculum to stimulate and support medical leadership development at undergraduate level.

DESIGN/METHODOLOGY/APPROACH

This study describes a theoretical framework for incorporation of medical leadership training into undergraduate curricula using a spiral curriculum approach, linked to competences outlined in the Undergraduate Medical Leadership Competency Framework. The curriculum includes core training in medical leadership for all students within each year group with additional tiers of learning for students with a particular interest.

FINDINGS

This curriculum includes theoretical and practical learning opportunities and it is designed to be deliverable within the existing teaching and National Health Service (NHS) structures. The engagement with local NHS organisations offers opportunities to broaden the university teaching faculty and also to streamline medical leadership development across undergraduate and postgraduate medical education.

ORIGINALITY/VALUE

This theoretical curriculum is generic and therefore adaptable to a variety of undergraduate medical courses. The combination of theoretical and practical learning opportunities within a leadership spiral curriculum is a novel and systematic approach to undergraduate medical leadership development.

The role of eLearning in health management and leadership capacity building in health system: a systematic review

BACKGROUND

Health leadership and management are essential for ensuring resilient health systems. Relevant training opportunities are often scarce, and the use of digital education could help address this gap. Our aim was to assess the effectiveness of eLearning for healthcare leadership and management capacity building.

METHODS

We performed a systematic review on the effectiveness of eLearning for health leadership and management training. We also reviewed literature on relevant competencies and training programmes. We conceptualise the role of health leadership and management capacity building in health system strengthening and explore the use of eLearning in this area.

RESULTS

No evidence was found on the effectiveness of eLearning for health leadership and management capacity guiding. Evidence on health leadership and management education effectiveness in general is scarce and descriptive and reports learning outcomes. We explore how various forms of eLearning can help meet specific requirements of health leadership and management training.

CONCLUSIONS

Literature on the effectiveness of health leadership and management education is scarce. The use of eLearning could support this type of training by making it more accessible and tailored. Future research should be carried out in diverse settings, assume experimental designs, evaluate the use of information technology and report health system outcomes.

The Role of Mentoring in the Development of Successful Orthopaedic Surgeons

Mentoring plays an integral role in orthopaedic surgeons' career development and personal growth. Effective mentors are committed to their roles, provide skilled instructional support, model continuous learning, and communicate optimism. Numerous obstacles impede productive mentoring relationships in medicine, including reluctance to ask for help, time constraints due to extensive work obligations, lack of institutional support, relational difficulties, and lack of mentoring skills. Effective partnerships require a concerted effort to establish behaviors conducive to mentoring, such as sharing knowledge and providing constructive feedback. Given that women represent only 13% of orthopaedic surgery residents and racial/ethnic minorities account for 3% to 10% of US orthopaedic surgeons, mentoring may help diversify the workforce by providing early exposure and professional support to physicians from underrepresented demographic groups. Orthopaedic leaders must embrace their professional obligation to cultivate and inspire the next generation of orthopaedic surgeons.

Developmental readiness and leadership development in medicine

Purpose

Leadership is a key competency for physicians. Based on the premise that not everyone benefits equally from leadership development programmes, the leader developmental readiness (LDR; ability and motivation to develop) construct has been proposed to account for the differences. The purpose of this project was to explore the relationship between LDR, leadership experience, leader behaviours and leader efficacy in medical learners.

Method

Survey data from 46 medical learners were collected in 2015–2016. Separate one-way analysis of variances, with between-group factors of leadership experience (<12 months, >12 months, 0 month), were carried out on LDR constructs ofabilityandmotivationusing five validated measures: motivation to lead, goal orientation, developmental efficacy, self-awareness and metacognitive ability. Spearman’s rank-order correlations were used to examine the relationship between LDR and experience with leader efficacy and leadership behaviours (transformational and transactional). Statistical significance was determined at p<0.05. Bonferroni corrections were applied for any multiple comparisons.

Results

Significant main effects were observed for both ability and motivation to develop, showing lower scores on these variables for individuals with less leadership experience. Both experience and LDR constructs (motivation and ability) were shown to be significantly positively associated with transformational leadership behaviour (and not transactional leadership behaviour). The LDR constructs, but not leadership experience, were significantly positively associated with leader efficacy.

Conclusions

The positive correlation between LDR, experience, and transformational leadership behaviours and between LDR and leader efficacy is of value in leadership development. Understanding the developmental readiness of learners and how this affects leadership development is paramount to better inform personal leadership development and structure leadership development programmes for medical learners and physicians.

Finding a path to growth as a leader: a medical learner perspective

Physicians are often required to lead teams in clinical and non-clinical environments but may not receive formal training in advance of these opportunities. In this commentary, three medical learners discuss their views on leadership education in undergraduate and postgraduate medicine, arguing that leadership development should be more explicitly integrated into training programmes and that medical leaders need to be better recognised for their contributions to this field, much like expert clinicians, clinician-educators and clinician-scientists are recognised for theirs. After reviewing the published literature in this domain, reflecting on their experiences engaging with medical leaders and attending a leadership education summit, the authors conclude that, as initial steps towards improving leadership training in medical education, faculties and programmes should commit to incorporating leadership training into their curricula, and strive to deliberately connect learners interested in leadership with practising clinician-leaders with an eye towards improving learners’ leadership skills. These first steps could help to catalyse the necessary shift towards improved leadership education and better patient care.

Leadership Training in Graduate Medical Education: A Systematic Review

BACKGROUND

Leadership is a critical component of physician competence, yet the best approaches for developing leadership skills for physicians in training remain undefined.

OBJECTIVE

We systematically reviewed the literature on existing leadership curricula in graduate medical education (GME) to inform leadership program development.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we searched MEDLINE, ERIC, EMBASE, and MedEdPORTAL through October 2015 using search terms to capture GME leadership curricula. Abstracts were reviewed for relevance, and included studies were retrieved for full-text analysis. Article quality was assessed using the Best Evidence in Medical Education (BEME) index.

RESULTS

A total of 3413 articles met the search criteria, and 52 were included in the analysis. Article quality was low, with 21% (11 of 52) having a BEME score of 4 or 5. Primary care specialties were the most represented (58%, 30 of 52). The majority of programs were open to all residents (81%, 42 of 52). Projects and use of mentors or coaches were components of 46% and 48% of curricula, respectively. Only 40% (21 of 52) were longitudinal throughout training. The most frequent pedagogic methods were lectures, small group activities, and cases. Common topics included teamwork, leadership models, and change management. Evaluation focused on learner satisfaction and self-assessed knowledge. Longitudinal programs were more likely to be successful.

CONCLUSIONS

GME leadership curricula are heterogeneous and limited in effectiveness. Small group teaching, project-based learning, mentoring, and coaching were more frequently used in higher-quality studies.

Medical student healthcare consulting groups: A novel way to train the next generation of physician-executives

Meeting the challenges of the evolving healthcare environment requires leadership of physicians well-trained in clinical medicine and healthcare management. However, many physicians lack training in business and leadership. While some residency programs have management tracks, training at the medical school level is currently lacking. We developed the Hopkins Health Management Advisory Group, an extracurricular program at Johns Hopkins University School of Medicine that exposes medical students to healthcare management and fosters development of leadership skills. Teams of students work directly with health system executives on 3-6 month-long projects using management consulting principles to address problems spanning health system domains, including strategy, operations, and quality improvement. Since the program's inception, 23 students have completed seven projects, with 13 additional students currently working on three more projects. Sponsors leading six out of seven completed projects have implemented recommendations. Qualitative survey respondents have found the program beneficial, with students frequently describing how the program has helped to develop professional skills and foster knowledge about healthcare management. These early assessments show positive impact for both students and the institution, and suggest that such programs can train students in management early and concurrently in their medication education by immersing them in team-based health system projects.

Medical School Factors That Prepare Students to Become Leaders in Medicine

PURPOSE

To identify medical school factors graduates in major leadership positions perceive as contributing to their leadership development.

METHOD

Using a phenomenological, qualitative approach, in August-November 2015 the authors conducted semistructured interviews with 48 medical leaders who were 1976-1999 baccalaureate-MD graduates of the University of Missouri-Kansas City School of Medicine (UMKC). At UMKC, they participated in longitudinal learning communities, the centerpiece for learning professional values and behaviors plus clinical skills, knowledge, and judgment, but received no formal leadership instruction. The authors subjected interview comments to directed, largely qualitative content analysis with iterative coding cycles.

RESULTS

Most graduates said their experiences and the people at UMKC positively influenced their leadership growth. Medical school factors that emerged as contributing to that growth were the longitudinal learning communities including docents, junior-senior partners, and team experiences; expectations set for students to achieve; a clinically oriented but integrated curriculum; admission policies seeking students with academic and nonacademic qualifications; supportive student-student and student-faculty relationships; and a positive overall learning environment. Graduates viewed a combination of factors as best preparing them for leadership and excellence in clinical medicine; together these factors enabled them to assume leadership opportunities after graduation.

CONCLUSIONS

This study adds medical leaders' perspective to the leadership development literature and offers guidance from theory and practice for medical schools to consider in shaping leadership education: Namely, informal leadership preparation coupled with extensive longitudinal clinical education in a nurturing, authentic environment can develop students effectively for leadership in medicine.

Medical leadership: An important and required competency for medical students

Good medical leadership is the key to building high-quality healthcare. However, in the development of medical careers, the teaching of leadership has traditionally not equaled that of technical and academic competencies. As a result of changes in personal standards, the quality of medical leadership has led to variations between different organizations, as well as occasional catastrophic failure in the standard of care provided for patients. Leaders in the medical profession have called for reform in healthcare in response to challenges in the system and improvements in public health. Furthermore, there has been an increased drive to see leadership education for doctors starting earlier, and continuing throughout their careers so that they can take on more important leadership roles throughout the healthcare system. Being a physician requires not only management and leadership but also the need to transfer competencies to communication and critical thinking. These attributes can be obtained through experience in teamwork under the supervision of teaching staff. Therefore, medical students are expected to develop skills to deal with and resolve conflicts, learn to share leadership, prepare others to help and replace them, take mutual responsibility and discuss their performance.

Developing a model for effective leadership in healthcare: a concept mapping approach

Purpose

Despite increasing awareness of the importance of leadership in healthcare, our understanding of the competencies of effective leadership remains limited. We used a concept mapping approach (a blend of qualitative and quantitative analysis of group processes to produce a visual composite of the group’s ideas) to identify stakeholders’ mental model of effective healthcare leadership, clarifying the underlying structure and importance of leadership competencies.

Methods

Literature review, focus groups, and consensus meetings were used to derive a representative set of healthcare leadership competency statements. Study participants subsequently sorted and rank-ordered these statements based on their perceived importance in contributing to effective healthcare leadership in real-world settings. Hierarchical cluster analysis of individual sortings was used to develop a coherent model of effective leadership in healthcare.

Results

A diverse group of 92 faculty and trainees individually rank-sorted 33 leadership competency statements. The highest rated statements were “Acting with Personal Integrity”, “Communicating Effectively”, “Acting with Professional Ethical Values”, “Pursuing Excellence”, “Building and Maintaining Relationships”, and “Thinking Critically”. Combining the results from hierarchical cluster analysis with our qualitative data led to a healthcare leadership model based on the core principle of Patient Centeredness and the core competencies of Integrity, Teamwork, Critical Thinking, Emotional Intelligence, and Selfless Service.

Conclusion

Using a mixed qualitative-quantitative approach, we developed a graphical representation of a shared leadership model derived in the healthcare setting. This model may enhance learning, teaching, and patient care in this important area, as well as guide future research.

The need for strong clinical leaders - Transformational and transactional leadership as a framework for resident leadership training

Background

For the purpose of providing excellent patient care, residents need to be strong, effective leaders. The lack of clinical leadership is alarming given the detrimental effects on patient safety. The objective of the study was to assess whether a leadership training addressing transactional and transformational leadership enhances leadership skills in residents.

Methods

A volunteer sample of 57 residents from postgraduate year one to four was recruited across a range of medical specialties. The residents took part in an interventional controlled trial. The four-week IMPACT leadership training provided specific strategies for leadership in the clinical environment, addressing transactional (e.g. active control, contingent reward) and transformational leadership skills (e.g. appreciation, inspirational motivation).

Transactional and transformational leadership skill performance was rated (1) on the Performance Scale by an external evaluator blinded to the study design and (2) self-assessed transformational and transactional leadership skills. Both measures contained items of the Multifactor Leadership Questionnaire, with higher scores indicating greater leadership skills.

Results

Both scores were significantly different between the IMPACT group and the control group. In the IMPACT group, the Performance Scale increased 15% in transactional leadership skill performance (2.10 to 2.86) (intervention effect, 0.76; 95% CI, 0.40 to 1.13; p < .001, eta² = 0.31) and 14% in transformational leadership skill performance (2.26 to 2.94) (intervention effect, 0.68; 95% CI, 0.27 to 1.09; p < .001, eta² = 0.22). The self-assessed transactional skills revealed a 4% increase (3.83 to 4.03) (intervention effect, 0.20; 95% CI, 0.08 to 0.33; p < .001, eta² = 0.18) and a 6% increase in transformational leadership skills (3.54 to 3.86) (intervention effect, 0.31; 95% CI, 0.02 to 0.40; p< .001, eta² = 0.53).

Discussion and conclusions

These findings support the use of the transactional and transformational leadership framework for graduate leadership training. Future studies should incorporate time-latent post-tests, evaluating the stability of the behavioral performance increase.

On the road to becoming a responsible leader: A simulation-based training approach for final year medical students

Background and objective: There is a need for young physicians to take a responsible role in clinical teams, comparable to a leadership role. However, today's medical curricula barely consider the development of leadership competencies. Acquisition of leadership skills are currently a by-product of medical education, even though it seems to be a competency relevant for physicians' success. Therefore, an innovative leadership training program for young physicians was developed and validated. Training conceptualisation were based upon findings of critical incidents interviews (N=19) with relevant personnel (e.g. experienced doctors/nurses, residents) and upon evidence-based leadership contents focusing on ethical leadership behaviors. Method: The training consists of four sessions (3-4 hours each) and provided evidence-based lectures of leadership theory and effective leader behaviors, interactive training elements and a simulation-based approach with professional role players focusing on interprofessional collaboration with care staff. Training evaluation was assessed twice after completion of the program (N=37). Assessments included items from validated and approved evaluation instruments regarding diverse learning outcomes (satisfaction/reaction, learning, self-efficacy, and application/transfer) and transfer indicators. Furthermore, training success predictors were assessed based on stepwise regression analysis. In addition, long-term trainings effects and behavioral changes were analysed. Results: Various learning outcomes are achieved (self-reported training satisfaction, usefulness of the content and learning effects) and results show substantial transfer effects of the training contents and a strengthened awareness for the leadership role (e.g. self-confidence, ideas dealing with work-related problems in a role as responsible physician). We identified competence of trainer, training of applied tools, awareness of job expectations, and the opportunity to learn from experiences of other participants as predictors of training success. Additionally, we found long-term training effects and participants reported an increase in specific competencies, relevant for effective interprofessional collaboration (active perspective-taking, communication, conflict management, personal competencies). Conclusion: The training of leadership competencies for young physicians seems feasible to develop constructive influence strategies for a successful interprofessional collaboration in early career stages. The simulation-based approach is beneficial for residents to practice leadership behaviour in realistic job situations.

Leadership and management in UK medical school curricula

Purpose Although medical leadership and management (MLM) is increasingly being recognised as important to improving healthcare outcomes, little is understood about current training of medical students in MLM skills and behaviours in the UK. The paper aims to discuss these issues. Design/methodology/approach This qualitative study used validated structured interviews with expert faculty members from medical schools across the UK to ascertain MLM framework integration, teaching methods employed, evaluation methods and barriers to improvement. Findings Data were collected from 25 of the 33 UK medical schools (76 per cent response rate), with 23/25 reporting that MLM content is included in their curriculum. More medical schools assessed MLM competencies on admission than at any other time of the curriculum. Only 12 schools had evaluated MLM teaching at the time of data collection. The majority of medical schools reported barriers, including overfilled curricula and reluctance of staff to teach. Whilst 88 per cent of schools planned to increase MLM content over the next two years, there was a lack of consensus on proposed teaching content and methods. Research limitations/implications There is widespread inclusion of MLM in UK medical schools' curricula, despite the existence of barriers. This study identified substantial heterogeneity in MLM teaching and assessment methods which does not meet students' desired modes of delivery. Examples of national undergraduate MLM teaching exist worldwide, and lessons can be taken from these. Originality/value This is the first national evaluation of MLM in undergraduate medical school curricula in the UK, highlighting continuing challenges with executing MLM content despite numerous frameworks and international examples of successful execution.

Challenges in Translation: Lessons from Using Business Pedagogy to Teach Leadership in Undergraduate Medicine

PROBLEM

Leadership is increasingly recognized as a core physician competency required for quality patient care, continual system improvement, and optimal healthcare team performance. Consequently, integration of leadership into medical school curriculum is becoming a priority. This raises the question of the appropriate context, timing, and pedagogy for conveying this competency to medical students.

INTERVENTION

Our program introduced a 1-week leadership course grounded in business pedagogy to Year 1 medical students. The curriculum centred on four themes: (a) Understanding Change, (b) Effective Teamwork, (c) Leading in Patient Safety, and (d) Leadership in Action. Post-curriculum qualitative student feedback was analyzed for insight into student satisfaction and attitude towards the leadership course content.

CONTEXT

The Undergraduate Medical Education program of the Schulich School of Medicine & Dentistry, Western University, is delivered over 4 years across 2 campuses in London and Windsor, Ontario, Canada. Course structure moved from traditional passive lectures to established business pedagogy, which involves active engagement in modules, case-based discussions, insights from guest speakers, and personal reflection.

OUTCOME

A student-led survey evaluated student opinion regarding the leadership course content. Students valued career development reading materials and insights from guest speakers working in healthcare teams. Students did not relate to messages from speakers in senior healthcare leadership positions. Course scheduling late in the second semester was viewed negatively. Overall student opinion suggested that the 1-week course was suboptimal for establishing leadership principles and translated business pedagogy was ineffective in this context.

LESSONS LEARNED

Leadership curriculum in Undergraduate Medical Education should be grounded in a healthcare context relevant to the student's stage of training. Student engagement may be better supported if leadership is framed as a competency throughout their career. Schools considering such innovations could draw lessons from other professional schools and utilize material and faculty that resonate with students.

Academic Primer Series: Five Key Papers about Team Collaboration Relevant to Emergency Medicine

Introduction

Team collaboration is an essential for success both within academics and the clinical environment. Often, team collaboration is not explicitly taught during medical school or even residency, and must be learned during one’s early career. In this article, we aim to summarize five key papers about team collaboration for early career clinician educators.

Methods

We conducted a consensus-building process among the writing team to generate a list of key papers that describe the importance or significance of team collaboration, seeking input from social media sources. The authors then used a three-round voting methodology akin to a Delphi study to determine the most important papers from the initially generated list.

Results

The five most important papers on the topic of team collaboration, as determined by this mixed group of junior faculty members and faculty developers, are presented in this paper. For each included publication, a summary was provided along with its relevance to junior faculty members and faculty developers.

Conclusion

Five key papers about team collaboration are presented in this publication. These papers provide a foundational background to help junior faculty members with collaborating in teams both clinically and academically. This list may also inform senior faculty and faculty developers about the needs of junior faculty members.

The state of leadership education in US medical schools: results of a national survey

Over the past two decades, there have been increasing calls for physicians to develop the capabilities to lead health care transformation. Many experts and authors have suggested that leadership education should begin during medical school; however, little information exists regarding the presence or nature of undergraduate medical education leadership curricula in the USA. This study sought to determine the prevalence of formal leadership education in US undergraduate medical schools, as well as the delivery methods and degree of student participation. A web-based survey of medical education deans from US allopathic medical schools (N = 144) was administered from November 2014 to February 2015. The survey included questions on the presence of leadership curricula, delivery format, student participation rates, and forms of recognition. Eighty-eight surveys were completed; the majority (85%) of respondents were associate or assistant deans for medical education. Approximately half (54.5%) of respondents reported leadership curricula within their medical schools. Of those, 34.8% (16/46) were required; 32.6% (15/46) were elective; and 32.6% (15/46) indicated both required and elective components. Of schools with formal leadership curricula ​(n = 48), the common forms of content delivery were: mentoring programs (65.1%); dual degree programs (54.5%); workshops (48.8%); seminar/lecture series (41.9%); courses (41.9%); or single seminars (18.6%). Nineteen percent of institutions offer longitudinal leadership education throughout medical school. Common forms of recognition for leadership education were: course credit (48.8%); dual degrees (37.2%); certificates of completion (18.6%); and transcript notations (7.0%). This study indicates that formal leadership education exists in more than half of US allopathic medical schools, suggesting it is an educational priority. Program format, student participation, delivery methods, and recognition varied considerably. Further study is needed to identify the optimal content, competencies, and pedagogy for leadership education. Identifying best practices may help guide standards for leadership curricula across UME and fill this educational need.​.

Design, implementation, and demographic differences of HEAL: a self-report health care leadership instrument

The medical community has recognized the importance of leadership skills among its members. While numerous leadership assessment tools exist at present, few are specifically tailored to the unique health care environment. The study team designed a 24-item survey (Healthcare Evaluation & Assessment of Leadership [HEAL]) to measure leadership competency based on the core competencies and core principles of the Duke Healthcare Leadership Model. A novel digital platform was created for use on handheld devices to facilitate its distribution and completion. This pilot phase involved 126 health care professionals self-assessing their leadership abilities. The study aimed to determine both the content validity of the survey and the feasibility of its implementation and use. The digital platform for survey implementation was easy to complete, and there were no technical problems with survey use or data collection. With regard to reliability, initial survey results revealed that each core leadership tenet met or exceeded the reliability cutoff of 0.7. In self-assessment of leadership, women scored themselves higher than men in questions related to patient centeredness (P=0.016). When stratified by age, younger providers rated themselves lower with regard to emotional intelligence and integrity. There were no differences in self-assessment when stratified by medical specialty. While only a pilot study, initial data suggest that HEAL is a reliable and easy-to-administer survey for health care leadership assessment. Differences in responses by sex and age with respect to patient centeredness, integrity, and emotional intelligence raise questions about how providers view themselves amid complex medical teams. As the survey is refined and further administered, HEAL will be used not only as a self-assessment tool but also in “360” evaluation formats.

Leadership training for undergraduate medical students

Purpose

Physicians play an important leadership role in the management and governance of the healthcare system. Yet, many physicians lack formal management and leadership training to prepare them for this challenging role. This Viewpoint article argues that leadership concepts need to be introduced to undergraduate medical students early and throughout their medical education.

Design/methodology/approach

Leadership is an integral part of medical practice. The recent inclusion of “Leader” competency in the CanMEDS 2015 represents a subtle but important shift from the previous “manager” competency. Providing medical students with the basics of leadership concepts early in their medical education allows them to integrate leadership principles into their professional practice.

Findings

The Faculty of Medicine at the Memorial University of Newfoundland (MUN) has developed an eight-module, fully online Physician Leadership Certificate for their undergraduate medical education program. This program is cited as an example of an undergraduate medical curriculum that offers leadership training throughout the 4 years of the MD program.

Originality/value

There are a number of continuing professional development opportunities for physicians in the area of management and leadership. This Viewpoint article challenges undergraduate medical education programs to develop and integrate leadership training in their curricula.

Workforce, learners, competencies, and the learning environment: Research in Medical Education 2014 and the way forward

Medicine in the United States is changing as a result of many factors, including the needs and demands of 21st-century society. In this commentary, the authors review the 2014 Research in Medical Education (RIME) articles in the context of these changes and with an eye toward the future. The authors organized the 12 RIME articles into four broad themes: career development and workforce issues; competency and assessment; admissions, wellness, and the learning environment; and intended and unintended learning. Although the articles represent a broad range of issues, the authors identified three key take-home points from the collection: (1) Schools may be able to address the looming shortage of primary care physicians through admission selection criteria and targeted curricular activities; (2) better understanding of the competencies required to perform complex physician tasks could lead to more effective ways to teach and assess these tasks; and (3) the intended and unintended learning that take place in the medical learning environment require careful attention in order to produce physicians who are both skilled enough and well enough to meet the needs of society.