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Rodríguez-Feria P, Paric M, Flórez LJH, Babich S, Czabanowska K. Critical route for development of medical student leadership competencies in 35 Pan American Health Organization member states: A scoping review and thematic analysis. Int J Health Plann Manage 2024; 39:844-859. [PMID: 38439138 DOI: 10.1002/hpm.3791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/06/2024] Open
Abstract
The Pan American Health Organization has been committed to training physicians in leadership competencies since 2008. However, four reviews on teaching leadership using competency-based education in undergraduate medical education (UME) identified only two of 35 MS: Canada and the USA. Previous reviews did not use a systemic approach or qualitative methodology to explore factors influencing leadership education. Therefore, this review aims to identify facilitating and inhibiting factors in teaching leadership in UME using a scoping review and thematic analysis. Six databases containing grey and indexed literature in English, Spanish, and Portuguese were searched, including a hand search and authors' consultations. Forty-eight documents out of 7849 were selected based on eligibility criteria. Braun and Clarke's thematic analysis guide was used, identifying eight themes: curriculum, intended learning outcomes, teaching methods, assessment, addressing barriers, supporting organisational change, building networks, and developing expertise. Considering these themes, the authors propose a critical route for teaching leadership in UME in the Americas. First, institutional design should consider governance gaps, such as having national and international policies for leadership training in UME with inter-professional, trans-professional, and citizen-focused approaches. There is a pressing need to provide leadership training for physicians and other professionals from government, academia, non-governmental organisations, hospitals, and national and international organisations whose missions are related to health or education. Networking opportunities for stakeholders in leadership education and teacher training is also essential. Second, instructional design reveals knowledge-do gaps in member states (MS) when incorporating leadership into the medical curriculum. This includes using leadership frameworks, defining learning outcomes, and employing assessment and monitoring tools for leadership education. Mechanisms to reduce these gaps in MS include the Equator Network and Evidence-Informed Policy Networks fostering knowledge translation and governance.
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Affiliation(s)
- Pablo Rodríguez-Feria
- Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Facultad de Medicina, Departamento de Salud Pública, Universidad de los Andes, Bogota, Colombia
| | - Martina Paric
- Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Luis Jorge Hernández Flórez
- Facultad de Medicina, Departamento de Salud Pública, Universidad de los Andes, Bogota, Colombia
- Program in Public Health, Schools of Medicine and Government, Universidad de Los Andes, Bogota, Colombia
| | - Suzanne Babich
- Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Community and Global Health, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Katarzyna Czabanowska
- Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Faculty of Health Sciences, Department of Health Policy and Management, Institute of Public Health, Jagiellonian University, Krakow, Poland
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Polanski A, Hall A, Reiser C, Uttal K, Kuhl A. Leadership development in genetic counseling graduate programs. J Genet Couns 2024. [PMID: 38655613 DOI: 10.1002/jgc4.1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
Leadership is emerging as an important component of health professional training. This study aimed to characterize current leadership development in accredited genetic counseling programs. Semi-structured interviews with program leadership were conducted to explore their program's leadership curricula and their perspectives on the meaning of leadership and its place in genetic counseling training. Eleven interviews were conducted and focused on seven categories related to study goals. Using the Framework Method, themes were generated within the predefined categories. Categories and themes included Defining Leadership (Positional vs Non-positional, Beliefs about Leadership, Role of Leadership in the Field of Genetic Counseling), Leadership Curricula Origin and Delivery (Course-based and Longitudinal, Explicit vs. Implicit, Origin of Material), Role of Faculty and Students (Role of Faculty, Expectations for Students and Qualities of Students), Skills, Evaluation, Priority (Potential for Improvement, Barriers and Facilitators), and Standards (Current Incorporation, Potential Incorporation). All programs had some form of leadership development, but many participants lacked a personal or program definition of leadership. Leadership development varied in curricula and delivery, but most were longitudinal and faculty-driven, with communication, teaching, advocacy, and collaboration as commonly taught skills. However, leadership development opportunities were rarely labeled as such, and participants identified labeling current leadership development as the top area for improvement. Labeling leadership development could improve assessment of current efforts and the ability to address gaps in leadership curricula. This would lay the foundation for necessary intentional leadership development, in turn helping us better advocate for our patients and the profession.
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Affiliation(s)
- Amanda Polanski
- Master of Genetic Counselor Studies Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - April Hall
- Center for Human Genomics and Precision Medicine, UW Health, Madison, Wisconsin, USA
| | - Catherine Reiser
- Emeritus Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Katherine Uttal
- Master of Genetic Counselor Studies Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ashley Kuhl
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Standiford TC, Eltawil Y, Durr ML, Pletcher SD, Chang JL. Leadership Training Curriculum for Otolaryngology-Head and Neck Surgery Residents: A Scoping Review. Otolaryngol Head Neck Surg 2023; 169:1436-1444. [PMID: 37555241 DOI: 10.1002/ohn.478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/25/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Otolaryngologists take on various leadership roles throughout their daily practice, but specific training focused on leadership development during otolaryngology-head and neck surgery (OHNS) residency is not well-defined. This project explores the current state of leadership curricula for OHNS residents. DATA SOURCES Google Scholar, Embase, PubMed, and MedEdPORTAL. REVIEW METHODS A scoping review was performed on English-language, full-text, peer-reviewed articles that describe leadership curricula for OHNS residents. Investigators reviewed curriculum settings, content, delivery methods, and assessment; curriculum effectiveness was evaluated using Kirkpatrick effectiveness scores and article quality was assessed using the Best Evidence in Medical Education (BEME) index. CONCLUSION Three thousand four hundred sixteen articles met search criteria, 198 articles were included for full-text review, and 4 articles met inclusion criteria. Curriculum content and delivery methods were diverse. Curriculum cadence ranged from 2-day immersion trainings to year-long longitudinal programs. Only one of the included studies utilized a needs assessment to inform curriculum development. Two articles achieved Kirkpatrick effectiveness scores of 2, indicating changes in the attitudes or perceptions among participants and a quality measure of 3, indicating clear conclusions drawn from the results. IMPLICATIONS FOR PRACTICE The current state of leadership training in OHNS residency is limited and nonuniform. These data align with descriptions of leadership training in other surgical residencies which are reported as heterogenous and lacking in effectiveness. This review highlights the need for standardized leadership training for OHNS residents. The high-quality leadership development initiatives within graduate medical education are reviewed to inform future directions for effective curriculum development and assessment.
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Affiliation(s)
- Taylor C Standiford
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, California, USA
| | - Yasmin Eltawil
- San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Megan L Durr
- Department of Otolaryngology-Head & Neck Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Steven D Pletcher
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head & Neck Surgery, Division of Sleep Surgery and General Otolaryngology, University of California, San Francisco, California, USA
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Lüchinger R, Audétat MC, Bajwa NM, Bréchet-Bachmann AC, Guessous I, Richard-Lepouriel H, Dominicé Dao M, Perron J. French-speaking Swiss physician's perceptions and perspectives regarding their competencies and training need in leadership and management: a mixed-methods study. BMC Health Serv Res 2023; 23:1095. [PMID: 37828553 PMCID: PMC10571431 DOI: 10.1186/s12913-023-10081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Effective leadership and management (L&M) are essential to the success of health care organizations. Young medical leaders often find themselves ill-prepared to take on these new responsibilities, but rarely attend training in L&M skills. The aims of this study were to evaluate physician's self-perceived competencies and training needs for L&M, to identify available regional L&M training, and to highlight opportunities, challenges and threats regarding physicians' training in medical L&M in the French-speaking part of Switzerland. METHODS We conducted a mixed methods study in three steps: (1) a survey on perceived L&M competencies and training needs (5 dimensions) to all physicians of a Swiss University Hospital (N = 2247); (2) a mapping of the Swiss French speaking L&M training programs through analysis of hospital websites and interviews; and (3) semi-structured interviews with L&M program coordinators about the programs' strengths and weaknesses as well as the opportunities and challenges to include physicians in such training. We used analysis of variance to compare differences in perceived competences between physicians of different hierarchical status and used Cramer's V to measure the association's degree between physicians' training needs and prior training in L&M and hierarchical status. We analysed semi-structured interviews using thematic analysis. RESULTS Five-hundred thirty-two physicians responded (24%). Physicians perceived themselves as rather competent in most leadership dimensions. More experienced physicians reported a higher sense of competence in all dimensions of leadership (e.g. Working with others: F = 15.55, p < .001; Managing services: F = 46.89, p < .001). Three competencies did not vary according to the hierarchical status: emotional intelligence (F = 1.56, p = .20), time management (F = 0.47, p = .70) and communicating (F = 1.97, p = .12). There was a weak to moderate association between the responders' self-perceived needs for training and their hierarchal status for all competencies (Cramer's V ∈ [0.16;0.35]). Physicians expressed a strong desire to seek out training for all competencies, especially for knowing one's leadership style (82%), managing teams (83%), and managing conflict (85%). Although existing local L&M training programs covered most relevant topics, only a forth of responders had attended any type of training. L&M program coordinators identified several facilitators and barriers to physician attendance on institutional (matching reality and training), relational (managing collective intelligence), and individual levels (beliefs and self-perceived identity). CONCLUSIONS French-speaking Swiss hospital physicians clearly express training needs for L&M skills although they only rarely attend such training programs. Reasons for non-attendance to such programs should be explored in order to understand physicians' low participation rates in these trainings.
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Affiliation(s)
- R Lüchinger
- Unit of Research and Development in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - M-C Audétat
- Unit of Research and Development in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Institute of Family and Child Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - N M Bajwa
- Unit of Research and Development in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Women, Children and Adolescents, University Hospitals of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
| | - A-C Bréchet-Bachmann
- Department of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - I Guessous
- Department of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - H Richard-Lepouriel
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - M Dominicé Dao
- Department of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Junod Perron
- Unit of Research and Development in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Directorate, University Hospitals of Geneva, Geneva, Switzerland
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Barry ES, Teunissen P, Varpio L. Followership in interprofessional healthcare teams: a state-of-the-art narrative review. BMJ LEADER 2023:leader-2023-000773. [PMID: 37696538 DOI: 10.1136/leader-2023-000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE A state-of-the-art (SotA) literature review-a type of narrative review- was conducted to answer: What historical developments led to current conceptualisations of followership in interprofessional healthcare teams (IHTs)? DESIGN Working from a constructivist orientation, SotA literature reviews generate a chronological overview of how knowledge evolved and presents this summary in three parts: (1) this is where we are now, (2) this is how we got here and (3) this is where we should go next. Using the SotA six-stage methodology, a total of 48 articles focused on followership in IHTs were used in this study. RESULTS Articles about followership within IHTs first appeared in 1993. Until 2011, followership was framed as leader-centric; leaders used their position to influence followers to uphold their dictums. This perspective was challenged when scholars outside of healthcare emphasised the importance of team members for achieving goals, rejecting a myopic focus on physicians as leaders. Today, followership is an important focus of IHT research but two contradictory views are present: (1) followers are described as active team members in IHTs where shared leadership models prevail and (2) conceptually and practically, old ways of thinking about followership (ie, followers are passive team members) still occur. This incongruity has generated a variable set of qualities associated with good followership. CONCLUSIONS Leadership and followership are closely linked concepts. For leaders and followers in today's IHTs to flourish, the focus must be on followers being active members of the team instead of passive members. Since theories are increasingly encouraging distributed leadership, shared leadership and/or situational leadership, then we must understand the followership work that all team members need to harness. We need to be cognizant of team dynamics that work within different contexts and use leadership and followership conceptualisations that are congruent with those contexts.
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Affiliation(s)
- Erin S Barry
- Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Pim Teunissen
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Lara Varpio
- Department of Pediatrics, Perelman School of Medicine at the University, Philadelphia, Pennsylvania, USA
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Brasier AR, Casey SL, Hatfield P, Kelly PW, Sweeney WA, Schweizer M, Liu B, Burnside ES. A leadership model supporting maturation of high-performance translational teams. J Clin Transl Sci 2023; 7:e171. [PMID: 37745935 PMCID: PMC10514693 DOI: 10.1017/cts.2023.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 09/26/2023] Open
Abstract
Despite understanding its impact on organizational effectiveness, practical guidance on how to train translational team (TT) leaders is lacking. Previously, we developed an evolutionary learning model of TT maturation consisting of three goal-directed phases: (1). team assembly (Formation); (2). conducting research (Knowledge Generation); and (3). dissemination and implementation (Translation). At each phase, the team acquires group-level knowledge, skills, and attitudes (KSAs) that enhance its performance. Noting that the majority of team-emergent KSAs are promoted by leadership behaviors, we examine the SciTS literature to identify the relevant behaviors for each phase. We propose that effective team leadership evolves from a hierarchical, transformational model early in team Formation to a shared, functional leadership model during Translation. We synthesized an integrated model of TT leadership, mapping a generic "functional leadership" taxonomy to relevant leadership behaviors linked to TT performance, creating an evidence-informed Leadership and Skills Enhancement for Research (LASER) training program. Empirical studies indicate that leadership behaviors are stable across time; to enhance leadership skills, ongoing reflection, evaluation, and practice are needed. We provide a comprehensive multi-level evaluation framework for tracking the growth of TT leadership skills. This work provides a framework for assessing and training relevant leadership behaviors for high-performance TTs.
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Affiliation(s)
- Allan R. Brasier
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Shannon L. Casey
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Peggy Hatfield
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Patrick W. Kelly
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Whitney A. Sweeney
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Marin Schweizer
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Bo Liu
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Elizabeth S. Burnside
- Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Rodríguez-Feria P, Czabanowska K, Babich S, Rodríguez-Sánchez D, Carreño Hernández FL, Hernández Flórez LJ. Divergence and Convergence of the Public Health Leadership Competency Framework Against Others in Undergraduate Medical Education: A Scoping Review. Public Health Rev 2023; 44:1605806. [PMID: 37426906 PMCID: PMC10323138 DOI: 10.3389/phrs.2023.1605806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/25/2023] [Indexed: 07/11/2023] Open
Abstract
Objective: The following scoping review is aimed at identifying leadership competency frameworks in Undergraduate Medical Education (UME) by analyzing the thematic scopes, target audiences, and methods involved. A further objective is to compare the frameworks against a standard framework. Methods: The authors extracted the thematic scope and methods of each framework based on the original author's formulations in each selected paper. The target audience was divided into three sections: UME, medical education, and beyond medical education. The frameworks were converged and diverged against the public health leadership competency framework. Results: Thirty-three frameworks covering thematic scopes such as refugees and migrants were identified. The most common methods to develop leadership frameworks were reviews and interviews. The courses targeted multiple disciplines including medicine and nurses. The identified competency frameworks have not converged among important domains of leadership such as systems thinking, political leadership, leading change, and emotional intelligence. Conclusion: There is a variety of frameworks that support leadership in UME. Nevertheless, they are not consistent in vital domains to face worldwide health challenges. Interdisciplinary and transdisciplinary leadership competency frameworks which address health challenges should be used in UME.
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Affiliation(s)
- Pablo Rodríguez-Feria
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Departamento de Salud Pública, Facultad de Medicina, Universidad de los Andes, Bogota, Colombia
| | - Katarzyna Czabanowska
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Health Policy and Management, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
| | - Suzanne Babich
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States
| | | | | | - Luis Jorge Hernández Flórez
- Departamento de Salud Pública, Facultad de Medicina, Universidad de los Andes, Bogota, Colombia
- Program in Public Health, Schools of Medicine and Government, Universidad de Los Andes, Bogota, Colombia
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Barry ES, Durning SJ, Schreiber-Gregory D, Grunberg NE, Yarnell AM, Dong T. Undergraduate Medical Education Leader Performance Predicts Postgraduate Military Leader Performance. Mil Med 2023; 188:87-93. [PMID: 37201490 DOI: 10.1093/milmed/usac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Developing physicians as leaders has gained attention across the United States. Undergraduate medical education (UME) and graduate medical education (GME) leader development programs have increased. During postgraduate years (PGY), graduates bring their leadership education to the bedside; however, associations between leader performance in medical school and GME is largely unknown. It is important to find experiences that can assess leader performance that may be useful to predict future performance. The purpose of this study was to determine if (1) there is a correlation between leader performance during the fourth year of medical school versus leader performance in PGY1 and 3, and (2) leader performance during the fourth year of medical school is associated with military leadership performance in PGY1 and 3s while taking previous academic performance markers into account. METHODS This study examined overall leader performance of learners (classes of 2016-2018) during the fourth year of medical school and their graduate leader performance post-medical school. Leader performance was assessed by faculty during a medical field practicum (UME leader performance) and graduate leader performance was assessed by program directors at the end of PGY1 (N = 297; 58.3%) and 3 (N = 142; 28.1%). Pearson correlation analysis examined relationships among UME leader performance and between the PGY leader performance items. In addition, stepwise multiple linear regression analyses were conducted to examine the relationship between leader performance at the end of medical school with military leadership performance in PGY1 and 3, while taking into account the academic performance markers. RESULTS Pearson correlation analyses revealed that the UME leader performance was correlated with 3 of 10 variables at PGY1, and was correlated at PGY3 with 10 out of 10 variables. Results of the stepwise multiple linear regression analysis indicated that leader performance during the fourth year of medical school explained an additional 3.5% of the variance of PGY1 leader performance after controlling for the previous academic performance markers (MCAT total score, USMLE Step 1 score and Step 2 CK score). In contrast, leader performance during the fourth year of medical school alone accounted for an additional 10.9% of the variance of PGY3 leader performance above and beyond the set of academic performance markers. Overall, UME leader performance has more predictive power in PGY leader performance than the MCAT or USMLE Step exams. CONCLUSIONS The findings of this study indicate that a positive relationship exists between leader performance at the end of medical school and leader performance in PGY1 and 3 years of residency. These correlations were stronger in PGY3 compared to PGY1. During PGY1, learners may be more focused on being a physician and an effective team member compared to PGY3 where they have a deeper understanding of their roles and responsibilities and can take on more leadership roles. Additionally, this study also found that MCAT and USMLE Step exams performance was not predictive of PGY1 or PGY3 leader performance. These findings provide evidence of the power of continued leader development in UME and beyond.
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Affiliation(s)
- Erin S Barry
- Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Steven J Durning
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Deanna Schreiber-Gregory
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Neil E Grunberg
- Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Angela M Yarnell
- Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Ting Dong
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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White BAA, Quinn JF. Personal Growth and Emotional Intelligence: Foundational Skills for the Leader. Clin Sports Med 2023; 42:261-267. [PMID: 36907624 DOI: 10.1016/j.csm.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Emotional intelligence (EI) has gained popularity and is being seen as a necessity, spreading beyond the business world, and becoming universal. In that shift, medicine and medical education have started to see the importance. This is evident in mandatory curriculum and accreditation requirements. EI includes 4 primary domains with several subcompetencies under each domain. This article outlines several of the subcompetencies necessary for success as a physician, competencies that can be honed with targeted professional growth. Empathy, communication, conflict management, burnout, and leadership are discussed in an application way to help identify importance of and how to improve each.
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Affiliation(s)
- Bobbie Ann Adair White
- MGH (Massachusetts General Hospital) Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA 02129, USA.
| | - Joann Farrell Quinn
- University of South Florida, Morsani College of Medicine, Muma College of Business, 560 Channelside Drive MDD 54, Tampa, FL 33602, USA
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Evans MA, James EJ, Misa Mi. Leadership Training in Undergraduate Medical Education: A Systematic Review. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2023. [DOI: 10.5195/ijms.2023.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: This review seeks to characterize existing curricular interventions implemented to develop leadership skills in undergraduate medical students at LCME-accredited medical schools and elucidate best practices for leadership curriculum development.
Methods: PRISMA guidelines were used to guide the review. Comprehensive literature searches of five databases retrieved peer-reviewed journal articles with empirical data published in English. Two phases of screening were conducted to identify studies describing leadership development curricular interventions, followed by data extraction and synthesis.
Results: Comprehensive literature searching and hand searching identified 977 articles potentially eligible for inclusion, with a final set of 16 articles selected for the review. A majority of the leadership development programs targeted preclinical students, while others spanned the entire curriculum. "Mixed settings," including both classroom and clinical and community components were common. There was a wide range of cohort sizes spanning from over 100 students to fewer than 10. Using the competencies defined by Mangrulkar et al, we determined that all of the programs described leadership skills development, including conflict management and emotional intelligence. Out of the 16 selected studies, curricula that emphasized the development of skills were evidence-based medicine and practice, and 6 curricula targeted interprofessionalism.
Conclusions: Leadership development needs to be standardized in undergraduate medical education, ideally using a competency-based framework to develop these standards. Longitudinal programs that had a didactic and project-based component received consistently high quality and effectiveness scores, as did programs with smaller cohort sizes that received more consistent mentorship and monetary investment from institutions.
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Nosé B, Sankey E, Moris D, Doty J, Taylor D. Leadership Training in Medicine-12 Years of Experience From the Feagin Leadership Program. Mil Med 2023; 188:e510-e515. [PMID: 34273171 DOI: 10.1093/milmed/usab293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/21/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Increasingly, physicians find themselves in demanding leadership positions. However, leadership education for medical trainees remains lacking with most physicians reporting that they are ill-equipped to tackle the challenges of leadership. Here, we set out to describe the Feagin Leadership Program (FLP) and assess its reception and impact on trainees over the past 12 years. MATERIALS AND METHODS During the 1-year FLP, selected scholars from Duke University, Wake Forest University, and the University of North Carolina participate in five leadership sessions, individual coaching, a leadership forum, and a multidisciplinary team-based capstone project. A 28-question survey with six optional free-response questions was distributed to the Feagin Alumni Network, and descriptive statistics were assessed. RESULTS Since its founding, 212 scholars have graduated from the FLP and 117 (55%) alumni have gone on to surgical specialties. A survey was distributed among all Feagin alumni. A total of 56 (26%) surveys were completed. Forty-three percent (n = 24) had held at least one leadership position since completing the FLP. When asked about the impact of their experience, 96% (n = 54) said that the program encouraged them to pursue a position of leadership within their field, 95% (n = 53) stated that it prepared them for such a position, and 93% (n = 52) stated that the program positively influenced their decision to be involved with current or future positions of leadership. CONCLUSIONS Over the last 12 years, the FLP has demonstrated a high perceived impact on personal growth, leadership proficiency, and the decision to pursue leadership positions in medicine. The current dearth of leadership education for surgical trainees can best be addressed with models such as the FLP, with adoption benefiting medical trainees, the medical community, and patients they serve.
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Affiliation(s)
- Brent Nosé
- Duke University Hospital, Durham, NC 27710, USA
| | - Eric Sankey
- Duke University Hospital, Durham, NC 27710, USA
| | | | - Joe Doty
- Duke University Hospital, Durham, NC 27710, USA
| | - Dean Taylor
- Duke University Hospital, Durham, NC 27710, USA
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12
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Integrating leadership into the undergraduate medical curriculum in the UK: a systematic review. BMJ LEADER 2023:leader-2022-000714. [PMID: 37192125 DOI: 10.1136/leader-2022-000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/19/2023] [Indexed: 03/12/2023]
Abstract
BackgroundLeadership is a critical skill required of a doctor and is necessary for clinical and organisational development. Literature suggests that newly qualified doctors are not prepared for the leadership roles and responsibilities that they need to undertake in clinical practice. The opportunities to develop the necessary skillset should be available in undergraduate medical training and throughout a doctor’s professional advancement. Various frameworks and guidance for a core leadership curriculum have been designed, but data on their integration in undergraduate medical education in the UK are minimal.MethodsThis systematic review collates and qualitatively analyses studies that have implemented and evaluated a leadership teaching intervention in undergraduate medical training in the UK.ResultsThere are various approaches to teaching leadership in medical school, differing in mode of delivery and evaluation. Feedback on the interventions revealed that students gained insight into leadership and honed their skills.ConclusionsThe long-term effectiveness of the described leadership interventions in preparing newly qualified doctors cannot be conclusively determined. The implications for future research and practice are also provided in this review.
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Do V, Maniate JM, Sultan N, Sonnenberg L. The 4C's of influence framework: fostering leadership development through character, competence, connection and culture. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print. [PMID: 36695538 DOI: 10.1108/lhs-05-2022-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this paper is to describe the 4C's of Infuence framework and it's application to medicine and medical education. Leadership development is increasingly recognised as an integral physician skill. Competence, character, connection and culture are critical for effective influence and leadership. The theoretical framework, "The 4C's of Influence", integrates these four key dimensions of leadership and prioritises their longitudinal development, across the medical education learning continuum. DESIGN/METHODOLOGY/APPROACH Using a clinical case-based illustrative model approach, the authors provide a practical, theoretical framework to prepare physicians and medical learners to be engaging influencers and leaders in the health-care system. FINDINGS As leadership requires foundational skills and knowledge, a leader must be competent to best exert positive influence. Character-based leadership stresses development of, and commitment to, values and principles, in the face of everyday situational pressures. If competence confers the ability to do the right thing, character is the will to do it consistently. Leaders must value and build relationships, fostering connection. Building coalitions with diverse networks ensures different perspectives are integrated and valued. Connected leadership describes leaders who are inspirational, authentic, devolve decision-making, are explorers and foster high levels of engagement. To create a thriving, learning environment, culture must bring everything together, or will become the greatest barrier. ORIGINALITY/VALUE The framework is novel in applying concepts developed outside of medicine to the medical education context. The approach can be applied across the medical education continuum, building on existing frameworks which focus primarily on what competencies need to be taught. The 4C's is a comprehensive framework for practically teaching the leadership for health care today.
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Affiliation(s)
- Victor Do
- The Hospital for Sick Children, Toronto, Canada and Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Jerry M Maniate
- Ottawa Hospital, Ottawa, Canada and Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Nabil Sultan
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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Ricotta DN, Freed JA, Hale AJ, Targan E, Smith CC, Huang GC. A Resident-as-Leader Curriculum for Managing Inpatient Teams. TEACHING AND LEARNING IN MEDICINE 2023; 35:73-82. [PMID: 35023796 DOI: 10.1080/10401334.2021.2009347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
PROBLEM Leading inpatient teams is a foundational clinical responsibility of resident physicians and leadership is a core competency for inpatient physicians, yet few training programs have formal leadership curricula to realize this clinical skill. INTERVENTION We implemented a 4-module curriculum for PGY1 internal medicine residents. The program focused on the managerial skills necessary for daily clinical leadership, followed by clinical coaching. Interns were first introduced to foundational concepts and then given the opportunity to apply those concepts to real-world practice followed by clinical coaching. CONTEXT Using direct-observations and a previously published checklist for rounds leadership, this study sought to evaluate the workplace behavior change for novice residents leading inpatient teams for the first time. We conducted a prospective cohort study (March 2016 and August 2018) of internal medicine residents at a large tertiary academic medical center in Boston, MA. Trained faculty raters performed direct observations of clinical rounding experiences using the checklist and compared the findings to historical and internal controls. Questionnaires were distributed pre- and post- curriculum to assess satisfaction and readiness to lead a team. IMPACT We trained 65 PGY1 residents and raters conducted 140 direct observations - 36 in the intervention group and 104 among historical controls. The unadjusted mean score in rounds leadership skills for the intervention group was 19.0 (SD = 5.1) compared to 16.2 (SD = 6.2) for historical controls. Adjusting for repeated measures, we found significant improvement in mean scores for behaviors linked to the curricular objectives (p = 0.008) but not for general behaviors not covered by the curriculum (p = 0.2). LESSONS LEARNED A formal curriculum to train residents as leaders led to behavior change in the workplace in domains essential to rounds leadership. We also found that the curriculum was highly regarded in that all interns indicated they would recommend the curriculum to a peer. Moreover, the program may have assuaged some anxiety during the transition to junior year as 90% of interns surveyed felt more ready to start PGY2 year than historical trainings. We learned that while a robust, multi-faceted modular curriculum and clinical coaching successfully resulted in behavior change, the resources required to manage this program are significant and difficult to sustain. Future iterations could include asynchronous material and potentially peer-observation of rounds leadership to reduce the burden on faculty and program curricular time.
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Affiliation(s)
- Daniel N Ricotta
- Carl J. Shapiro Institute for Education and Research, Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jason A Freed
- Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andrew J Hale
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Elizabeth Targan
- Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - C Christopher Smith
- Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Grace C Huang
- Carl J. Shapiro Institute for Education and Research, Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Otaki F, AlHashmi D, Khamis AH, Azar AJ. Investigating the evolution of undergraduate medical students' perception and performance in relation to an innovative curriculum-based research module: A convergent mixed methods study launching the 8A-Model. PLoS One 2023; 18:e0280310. [PMID: 36638127 PMCID: PMC9838838 DOI: 10.1371/journal.pone.0280310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 12/13/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Embedding into undergraduate medical programs experiential research curricula, based on holistic theories of education which emphasize participation in the social world, remains uncommon. The purpose of this study was to investigate the journey of undergraduate medical students in relation to an innovative compulsory curriculum-based research module, which has a prominent experiential learning component. METHODS A convergent mixed methods study design was adapted to develop a systemic understanding of the experience of the undergraduate medical students throughout the respective research module. As such, the students' perception of the experience was qualitatively explored using thematic analysis (n = 15). In parallel, the students' performance data were quantitatively analyzed using multi-repeated ANOVA (n = 158). The findings from both types of analyses (i.e., qualitative and quantitative study components) were then mapped onto each using joint display analysis. FINDINGS The exploration generated four themes that correspond to sequential steps that the students go through to effectively integrate the scientific research method. These themes include: 1- Attend-Acquire, 2- Accumulate-Assimilate, 3- Apply-Appreciate, and 4-Articulate-Affect. Quantitatively, two distinct clusters of mean Grade Point Average were revealed (p<0.01). Joint display analysis enabled integrating the qualitative and quantitative findings, generating the 8A-Model. CONCLUSION The evidence-driven 8A-Model, generated by this study, highlights that medical students' understanding of the true value of research seems to increase as they progress in the module. They begin expressing appreciation of the significance of the experience when they start implementing what they are learning as part of their own research studies. It is recommended for such a research module, with a firm experiential learning component, to be integral to undergraduate medical programs. This is expected to improve the future physicians' research competences, and in turn add value in terms of quality of care and patient outcomes.
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Affiliation(s)
- Farah Otaki
- Strategy and Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Deena AlHashmi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Amar Hassan Khamis
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Aida Joseph Azar
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- * E-mail:
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Turner A, Ryan M, Wolvaardt J. We know but we hope: A qualitative study of the opinions and experiences on the inclusion of management, health economics and research in the medical curriculum. PLoS One 2022; 17:e0276512. [PMID: 36269759 PMCID: PMC9586360 DOI: 10.1371/journal.pone.0276512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
The achievement of global and national health goals requires a health workforce that is sufficient and trained. Despite considerable steps in medical education, the teaching of management, health economics and research skills for medical doctors are often neglected in medical curricula. This study explored the opinions and experiences of medical doctors and academic educationalists on the inclusion of management, health economics and research in the medical curriculum. A qualitative study was undertaken at four medical schools in Southern Africa (February to April 2021). The study population was medical doctors and academic educationalists. Semi-structured interviews with purposively sampled participants were conducted. All interviews were recorded and professionally transcribed. Constructivist grounded theory guided the analysis with the use of ATLAS.ti version 9.1.7.0 software. In total, 21 academic educationalists and 28 medical doctors were interviewed. In the first theme We know, participants acknowledged the constraints of medical schools but were adamant that management needed to be taught intentionally and explicitly. The teaching and assessment of management and health economics was generally reported to be ad hoc and unstructured. There was a desire that graduates are able to use, but not necessarily do research. In comparison to management and research, support for the inclusion of health economics in the curriculum was insignificant. Under We hope, educationalists hoped that the formal clinical teaching will somehow instil values and best practices of management and that medical doctors would become health advocates. Most participants wished that research training could be optimised, especially in relation to the duration of allocated time; the timing in the curriculum and the learning outcomes. Despite acknowledgement that management and research are topics that need to be taught, educationalists appeared to rely on chance to teach and assess management in particular. These qualitative study findings will be used to develop a discrete choice experiment to inform optimal curricula design.
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Affiliation(s)
- Astrid Turner
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- * E-mail:
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, King’s College, Aberdeen, Scotland
| | - Jacqueline Wolvaardt
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Keluth Chavan A, Bendriss R. Leadership Curriculum in Medical Education: Exploring Student and Faculty Perceptions in a US Medical School in Qatar. J Healthc Leadersh 2022; 14:163-173. [PMID: 36217372 PMCID: PMC9547622 DOI: 10.2147/jhl.s370645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Leadership has long been recognized as a core competency required to excel in medical practice. This qualitative study investigates the extent to which leadership competencies are incorporated in the curriculum of a US medical college in Qatar and examines the perceptions of medical students and faculty about leadership in the medical curriculum. Methods The study uses a student survey, faculty interviews, and a student focus group to gather data. Results The study found that 79% of the survey respondents perceive leadership as a core competency while 55% feel that leadership skills are not adequately taught to students. The focus group and interviews revealed that students believe more importance should be given to leadership training whereas faculty assert that, while leadership can be beneficial, leadership training is implicit, and more research is required for further implementation. Conclusion This study shows the need for an increased emphasis on developing leadership curricula in undergraduate medical education and highlights ways to address certain obstacles to implementation. Further research on exploring medical alumni’s perceptions and optimal teaching methods to implement leadership training is needed.
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Affiliation(s)
| | - Rachid Bendriss
- Premedical Education, Weill Cornell Medicine-Qatar, Doha, Qatar,Correspondence: Rachid Bendriss, Premedical Education Division, Weill Cornell Medicine-Qatar, P.O. Box 24144, Doha, Qatar, Tel +974 4492 8221, Email
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Lyons MD, Oyler J, Iossi K, Merriam S. Leadership Experiences of Internal Medicine Residents: A Needs Assessment for Leadership Curricula. J Healthc Leadersh 2022; 14:155-161. [PMID: 36168427 PMCID: PMC9509665 DOI: 10.2147/jhl.s376089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Leadership development during medical training is critical. Accrediting bodies strongly recommend and residents desire leadership training. However, limited needs assessment data exist regarding trainee perceptions of and experiences with leadership training. Our objective is to describe residents' perceptions of leadership and desires for leadership training with the goal of informing effective curricular development. Patients and Methods In 2019 a trained qualitative interviewer conducted semi-structured interviews with volunteer second-year categorical internal medicine residents recruited via email across four institutions. Interviews were audio-recorded, transcribed, and inductively coded by two independent coders. After adjudicating discrepancies, coders synthesized codes into broader themes. Final thematic analysis was triangulated with the entire author group. Results Fourteen residents were interviewed (50% female). Few reported prior leadership training. Thematic analysis yielded six main themes. First, residents perceive "leadership" to be related to formal, assigned, hierarchical roles. Second, residents identify their own leadership primarily in the inpatient clinical setting. Third, residents identify clinical competence, emotional intelligence, and communication as important skills for effective leadership. Fourth, residents struggle to identify where leadership is currently being taught. Fifth, residents desire additional leadership development. Finally, residents prefer well-labeled, interactive methods for leadership development. Conclusion Although residents desire leadership development, these skills are not often explicitly taught, labeled, or assessed. Curriculum developers may consider explicitly contextualizing leadership training within an "everyday leadership" framework, dovetailing leadership coaching with daily teaching workflow and feedback structures, and implementing faculty development initiatives to allow for appropriate feedback and assessment of these skills.
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Affiliation(s)
- Maureen D Lyons
- Division of General Internal Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie Oyler
- Section of General Internal Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Katherine Iossi
- Department of Medicine, Portland VA Medical Center, Portland, OR, USA
| | - Sarah Merriam
- Division of General Internal Medicine, Department of Medicine, VA Pittsburgh Healthcare System and Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Matsas B, Goralnick E, Bass M, Barnett E, Nagle B, Sullivan EE. Leadership Development in U.S. Undergraduate Medical Education: A Scoping Review of Curricular Content and Competency Frameworks. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:899-908. [PMID: 35171123 DOI: 10.1097/acm.0000000000004632] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To inform research on developing or adopting leadership competency frameworks for use in U.S. undergraduate medical education (UME), this scoping review describes the content of U.S. UME leadership curricula, associated competency frameworks, and content delivery. METHOD The authors searched PubMed, Embase, and ERIC databases on June 22, 2020. They included English-language studies that described U.S. UME curricula in which the primary end goal was leadership development. They excluded studies published before January 1, 2000. Data were extracted on leadership competency frameworks and curricular content, audience, duration, electivity, selectivity, learning pedagogies, and outcome measures. The curricular content was coded and categorized within the Medical Leadership Competency Framework (MLCF) using the constant comparative method. A repeated search of the literature on May 14, 2021, did not yield any additional studies. RESULTS Of 1,094 unique studies, 25 studies reporting on 25 curricula met inclusion criteria. The course content of the curricula was organized into 91 distinct themes, most of which could be organized into the first 2 competencies of the MLCF: Demonstrating Personal Qualities and Working With Others. Thirteen curricula (52%) aligned with leadership competency frameworks, and 12 (48%) did not appear to use a framework. Number of participants and target learner level varied widely, as did curricula duration, with fewer than half (n = 12, 48%) spanning more than 1 semester. Most curricula (n = 14, 56%) were elective, and many (n = 16, 64%) offered experiential learning. Most studies (n = 16, 64%) reported outcomes as student perception data. CONCLUSIONS The authors found wide variation in content of U.S. UME leadership development curricula, and few curricula aligned with an established leadership competency framework. The lack of professional consensus on the scope of medical leadership and how it should be taught thwarts effective incorporation of medical leadership training within UME.
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Affiliation(s)
- Bridget Matsas
- B. Matsas was a medical student, Harvard Medical School, Boston, Massachusetts, at the time that this was written
| | - Eric Goralnick
- E. Goralnick is associate professor, Emergency Medicine, and medical director, Access and Network Development, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle Bass
- M. Bass is medical librarian and manager, Research and Instruction Team, Harvard Medical School, Boston, Massachusetts
| | - Erica Barnett
- E. Barnett is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Baily Nagle
- B. Nagle is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Erin E Sullivan
- E.E. Sullivan is associate professor, Healthcare Management, Sawyer School of Business, Suffolk University, Boston, Massachusetts, and lecturer, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-9118-7936
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20
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Winters RC, Chen R, Lal S, Chan TM. Six Principles for Developing Leadership Training Ecosystems in Health Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:793-796. [PMID: 35703908 DOI: 10.1097/acm.0000000000004640] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Leadership education in medicine is evolving to better meet the challenges of health care complexity, interprofessional practice, and threats from viruses and budget cuts alike. In this commentary, the authors build upon the findings of a scoping review by Matsas and colleagues, published in the same issue, and ask us to imagine what a learning ecosystem around leadership might look like. They subsequently engage in their own synthesis of leadership development literature and propose 6 key principles for medical educators and health care leaders to consider when designing leadership development within their educational ecosystems: (1) apply a conceptual framework; (2) scaffold development-oriented approaches; (3) accommodate individual levels of adult development; (4) integrate diversity of perspective; (5) interweave theory, practice, and reflection; and (6) recognize the broad range of leadership conceptualization.
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Affiliation(s)
- Richard C Winters
- R.C. Winters is assistant professor and finance chair, Department of Emergency Medicine, executive and professional coach, Mayo Clinic, and medical director, professional leadership development, Mayo Clinic Care Network, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-6242-9529
| | - Ruth Chen
- R. Chen is associate professor, School of Nursing, and assistant dean of faculty development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; ORCID: https://orcid.org/0000-0002-4886-1702
| | - Sarrah Lal
- S. Lal is assistant professor, Division of Education and Innovation, Department of Medicine, director, Health Venture Development, member, McMaster Education Research, Innovation, and Theory, and head, leadership and management team, Program for Faculty Development, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; ORCID: https://orcid.org/0000-0001-8195-8605
| | - Teresa M Chan
- T.M. Chan is associate dean, continuing professional development, Faculty of Health Sciences, associate professor, Division of Education & Innovation and Division of Emergency Medicine, Department of Medicine, and clinician scientist, McMaster Education Research, Innovation, and Theory, McMaster University, Hamilton, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6104-462X
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Training Surgery Residents to be Leaders: Construction of a Resident Leadership Curriculum. Plast Reconstr Surg 2022; 149:765-771. [PMID: 35196699 DOI: 10.1097/prs.0000000000008853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Historically, the traditional pathways into plastic surgery required board eligibility in a surgical specialty such as general surgery, orthopedics, urology, neurosurgery, otolaryngology, or ophthalmology. This requirement resulted in plastic surgery residents who had served as chief residents before plastic surgery training. Their maturity emotionally and surgically allowed them to immediately concentrate on the new language and principles of plastic surgery. They had led others and were capable of leading themselves in a new surgical discipline. Today, medical students typically match into surgical specialties directly out of medical school and need to spend their time learning basic surgical skills and patient care because of the contracted time afforded to them. Formal leadership training has historically been limited in surgical training. The authors set out to delineate the creation, implementation, and perceptions of a leadership program within a surgical residency and provide guideposts for the development of engaged, conscious, and dedicated leaders within the residencies they lead.
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Wiseman M, Hartzell J, Kelly WF, Hemmer PA, Stein M. Reflective Essays During Clerkship Following a Pre-clerkship Leadership Curriculum. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221091523. [PMID: 35592133 PMCID: PMC9112299 DOI: 10.1177/23821205221091523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Leadership curricula in medical student education require assessment - to determine if leadership skills can be taught to medical students and applied during clinical and medical team interactions to aid in medical student leadership development. OBJECTIVES To examine whether medical students applied principles of their pre-clerkship leadership curriculum (character, competence, context, and communication elements across four levels: personal, interpersonal, team, and organizational) during an internal medicine clerkship. METHODS Using art as a prompt, Uniformed Services University (USU) internal medicine clerkship students completed a structured reflection on a critical incident. Medical student essays written during a 10-week internal medicine clerkship at USU in 2019 were collected. 158 medical student submissions were de-identified and analyzed. RESULTS Sixty-four submissions (40.5%) focused on leadership or leadership and professionalism. Students identified as male (n = 34, 53%), female (21, 33%), or not reported (9, 14%). Most, 48 (75%), did not describe PITO explicitly in their essay. They instead focused on personal and interpersonal aspects (17, 27%) of leadership, the attending physicians they worked with (33, 52%), and effective leadership strategies (46, 72%). The most common themes written about were responsibility (30, 47%), teamwork (18, 28%), competence (17, 27%), and character/integrity (15, 23%). CONCLUSION Although the students' explicit use of the PITO model was limited, student essays centered on themes that reflected leadership concepts taught in pre-clerkship years, such as character, competence, and responsibility. This study demonstrates that an internal medicine clerkship rotation can feasibly implement a leadership reflection.
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Affiliation(s)
- Melanie Wiseman
- Internal medicine residency, National Capital Consortium, Bethesda,
MD
- Department of medicine Uniformed Services University of the Health
Sciences, Bethesda, MD
| | - Joshua Hartzell
- Internal medicine residency, National Capital Consortium, Bethesda,
MD
- Department of medicine Uniformed Services University of the Health
Sciences, Bethesda, MD
| | - William F. Kelly
- Department of medicine Uniformed Services University of the Health
Sciences, Bethesda, MD
| | - Paul A. Hemmer
- Department of medicine Uniformed Services University of the Health
Sciences, Bethesda, MD
| | - Michael Stein
- Department of medicine Uniformed Services University of the Health
Sciences, Bethesda, MD
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Ng CY, Allison I, Ooi E, Davitadze M, Melson E, Kempegowda P. Medical students’ and junior doctors’ leadership and teamwork skills improved after involvement with Simulation via Instant Messaging-Birmingham Advance (SIMBA). BMJ LEADER 2021; 6:233-236. [DOI: 10.1136/leader-2021-000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022]
Abstract
BackgroundLeadership and teamwork skills are essential components of medical education. Simulation via Instant Messaging-Birmingham Advance (SIMBA) is an innovative simulation-based learning tool mainly delivered by medical students and junior doctors. This study aimed to investigate the effect of SIMBA on leadership and teamwork skills of medical students and junior doctors during COVID-19.MethodsAll medical students and junior doctors involved in the delivery of SIMBA were invited to complete the Leadership Trait Questionnaire (LTQ) and Teamwork Skills Questionnaire (TSQ) assessing their views pre-SIMBA and post-SIMBA involvement. The changes in scores were analysed using the Wilcoxon signed-rank test. Open-ended questions were reviewed in an inductive thematic analysis.ResultsA total of 33 SIMBA team members completed both questionnaires. There was improvement in all traits measured in the LTQ and TSQ, significant in 9/14 LTQ traits, and all 6 TSQ traits (p<0.05). ‘Decision making’ had the highest improvement (p<0.0001). Response to open-ended questions reported positive effects on personal development, medical professionalism, communication skills and medical/clinical knowledge.ConclusionsSIMBA is an effective model to inculcate leadership and teamwork skills among medical students and junior doctors. Prospective studies are underway to assess long-term impact.
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Gupta B, Li D, Dong P, Acri MC. From intention to action: A systematic literature review of provider behaviour change-focused interventions in physical health and behavioural health settings. J Eval Clin Pract 2021; 27:1429-1445. [PMID: 33565177 DOI: 10.1111/jep.13547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/31/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES It is clear there are significant delays in the uptake of best practices as part of routine care in the healthcare system, yet there is conflicting evidence on how to specifically align provider behaviour with best practices. METHOD We conducted a review of interventions utilized to change any aspect of provider behaviour. To extend prior research, studies were included in the present review if they had an active intervention targeting behaviour change of providers in health or behavioural-health settings and were published between 2001 and 2020. RESULTS Of 1547 studies, 44 met inclusion criteria. Of 44 studies identified, 28 studies utilized contextually relevant interventions (eg, tailored to a specific provider population). Twenty six interventions with a contextually relevant approach resulted in provider behaviour change. CONCLUSIONS Findings are promising for encouraging provider behaviour change when interventions are tailored to be contextually relevant, as both single-component and multifaceted interventions were successful when they were contextually relevant. It is critical to conduct additional research to ensure that providers sustain behaviour changes over a long-term beyond an intervention's implementation and evaluation period.
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Affiliation(s)
- Brinda Gupta
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Dongze Li
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Peiyu Dong
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mary C Acri
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
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Dewsnap MA, Arroliga AC, Adair-White BA. The lived experience of medical training and emotional intelligence. Proc (Bayl Univ Med Cent) 2021; 34:744-747. [PMID: 34744303 DOI: 10.1080/08998280.2021.1941582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The shifting health care landscape in the United States has surfaced challenges related to increased accountability, interprofessional health care teams, and changes in federal policy-all of which compel physicians to adopt roles beyond clinician such as clinical investigator, team leader, and manager. To address these challenges, leadership development programs across the continuum of medical education aim to develop critical leadership skills and competencies, such as emotional intelligence. Such skills and competencies are largely taught through didactic approaches (e.g., classroom). These approaches often neglect the context of learning. From medical residency to a hospital or clinic, the contextual lived experience is habitually overlooked as a vehicle for developing emotional intelligence. This article highlights lived experience, such as medical residency, as an approach to develop emotional intelligence. First, we address the need for developing emotional intelligence as a leadership skill as well as the suitability of medical residency for such development. Next, we discuss the background of lived experience and emotional intelligence. Lastly, we identify future directions for leveraging lived experiences of medical residency to develop emotional intelligence.
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Affiliation(s)
- Michael A Dewsnap
- Department of Humanities in Medicine, Texas A&M University College of Medicine, Bryan, Texas
| | - Alejandro C Arroliga
- Department of Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Bobbie Ann Adair-White
- Department of Health Professions Education, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts
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Merriam SB, Rothenberger SD, Corbelli JA. Establishing Competencies for Leadership Development for Postgraduate Internal Medicine Residents. J Grad Med Educ 2021; 13:682-690. [PMID: 34721798 PMCID: PMC8527928 DOI: 10.4300/jgme-d-21-00055.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/09/2021] [Accepted: 06/14/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although graduate medical education accrediting bodies recognize the importance of leadership for residents and encourage curricular development, it remains unclear which competencies are most important for early career physicians to possess. OBJECTIVE To generate a prioritized list of essential postgraduate leadership competencies to inform best practices for future curricular development. METHODS In 2019, we used a Delphi approach, which allows for generation of consensus, to survey internal medicine (IM) physicians in leadership roles with expertise in medical education and/or leadership programming within national professional societies. Panelists ranked a comprehensive list of established leadership competencies for health care professionals, across 3 established domains (character, emotional intelligence, and cognitive skills), on importance for categorical IM residents to perform by the end of residency. Respondents also identified number of content hours and pedagogical format best suited to teach each skill. RESULTS Sixteen and 14 panelists participated in Delphi rounds 1 and 2, respectively (88% response rate). Most were female (71%) and senior (64% in practice > 15 years, 57% full professor). All practiced in academic environments and all US regions were represented. The final consensus list included 12 "essential" and 9 "very important" leadership skills across all 3 leadership domains. Emotional intelligence and character domains were equally represented in the consensus list despite being disproportionately underweighted initially. Panelists most frequently recommended content delivery via mentorship/coaching, work-based reflection, and interactive discussion. CONCLUSIONS This study's results suggest that postgraduate curricular interventions should emphasize emotional intelligence and character domains of leadership and prioritize coaching, discussion, and reflection for delivery.
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Affiliation(s)
- Sarah B. Merriam
- Sarah B. Merriam, MD, MS, is Clinical Assistant Professor, Department of Medicine, VA Pittsburgh Healthcare System
| | - Scott D. Rothenberger
- Scott D. Rothenberger, PhD, is Assistant Professor, Center for Research on Health Care Data Center, Department of Medicine, University of Pittsburgh School of Medicine
| | - Jennifer A. Corbelli
- Jennifer A. Corbelli, MD, MS, is Associate Professor, Department of Medicine, University of Pittsburgh School of Medicine, and Program Director, Internal Medicine Residency Training Program, University of Pittsburgh Medical Center
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Bonazza NA, Cabell GH, Cheah JW, Taylor DC. Effect of a novel healthcare leadership program on leadership and emotional intelligence. Healthc Manage Forum 2021; 34:272-277. [PMID: 34428988 DOI: 10.1177/08404704211036667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to assess the effectiveness of the Feagin Leadership Program (FLP) in teaching leadership domains and emotional intelligence. An anonymous survey of 178 graduates of FLP (2011-2019) including the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) was used to assess emotional intelligence and program views. ANOVA was used to compare the difference in emotional intelligence domains between groups. Respondents reported the FLP most improved skills in communication, emotional intelligence, and team building. Medical students (18, 38.3%) and faculty/staff (5/14, 35.7%) reported the most relevant domain was emotional intelligence; residents/fellows reported the most relevant domain was teamwork (8/37, 21.6%). Respondents in residency/fellowship had the highest score in emotionality (P = .01). These results suggest that a healthcare leadership program tailored to medical trainees was effective in improving their competency in various leadership domains, and that emotional intelligence and teamwork were the most relevant components of the program.
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Affiliation(s)
| | - Grant H Cabell
- 12277Duke University School of Medicine, Durham, North Carolina, USA
| | - Jonathan W Cheah
- 14454Santa Clara Valley Medical Center, San Jose, California, USA
| | - Dean C Taylor
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Sethi S, Shah H, Supe A. Framework to Incorporate Leadership Training in Competency-Based Undergraduate Curriculum for the Indian Medical Graduate. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cabell GH, Anjorin A, Price M, Biswas S, Doty JP. How the COVID-19 Pandemic Has Demonstrated a Need for Increased Leadership Education in Medicine. J Healthc Leadersh 2021; 13:137-138. [PMID: 34177282 PMCID: PMC8219661 DOI: 10.2147/jhl.s317847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
The healthcare system in the United States has been taxed in various ways throughout the COVID-19 pandemic, stressing healthcare facilities to their breaking point. This has forced decision-makers in healthcare to make difficult choices, highlighting the need for effective leadership. However, there are little intentional leadership development curricula in medical education. Leadership skills can be taught and acquired similar to other skills in medical school, and we believe medical education institutions should cultivate these skills in their trainees. We hope that this will help inspire change in medical education curricula to intentionally teach and develop leadership skills in their students.
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Affiliation(s)
- Grant H Cabell
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Aderike Anjorin
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Meghan Price
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Sonali Biswas
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Joseph P Doty
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
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Jones SK, Chan KH, Bourdage JS, Bharwani A. Identifying leadership in medical trainees: evaluation of a competency-based approach. BMJ LEADER 2021; 6:20-29. [DOI: 10.1136/leader-2020-000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 11/04/2022]
Abstract
BackgroundAs medical professional roles diversify, it is essential to understand what makes effective medical leaders. This study develops and validates a medical leadership competency framework that can be used to develop and evaluate leaders across all levels of medical organisations.MethodIn Phase One, the authors derived desired leadership traits and behaviours in the medical context from a panel of subject matter experts (SMEs). Traits and behaviours were then combined into multifaceted competencies which were ranked and further refined through evaluation with additional SMEs. In Phase Two, the final seven competencies were evaluated with 181 medical trainees and 167 supervisors between 2017 and 2018 to determine the validity of rapid-form and long-form leadership assessments of medical trainees. Self and supervisor reports of the seven competencies were compared with validated trait and leadership behaviour measures as well as clinical performance evaluations.ResultsThe final seven leadership competencies were: Ethical and Social Responsibility, Civility, Self-Leadership, Team Management, Vision and Strategy, Creativity and Innovation, and Communication and Interpersonal Influence. Results demonstrate initial validity for rapid-form and long-form leadership evaluations; however, perceptions of good leadership may differ between trainees and supervisors. Further, negative leadership behaviours (eg, incivility) are generally not punished by supervisors and some positive leadership behaviours (eg, ethical leadership) were associated with poor leadership and clinical performance evaluations by supervisors. Supervisor perceptions of leadership were significantly driven by trainee scores on social boldness (a facet of extraversion).ConclusionsA multicompetency framework effectively evaluates leadership in medicine. To more effectively reinforcepositive leadership behaviours and discourage negative leadership behaviours in medical students and resident physicians, we recommend that medical educators:: (1) Use validated frameworks to build leadership curriculum and evaluations. (2) Use short-term and long-term assessment tools. (3) Teach assessors how to evaluate leaders and encourage positive leadership behaviours early in training.
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Adirim Z, Sockalingam S, Thakur A. Post-graduate Medical Training in Intellectual and Developmental Disabilities: a Systematic Review. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:371-381. [PMID: 33433827 DOI: 10.1007/s40596-020-01378-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/24/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Despite the increasing number of people with autism-spectrum disorder (ASD), intellectual disabilities (ID), and developmental disabilities (DDs), individuals with these conditions continue to have high levels of unmet physical and mental health needs. Robust training of health professionals can help bridge this gap. A systematic review was conducted to describe the features and educational outcomes of existing postgraduate medical education curricula to inform the development of future training to address the growing unmet care needs of people with intellectual and developmental disabilities (IDD) such as ASD and ID. METHODS Four major databases were searched for peer-reviewed, English-language research focusing on post-graduate training in IDD education. Educational curricula and outcomes were summarized including Best Evidence in Medical Education (BEME) Quality of Evidence and Kirkpatrick training evaluation model. RESULTS Sixteen studies were identified with a majority published after 2000 (69%). Pediatric departments were involved in 69%, Psychiatry 19%, Medicine-Pediatrics 19%, and Family Medicine 6.3%. Analysis of Kirkpatrick outcomes showed 31% were level 1 (satisfaction or comfort); 38% level 2 (change in objective knowledge or skills); 13% level 3 (change in behavior); and none at level 4. BEME analysis showed 19% of studies were grade 1 (no clear conclusions), 31% grade 2 (ambiguous results), and half (50%) grade 3 (conclusions can probably be based on findings), with none scoring four or higher. CONCLUSIONS There is a paucity of objectively evaluated research in the area. Studies reviewed show clear promise for specialized, interdisciplinary, competency-based education which may be foundational for future curriculum development.
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Affiliation(s)
| | | | - Anupam Thakur
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Hayat AA, Amini M, Tabari P, Moosavi M. Training future physician leaders in the COVID-19 pandemic. MEDICAL EDUCATION 2021; 55:645. [PMID: 33665880 PMCID: PMC8014799 DOI: 10.1111/medu.14488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
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Ross SJ, Sen Gupta T, Johnson P. Leadership curricula and assessment in Australian and New Zealand medical schools. BMC MEDICAL EDUCATION 2021; 21:28. [PMID: 33413349 PMCID: PMC7792303 DOI: 10.1186/s12909-020-02456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Australian Medical Council, which accredits Australian medical schools, recommends medical leadership graduate outcomes be taught, assessed and accredited. In Australia and New Zealand (Australasia) there is a significant research gap and no national consensus on how to educate, assess, and evaluate leadership skills in medical professional entry degree/programs. This study aims to investigate the current curricula, assessment and evaluation of medical leadership in Australasian medical degrees, with particular focus on the roles and responsibilities of medical leadership teachers, frameworks used and competencies taught, methods of delivery, and barriers to teaching leadership. METHODS A self-administered cross-sectional survey was distributed to senior academics and/or heads or Deans of Australasian medical schools. Data for closed questions and ordinal data of each Likert scale response were described via frequency analysis. Content analysis was undertaken on free text responses and coded manually. RESULTS Sixteen of the 22 eligible (73%) medical degrees completed the full survey and 100% of those indicate that leadership is taught in their degree. In most degrees (11, 69%) leadership is taught as a common theme integrated throughout the curricula across several subjects. There is a variety of leadership competencies taught, with strengths being communication (100%), evidence based practice (100%), critical reflective practice (94%), self-management (81%), ethical decision making (81%), critical thinking and decision making (81%). Major gaps in teaching were financial management (20%), strategic planning (31%) and workforce planning (31%). The teaching methods used to deliver medical leadership within the curricula are diverse, with many degrees providing opportunities for leadership teaching for students outside the curricula. Most degrees (10, 59%) assess the leadership education, with one-third (6, 35%) evaluating it. CONCLUSIONS Medical leadership competencies are taught in most degrees, but key leadership competencies are not being taught and there appears to be no continuous quality improvement process for leadership education. There is much more we can do as medical educators, academics and leaders to shape professional development of academics to teach medical leadership, and to agree on required leadership skills set for our students so they can proactively shape the future of the health care system.
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Affiliation(s)
- Simone Jacquelyn Ross
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia.
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
| | - Peter Johnson
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
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Daaleman TP, Storrie M, Beck Dallaghan G, Smithson S, Gilliland KO, Byerley JS. Medical Student Leadership Development through a Business School Partnership Model: A Case Study and Implementation Strategy. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211010479. [PMID: 33997287 PMCID: PMC8082997 DOI: 10.1177/23821205211010479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is an ongoing call for leadership development in academic health care and medical students desire more training in this area. Although many schools offer combined MD/MBA programs or leadership training in targeted areas, these programs do not often align with medical school leadership competencies and are limited in reaching a large number of students. METHODS The Leadership Initiative (LI) was a program created by a partnership between a School of Medicine (SOM) and Business School with a learning model that emphasized the progression from principles to practice, and the competencies of self-awareness, communication, and collaboration/teamwork. Through offerings across a medical school curriculum, the LI introduced leadership principles and provided an opportunity to apply them in an interactive activity or simulation. We utilized the existing SOM evaluation platform to collect data on program outcomes that included satisfaction, fidelity to the learning model, and impact. RESULTS From 2017 to 2020, over 70% of first-year medical students participated in LI course offerings while a smaller percentage of fourth-year students engaged in the curriculum. Most students had no prior awareness of LI course material and were equivocal about their ability to apply lessons learned to their medical school experience. Students reported that the LI offerings provided opportunities to practice the skills and competencies of self-awareness, communication, and collaboration/teamwork. DISCUSSION Adding new activities to an already crowded medical curriculum was the greatest logistical challenge. The LI was successful in introducing leadership principles but faced obstacles in having participants apply and practice these principles. Most students reported that the LI offerings were aligned with the foundational competencies.
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Affiliation(s)
- Timothy P Daaleman
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Mindy Storrie
- University of North Carolina Kenan-Flagler Business School, Chapel Hill, NC, USA
| | - Gary Beck Dallaghan
- Office of Medical Education, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sarah Smithson
- Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kurt O Gilliland
- Office of Medical Education, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Julie S Byerley
- Office of Medical Education, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Swanwick T, McKimm J. Assessment of leadership development in the medical undergraduate curriculum: a UK consensus statement. BMJ LEADER 2020. [DOI: 10.1136/leader-2020-000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
With the increasing prominence of leadership within the medical undergraduate curriculum, assessment becomes a significant issue. In the absence of evidence to support specific strategies, tools or approaches, faculty from universities across the UK came together in October 2019 in a workshop convened by the Faculty of Medical Leadership and Management. The workshop aimed to develop a collective view on the assessment of leadership development in the medical undergraduate curriculum. This resulting consensus statement was generated around five prompts: why, what, how, when and who? In addition to the statement’s key messages, several questions for further exploration were defined. See Box 1.
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Yu Z, Chen ST, LaChance AH. Skills-based education in medical school: a step towards health equity & social justice. Postgrad Med J 2020; 97:205-206. [PMID: 33158937 DOI: 10.1136/postgradmedj-2020-139238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Zizi Yu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Avery H LaChance
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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White BAA, White HD, Bledsoe C, Hendricks R, Arroliga AC. Conflict Management Education in the Intensive Care Unit. Am J Crit Care 2020; 29:e135-e138. [PMID: 33130869 DOI: 10.4037/ajcc2020886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Conflicts in medical settings affect both team function and patient care, yet a standardized curriculum for conflict management in clinical teams does not exist. OBJECTIVES To evaluate the effects of an educational intervention for conflict management on knowledge and perceptions and to identify trends in preferred conflict management style among intensive care unit workers. METHODS A conflict management education intervention was created for an intensive care team. The intervention was 1 hour long and incorporated the Thomas-Kilmann Conflict Mode Instrument as well as conflict management concepts, self-reflection, and active learning through discussion and reviewing clinical cases. Descriptive statistics were prepared on the participants' preferred conflict management modes. A pretest/posttest was analyzed to evaluate knowledge and perceptions of conflict before and after the intervention, and 3 open-ended questions on the posttest were reviewed for categories. RESULTS Forty-nine intensive care providers participated in the intervention. The largest portion of participants had an avoiding conflict management mode (32%), followed by compromising (30%), accommodating (25%), collaborating (9%), and competing (5%). Pretest/posttest data were collected for 31 participants and showed that knowledge (P < .001) and perception (P = .004) scores increased significantly after the conflict management intervention. CONCLUSIONS The conflict management educational intervention improved the participants' knowledge and affected perceptions. Categorization of open-ended questions suggested that intensive care providers are interested in concrete information that will help with conflict resolution, and some participants understood that mindfulness and awareness would improve professional interactions or reduce conflict.
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Affiliation(s)
- Bobbie Ann Adair White
- Bobbie Ann Adair White is an adjunct associate professor, MGH Institute of Health Professions, Health Professions Education, Boston, Massachusetts
| | - Heath D. White
- Heath D. White is the chair for the Critical Care Council, Baylor Scott & White Health, Division of Pulmonary, Critical Care & Sleep Medicine, Temple, Texas and an assistant professor, Texas A&M University, College of Medicine
| | - Christie Bledsoe
- Christie Bledsoe and Randy Hendricks are associate professors, University of Mary Hardin-Baylor, College of Education, Belton, Texas
| | - Randy Hendricks
- Christie Bledsoe and Randy Hendricks are associate professors, University of Mary Hardin-Baylor, College of Education, Belton, Texas
| | - Alejandro C. Arroliga
- Alejandro C. Arroliga is the system chief medical officer, Baylor Scott & White Health
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Omar A, Shrestha A, Fernandes R, Shah A. Perceived barriers to medical leadership training and methods to mitigate them in the undergraduate medical curriculum: A mixed-methods study of final-year medical students at two medical schools. Future Healthc J 2020; 7:e11-e16. [PMID: 33094239 DOI: 10.7861/fhj.2019-0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Effective leadership is vital for high-quality healthcare. Despite progress in leadership development for junior doctors, studies reflect perceptions that junior doctors feel underprepared for leadership. This study aims to understand medical students' perceptions about barriers to effective leadership training and how to mitigate these. Methods This was a mixed-methods study utilising focus group interviews structured using four trigger questions. Qualitative narrative responses underwent quantitative inductive coding applied by two independent coders. Commonly occurring codes underwent thematic analysis to understand underpinning themes. Results Thirty-one students were interviewed from King's College London (n=24) and St George's, University of London (n=7). Cohen's kappa statistic of inter-rater reliability was 0.73. The priority areas were the equity of teaching, implemented approaches and methods of assessing competency. The study presents a driver diagram summarising findings. Conclusion This study presents medical students' perceptions about barriers to effective leadership training in current undergraduate curriculum and interventions to mitigate these.
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Gottenborg E, Anstett T, Diaz M, Pierce R, Sweigart J, Glasheen JJ. Teaching Students to Transform: The Health Innovations Scholars Program 6 Years Later. Am J Med Qual 2020; 36:277-280. [PMID: 33030033 DOI: 10.1177/1062860620961168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Training in leadership and health system transformation is increasingly important in undergraduate medical education in order to develop a pipeline of engaged physicians dedicated to transforming health care. Despite this growing need, it is unclear whether current leadership training methods have long-term impact on students' career trajectory. The authors analyzed career outcomes from 6 years of the Health Innovations Scholars Program (HISP) to better understand how the program affected the 46 graduates' future involvement in health system transformation and leadership. Eighty-eight percent of the graduates remained involved in quality improvement, 70% held leadership positions, 31% participated in health innovation, and 15% participated in patient safety initiatives. Project involvement of the graduates represented both primary and secondary catalysts for health system change, leading to 28 unique catalyst events. HISP is a model for directing trainees' career trajectory toward engagement in health system leadership and redesign.
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Affiliation(s)
- Emily Gottenborg
- University of Colorado, Aurora, CO University of Kentucky, Lexington, KY
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Mangrulkar RS, Tsai A, Cox SM, Halaas GW, Nelson EA, Nesse RE, Silvestri RC, Radabaugh CL, Skochelak S, Beck Dallaghan GL, Steiner B. A Proposed Shared Vision for Leadership Development for all Medical Students: A Call from a Coalition of Diverse Medical Schools. TEACHING AND LEARNING IN MEDICINE 2020; 32:561-568. [PMID: 32363950 DOI: 10.1080/10401334.2020.1754835] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Issue: Despite clear relevance, need, descriptive literature, and student interest, few schools offer required curriculum to develop leadership skills. This paper outlines a proposed shared vision for leadership development drawn from a coalition of diverse medical schools. We advocate that leadership development is about self (looking inward), teams (not hierarchy), and change (looking outward). We propose that leadership development is for all medical students, not for a subset, and we believe that leadership curricula and programs must be experiential and applied. Evidence: This paper also draws on the current literature and the experience of medical schools participating in the American Medical Association's (AMA) Accelerating Change in Medical Education Consortium, confronts the common arguments against leadership training in medical education, and provides three cross-cutting principles that we believe must each be incorporated in all medical student-centered leadership development programs as they emerge and evolve at medical schools. Implications: By confronting common arguments against leadership training and providing a framework for such training, we give medical educators important tools and insights into developing leadership training for all students at their institutions.
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Affiliation(s)
- Rajesh S Mangrulkar
- Departments of Internal Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Antonius Tsai
- Leadership Development and Education Strategy, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Susan M Cox
- Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Gwen W Halaas
- Academic Affairs, Washington State University, Spokane, WA, USA
| | - Elizabeth A Nelson
- Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Robert E Nesse
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronald C Silvestri
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie L Radabaugh
- Medical Education Programs, American Medical Association, Chicago, Illinois, USA
| | - Susan Skochelak
- Medical Education, American Medical Association, Chicago, Illinois, USA
| | - Gary L Beck Dallaghan
- Educational Scholarship, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Beat Steiner
- Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Leadership development in undergraduate medical education: evaluation of students’ perceptions of a student-selected leadership module. BMJ LEADER 2020. [DOI: 10.1136/leader-2019-000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThere is increasing recognition of the importance of leadership development within undergraduate medical training. One method of doing this is through student-selected components (SSCs), optional modules that allow students to explore an area in greater depth than in the core curriculum. An SSC in medical leadership has been offered at the University of Glasgow since 2015. We evaluated students’ perceptions of this SSC.MethodsStudents are required to submit a written reflective report on the SSC. These were analysed thematically to determine students’ lived experience. Respondent validation and independent anonymised feedback to the university were used for triangulation.ResultsStudents reported that the SSC allowed them to experience aspects of healthcare not encountered elsewhere in their training. Three themes were derived from the analysis, relating to SSC structure, areas of learning and personal development/impact. Students recognised that leadership development is important within the curriculum and felt that it should be available to all medical students.ConclusionThis evaluation of students’ perceptions of a leadership SSC identified characteristics of the module that were felt by students to be valuable in leadership development and will support development of similar leadership modules at undergraduate and postgraduate levels.
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Burk-Rafel J, Harris KB, Heath J, Milliron A, Savage DJ, Skochelak SE. Students as catalysts for curricular innovation: A change management framework. MEDICAL TEACHER 2020; 42:572-577. [PMID: 32017861 DOI: 10.1080/0142159x.2020.1718070] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction: The role of medical students in catalyzing and leading curricular change in US medical schools is not well described. Here, American Medical Association student and physician leaders in the Accelerating Change in Medical Education initiative use qualitative methods to better define student leadership in curricular change.Methods: The authors developed case studies describing student leadership in curricular change efforts. Case studies were presented at a national medical education workshop; participants provided worksheet reflections and were surveyed, and responses were transcribed. Kotter's change management framework was used to categorize reported student roles in curricular change. Thematic analysis was used to identify barriers to student engagement and activators to overcome these barriers.Results: Student roles spanned all eight steps of Kotter's change management framework. Barriers to student engagement were related to faculty (e.g. view student roles narrowly), students (e.g. fear change or expect faculty-led curricula), or both (e.g. lack leadership training). Activators were: (1) recruiting collaborative faculty, staff, and students; (2) broadening student leadership roles; (3) empowering student leaders; and (4) recognizing student successes.Conclusions: By applying these activators, medical schools can build robust student-faculty partnerships that maximize collaboration, moving students beyond passive educational consumption to change agency and curricular co-creation.
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Affiliation(s)
- Jesse Burk-Rafel
- Department of Internal Medicine, NYU Langone Health, New York, NY, USA
| | - Kevin B Harris
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jacqueline Heath
- Department of Internal Medicine, NYU Langone Health, New York, NY, USA
| | - Alyssa Milliron
- Department of Internal Medicine, UC Davis Health, Sacramento, CA, USA
| | - David J Savage
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
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Thakur A, Sockalingam S, Varatharajan T, Soklaridis S. "You are in Some Sort of Occupational Adolescence": An Exploratory Study to Understand Knowledge, Skills, and Experiences of CanMEDS Leader Role in Psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:184-191. [PMID: 31863412 DOI: 10.1007/s40596-019-01162-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The study explored knowledge, attitude, and practices of Canadian Medical Education Directions for Specialists (CanMEDS) "'Leader" role in faculty psychiatrists in a university setting. METHODS This is a qualitative study using a thematic analysis approach. Participants were identified by purposive, convenience, and snowball sampling. Telephone interviews were conducted to explore participants' perceptions of leadership. Qualitative analysis was carried out using a constant comparative analysis approach to identify themes across the interview data. Data was transcribed and coded into themes and categories to form an analysis of physicians' knowledge, attitude, and practices of the CanMEDS "Leader" role. RESULTS Twenty-eight faculty psychiatrists participated in the study. The following themes and subthemes emerged from analysis: (a) characteristics of leadership and lack of clarity regarding CanMEDS "Leader" role (subthemes: differences between manager and leader, lack of specificity and practicality, relevance to practice) and (b) the meaning of leadership (subthemes: "positional leadership" and "everyday leadership," physician as team leader, developing leadership skills, getting beyond "occupational adolescence"). CONCLUSION Participants perceived CanMEDS "Leader" role description as a high-level vision, which needs practice-oriented guidance. Participants conceptualized the dual nature of physician leadership at an individual level and at an organizational level. Leadership training is important both in residency as well as lifelong learning.
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Affiliation(s)
- Anupam Thakur
- Depatment of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, Toronto, Canada.
| | - Sanjeev Sockalingam
- Depatment of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Thepikaa Varatharajan
- Depatment of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Sophie Soklaridis
- Depatment of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
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Schmidt JW, Linenberger SJ. Medicine: A Prescription for Medical Student Leadership Education. New Dir Stud Leadersh 2020; 2020:125-136. [PMID: 32187876 DOI: 10.1002/yd.20374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This chapter proposes a medical school leadership curriculum that is context-driven, dovetails seamlessly with the medical student experience, and goes beyond managerial and professional interests by developing purposeful physician-leaders and focusing leadership knowledge on patient outcomes.
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Barnes T, Yu TCW, Webster CS. Preparedness of medical students and junior doctors for their role as clinical leaders: A systematic review. MEDICAL TEACHER 2020; 42:79-85. [PMID: 31566997 DOI: 10.1080/0142159x.2019.1665632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction: Clinical leadership skills are essential across all levels of a healthcare organization and must be employed by those most appropriate to the situation, regardless of position or profession. However, most medical students and junior doctors remain unaware of how leadership can be assimilated into their everyday clinical practice.Aim: To investigate the perceived preparedness of medical students and junior doctors for their role as clinical leaders.Methods: A systematic search was performed of the MEDLINE, ERIC and PubMed databases. Papers pertaining to medical students and junior doctors that included primary data on preparedness for clinical leadership or behaviors associated with being a clinical leader were included.Results: Sixteen papers were included and analyzed after screening 254. No studies specifically assessed the transition to clinical leader. Evidence suggests that new graduates perceive leadership as individualistic and hierarchical, and that they are only partially prepared to fill this role. Preparedness for clinical leadership was associated with increasing responsibility, experience and time-served.Conclusions: New graduates are unlikely to question senior colleagues as they lack leadership-specific communication skills. Further research is required into how to actively promote leadership in medical students and ease the transition to leadership roles within clinical teams.
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Affiliation(s)
- Tracey Barnes
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
- Department of General Surgery, Dunedin Hospital, Dunedin, New Zealand
| | - Tzu-Chieh Wendy Yu
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
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Smithson S, Beck Dallaghan G, Crowner J, Derry LT, Vijayakumar A(A, Storrie M, Daaleman TP. Peak Performance: A Communications-Based Leadership and Teamwork Simulation for Fourth-Year Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520929990. [PMID: 32637637 PMCID: PMC7318812 DOI: 10.1177/2382120520929990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Medical education has traditionally been rooted in the teaching of health and disease processes, with little attention to the development of teamwork and leadership competencies. OBJECTIVE In an era of value-based health care provided by high-functioning teams, new approaches are needed to develop communication, leadership, and teamwork skills for medical students. DESIGN We designed and piloted a simulation-based educational activity called Peak Performance that linked a workbook, which focused on self-reflection on communication and leadership skills, with professional coaching. The simulation scenario placed students in the role of an upper-level resident on an inpatient service, followed by a small group debrief with students, a clinical faculty member, and a professional executive coach. After the debriefing session, students were invited to complete a self-reflection workbook within 1 week of the initial simulation. The final element of the curriculum was an individualized session with an executive coach. Peak Performance was offered to all fourth-year medical students enrolled in the Social and Health Systems Science required course at the University of North Carolina School of Medicine. RESULTS Pre-/post-self-assessments of leadership competencies were completed by students. Pre-simulation self-assessment scores ranged from 3.72 to 4.33 on a 5-point scale. The lowest scores were in "Managing Conflict" and "Managing Others." The highest score was in "Self-Awareness." The post-simulation scores decreased in every competency, with "Managing Others" dropping significantly from 3.72 pre-simulation to 3.36 post-simulation (0.31, P < .05). Satisfaction with the curriculum was high, as reflected by a Net Promoter Score of 91% ("excellent" > 50%). CONCLUSIONS A novel simulation-based educational activity linked to professional coaching is a feasible and impactful strategy to develop leadership, communication, and teamwork skills in medical students. Student insight and self-awareness increased as evidenced by a decrease in competency self-assessment after guided reflection and individualized coaching.
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Affiliation(s)
- Sarah Smithson
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Jason Crowner
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | | | - Mindy Storrie
- Kenan-Flagler Business School, University of North Carolina, Chapel Hill, NC, USA
| | - Timothy P Daaleman
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Yayac M, Trojan JD, Brown S, Mulcahey MK. Formal leadership training for orthopedic surgeons: Limited opportunities amongst growing demand. Orthop Rev (Pavia) 2019; 11:8151. [PMID: 31897275 PMCID: PMC6912144 DOI: 10.4081/or.2019.8151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/04/2019] [Indexed: 11/23/2022] Open
Abstract
Leadership skills are important to all orthopedic surgeons, regardless of practice or location, as interactions with patients, staff, and other physicians necessitate professionalism and leadership. Leadership skills are best developed through formal training and experiential opportunities. Several programs emphasizing leadership skills for orthopedic surgeons exist; however, the number of programs is not adequate to meet the demand. It is difficult for orthopedic surgeons to take advantage of these opportunities, given clinical and professional responsibilities. To appropriately adapt to the changing healthcare environment and ensure advancement of the orthopedic field, formal leadership skills development should be widely integrated into orthopedic training.
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Affiliation(s)
- Michael Yayac
- Department of Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - Jeffrey D Trojan
- Department of Orthopedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Symone Brown
- Department of Orthopedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mary K Mulcahey
- Department of Orthopedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Barry ES, Dong T, Durning SJ, Schreiber-Gregory D, Torre D, Grunberg NE. Medical Student Leader Performance in an Applied Medical Field Practicum. Mil Med 2019; 184:653-660. [PMID: 31111893 DOI: 10.1093/milmed/usz121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/27/2019] [Accepted: 04/30/2019] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Erin S Barry
- Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
| | - Ting Dong
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
| | - Steven J Durning
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
| | - Deanna Schreiber-Gregory
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
| | - Dario Torre
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
| | - Neil E Grunberg
- Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
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Keijser WA, Handgraaf HJM, Isfordink LM, Janmaat VT, Vergroesen PPA, Verkade JMJS, Wieringa S, Wilderom CPM. Development of a national medical leadership competency framework: the Dutch approach. BMC MEDICAL EDUCATION 2019; 19:441. [PMID: 31779632 PMCID: PMC6883542 DOI: 10.1186/s12909-019-1800-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Wouter A. Keijser
- Faculty of Behavioural, Management and Social Sciences (BMS) Change, Management and Organizational Behavior (CMOB), University Twente, Enschede, The Netherlands
- DIRMI Foundation, Utrecht, The Netherlands
| | | | - Liz M. Isfordink
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Vincent T. Janmaat
- Erasmus Medical Center, Wytemaweg 80, 3015 CP Rotterdam, The Netherlands
| | - Pieter-Paul A. Vergroesen
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - Sietse Wieringa
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Continuing Education, University of Oxford, Oxford, OX1 2JD UK
| | - Celeste P. M. Wilderom
- Faculty of Behavioural, Management and Social Sciences (BMS) Change, Management and Organizational Behavior (CMOB), University Twente, Enschede, The Netherlands
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Portney DS, VonAchen P, Standiford T, Carey MR, Vu J, Kirst N, Zink B. Medical Student Consulting: Providing Students Leadership and Business Opportunities While Positively Impacting the Community. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10838. [PMID: 31773064 PMCID: PMC6869981 DOI: 10.15766/mep_2374-8265.10838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/07/2019] [Indexed: 05/24/2023]
Abstract
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.
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Affiliation(s)
- David S. Portney
- Third-Year Medical Student, University of Michigan Medical School
| | - Paige VonAchen
- Fourth-Year Medical Student, University of Michigan Medical School
| | | | - Matthew R. Carey
- Fourth-Year Medical Student, University of Michigan Medical School
| | - Joceline Vu
- Resident, PGY 5, Department of Surgery, University of Michigan Medical School
| | - Nell Kirst
- Assistant Professor, Department of Family Medicine, University of Michigan Medical School
- Co-Director of Medical School Leadership Development Program, University of Michigan Medical School
| | - Brian Zink
- Professor, Department of Emergency Medicine, University of Michigan Medical School
- Senior Associate Chair of Education and Faculty Development, Department of Emergency Medicine, University of Michigan Medical School
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