Preparing health professions students to lead change

Leadership Development Strategies in Interprofessional Healthcare Collaboration: A Rapid Review

Background

Contemporary healthcare practitioners require leadership skills for a variety of professional roles related to improved patient/client outcomes, heightened personal and professional development, as well as strengthened interprofessional collaboration and teamwork.

Objective/Aim

The aim of this study is to systematically catalogue literature on leadership in healthcare practice and education to highlight the leadership characteristics and skills required by healthcare practitioners for collaborative interprofessional service delivery and the leadership development strategies found to be effective.

Methods/Design

A rapid review was conducted. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) diagram shows that the 11 databases, yielded 465 records. A total of 147 records were removed during the initial screening phase. The remaining 318 records were uploaded onto Rayyan, an online collaborative review platform. Following abstract level screening, a further 236 records were removed with 82 records meeting the eligibility criteria at full text level, of which 42 were included in the data extraction. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal.

Results

Results showed variability in methodologies used, representing various healthcare disciplines with a range in population size (n = 6 to n = 537). Almost half of the results reported on new programs, with interprofessional collaboration and teamwork being the most frequently mentioned strategies. The training content, strategies used as well as the length of training varied. There were five outcomes which showed positive change, namely skills, knowledge, confidence, attitudes, and satisfaction.

Conclusion

This rapid review provided an evidence-base, highlighted by qualitative, quantitative, and mixed methods research, which presents distinct opportunities for curriculum development by focusing on both content and the methods needed for leadership programs. Anchoring this evidence-base within a systematic search of the extant literature provides increased precision for curriculum development.

Leadership Lessons Learned from the Military

The military provides a valuable resource for the civilian medical education sector to potentially model or adopt strategies used to train emerging leaders. The Department of Defense has a long tradition of cultivating leaders, espousing a culture that emphasizes a value system that promotes selfless service and integrity. In addition to leadership training, and a fostered value system, the military additionally trains leaders to use a defined military decision-making process. This article identifies and shares lessons learned in how the military structures and focuses to accomplish the mission, and develops and invests in military leadership training.

Leadership Training in Undergraduate Medical Education: A Systematic Review

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.

Leadership Development in U.S. Undergraduate Medical Education: A Scoping Review of Curricular Content and Competency Frameworks

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.

Using adaptive leadership principles to support Public Health 3.0 in multidisciplinary undergraduate education

Purpose

The COVID-19 pandemic has uncovered public health vulnerabilities worldwide, particularly in the hard-hit USA. US public health professionals, regardless of role, may need to exercise leadership in both planned and unexpected situations. This model of practice outside of traditional roles, known as Public Health 3.0, requires adaptive leadership – a systems approach to making progress on complex challenges. Educational programs should improve students’ adaptive leadership competency to prepare them for the public health workforce. This paper aims to provide an educational framework for implementing adaptive leadership instruction for undergraduate students.

Design/methodology/approach

This paper used experiential and traditional instructional strategies and adaptive leadership competencies to develop a semester-length leadership course for undergraduate students in health, nursing, social science, business and education. Adaptive leadership principles were learned and practiced, preparing students for systemic challenges through the lens of Public Health 3.0. Competencies were assessed pre- and post-semester.

Findings

Of 248 students, 72% were health professions majors. Students reported pre-post scores on 29 measures of competency, interest, learning and behavioral change. Quantitative evaluations identified statistically significant improvement in all domains. Additional quantitative feedback indicated improvement on the three Kirkpatrick levels of evaluation assessed (reaction, learning and behavior).

Originality/value

Tiered evaluation methods indicated that this leadership course enhanced participants’ self-reported adaptive leadership learning and competency, as well as intention and ability to translate learning into practice. A broad spectrum of competency development is needed for students entering practice in the Public Health 3.0 era, particularly related to pandemic response.

Viewpoints on Healthcare Delivery Science Education Among Practicing Physicians in a Rural State

INTRODUCTION

Healthcare Delivery Science Education (HDSE) covers important aspects of the business of medicine, including, operations management, managerial accounting, entrepreneurship, finance, marketing, negotiations, e-health and policy/advocacy. We need to investigate and understand practicing physicians' viewpoints on HDSE in order to inform interventions capable of preventing the double loss phenomena and improving medical and continuing medical education opportunities in HDSE. This qualitative study aims to provide a rich, contextualized understanding of the HDSE experiences and interests of physicians practicing in a rural state through the intensive study of particular cases.

MATERIALS AND METHODS

We interviewed 18 practicing physicians from a rural, Midwestern state over the telephone about their viewpoints on past experiences obtaining HDSE, interest in HDSE, barriers to pursuing HDSE, and interest in an example HDSE certificate program.

RESULTS

Salient themes in our study were that physicians were interested in HDSE and believed HDSE could lead to improved patient care and practice efficiency. However, many of the respondents had not received longitudinal, diversified, didactic or practical HDSE. Time limited many physicians from pursuing HDSE opportunities. Many physicians in the study were interested in the example HDSE certificate program.

DISCUSSION AND CONCLUSIONS

Physicians in our qualitative study were interested in obtaining HDSE and had not received diversified, didactic HDSE in the past. Our research suggests innovative HDSE programs will likely be utilized and pursued if they are developed.

Transformational leadership in nursing practice: challenges and strategies

OBJECTIVE

to understand the challenges and strategies adopted by nurses for the exercise of Transformational Leadership in a university hospital.

METHODS

qualitative and exploratory study, in which 25 nurses working in a university hospital in the state of Bahia, Brazil participated. Data collection took place through semi-structured interviews and categorized according to Thematic Analysis, using Nvivo software.

RESULTS

The prevalent challenges involved: lack of encouragement from the institution for the training of leaders; professional inexperience and young age; resistance to leadership and insubordination. The strategies adopted by nurses consist of acting as team examples and establishing dialogic relationships. Final considerations: The practice of Transformational Leadership has been relevant in the daily lives of nurses and contributes to the quality of care.

Leadership skills essential in the value-based care era

Purpose

The purpose of this paper is to identify the primary executive leadership skills required to promote the effectiveness of Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) and to create a new substantive theory describing these skills. The author identifies that MSSP ACO is a relatively new value-based care delivery (VBCD) structure in the USA that links clinicians’ compensation to their clinical outcomes. The research question concerns what primary executive leadership skills are essential in the VBCD era.

Design/methodology/approach

This single, embedded, exploratory case study is based on interviews, a focus group discussion and archival record data of MSSP ACO executives in the Northeast, Midwest, South and West of the USA.

Findings

The findings represented seven major categories or the primary executive leadership skills required to succeed in the VBCD environment. Each category or skill included five subcategories or concepts supporting the leadership skills essential for reaching VBCD goals. The categories and subcategories gave rise to a new substantive theory – the Accountable Healthcare Leadership Theory of Five Ps: promoting partnership between providers, patients and payers.

Research limitations/implications

The empirical generalizability of the results was limited by its essence as a single, embedded, exploratory case study of 18 MSSP ACO executives in 4 regions of the USA. The strength of this study, however, lies in its potential for making analytic generalizations for identifying theoretically meaningful leadership skills essential for success in the VBCD era.

Originality/value

The author has developed and validated a new theory describing the primary executive leadership skills required to succeed in the VBCD environment.

Filling the void in lesbian, gay, bisexual, transgender and queer (LGBTQ+) leadership training

Purpose

Leadership training refers to the process of helping individuals develop skills to successfully perform in leadership positions. Existing leadership programs have several drawbacks, including the paucity of leadership programs designed for lesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals in health care. The authors addressed this gap by creating and hosting Q-Forward (formerly Q-Med), the first conference focused specifically on leadership development for LGBTQ+ health trainees.

Design/methodology/approach

In this paper, the authors explain how a conference focused on leadership development for LGBTQ+ health trainees can have benefits for trainees, patients and the health-care system. The authors also report the conference proceedings, including planning, participants, guiding principles and programming.

Originality/value

This conference was the first conference for LGBTQ+ health trainees focused specifically on leadership training. The authors believe that the conference was unique, and that such training represents an essential step toward long-term improvements in the health of LGBTQ+ people and other populations.