The resident physician as leader within the healthcare team

Leading from the bottom: The clinical leaders roles in an HIV primary care facility in Eldoret, Kenya

BACKGROUND

Clinical leaders in health systems play critical roles in making decisions that impact patient care and health system performance. Current literature has focused on the importance of clinical leaders' roles in healthcare settings and has not addressed the leadership aspect that clinical leaders engage in day-to-day decision-making in HIV facilities while providing HIV patient care. Therefore, identifying the leadership roles that wclinical leaders perform at HIV primary facilities is of critical importance.

PURPOSE

The study explored the views of healthcare providers working in AMPATH-MTRH HIV facility on what they perceived as the roles of clinical leaders at the HIV primary care facility.

METHODS

We conducted a qualitative exploratory study between December 2019 to May 2020, involving in-depth interviews with (n = 22) healthcare providers working in AMPATH-MTRH HIV facility, who were purposively and conveniently sampled to participate in in-depth interviews to explore perceptions regarding the leadership roles of clinical leaders. The collected data were analyzed thematically and Nvivo vs.12 software was used for data management.

RESULTS

The following themes were identified from the analysis regarding perceived clinical leaders' roles in an HIV primary care facility: 1) Strategic roles: providing direction and guidance, ensuring goals and objectives of the department are achieved within the set timelines, planning, and budgeting for adequate resources to support patient HIV care 2) Interconnecting health systems levels and supervisory oversight roles: a link between management, staff, and patients, solving problems, organizing and attending departmental meetings, facilitate staff training, accountable, collaborating with other departments and leaders, defines and assigns responsibilities, ensure quality patient service, coordination, and management of daily activities 3) Research roles: data collation, analysis, generation, review and reporting to the management.

CONCLUSION

Clinical leaders in the HIV care system perform leadership roles that are characterized by strategic, middle-level, supervisorial and research which reflects the model of the leadership and management style of the HIV care system. The understanding of these roles contributes valuable insights to HIV leaders and managers to recognize the important contribution of clinical leaders and consider reviewing Standard Operating Procedures to include these leadership roles and strengthen their capacity to maximize clinicians' contribution to improve HIV care and enhance responsive health systems.

Defining a competency framework for health and social professionals to promote healthy aging throughout the lifespan: an international Delphi study

The promotion of healthy aging has become a priority in most parts of the world and should be promoted at all ages. However, the baseline training of health and social professionals is currently not adequately tailored to these challenges. This paper reports the results of a Delphi study conducted to reach expert agreement about health and social professionals' competencies to promote healthy aging throughout the lifespan within the SIENHA project. Materials and methods: This study was developed following the CREDES standards. The initial version of the competence framework was based on the results of a scoping review and following the CanMEDS model. The expert panel consisted of a purposive sample of twenty-two experts in healthy aging with diverse academic and clinical backgrounds, fields and years of expertise from seven European countries. Agreement was reached after three rounds. The final framework consisted of a set of 18 key competencies and 80 enabling competencies distributed across six domains. The SIENHA competence framework for healthy aging may help students and educators enrich their learning and the academic content of their subjects and/or programs and incentivize innovation.

An Evaluation of Mentorship for Hospital Residents in Saudi Arabia: A Qualitative study using Semi-structured Interviews

Background

In this study, we explore how doctors in training perceive mentorship and leadership and whether they believed that mentoring influences the development of leadership skills. The study also addressed whether certain leadership styles lend themselves better to mentoring.

Methods

A qualitative research method was employed in this study and ethical approval was granted by the Research Ethics Committee (REC) at King Faisal Specialist Hospital and Research Centre (KFSH&RC), after which twelve hospital residents were recruited using purposive sampling. Semi-structured interviews were conducted by the authors and thematic data analysis was performed.

Results

Three themes emerged and were later refined, using Braun and Clarke's 2006 thematic analysis method:1. Purpose of mentorship, with sub themes: a. Expectations, b. Perception of mentorship as supervision, and c. The role of mentorship, including informal mentoring in leadership development2. Role of mentorship in leadership development.3. Perceptions of a leader, with sub-themes: a. The leader as a manager, b. The leader as a role model, and c. The merits of different leadership styles.

Discussion

Most of the residents (doctors in training) viewed mentorship in a positive way. However, when the mentor was perceived more as a supervisor, the usefulness of mentoring was less clear. However, they found that informal mentoring would contribute to leadership skills and would inspire them to become leaders themselves. They were likely to be influenced positively when they saw the leader as a role model, rather than a manager.

Hospital residents’ perception of mentorship as influencing clinical leadership: a qualitative study using semi-structured interviews

Background: In this study, we explored how doctors in training perceive mentorship and leadership and whether they believed that mentoring influences the development of leadership skills. The study also addressed whether certain leadership styles lend themselves better to mentoring. Methods: A qualitative research method was employed in this study and ethical approval was granted by the Research Ethics Committee (REC) at King Faisal Specialist Hospital and Research Centre (KFSH&RC), after which twelve hospital residents were recruited using purposive sampling. Semi-structured interviews were conducted by the authors and thematic data analysis was performed.  Results: Three themes emerged and were later refined, using Braun and Clarke’s 2006 thematic analysis method: 1. Purpose of mentorship, with sub themes: a. Expectations, b.  Perception of mentorship as supervision, and c. The role of mentorship, including informal mentoring in leadership development 2. Role of mentorship in leadership development. 3. Perceptions of a leader, with sub-themes: a. The leader as a manager, b. The leader as a role model, and c. The merits of different leadership styles. Discussion: Most of the residents (doctors in training) viewed mentorship in a positive way. However, when the mentor was perceived more as a supervisor, the usefulness of mentoring was less clear. However, they found that informal mentoring would contribute to leadership skills and would inspire them to become leaders themselves. They were likely to be influenced positively when they saw the leader as a role model, rather than a manager.

The 4C's of influence framework: fostering leadership development through character, competence, connection and culture

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.

Pharmacist trainees narrow scope of interprofessional collaboration and communication in hospital practice

Early curricular exposure to interprofessional education (IPE) is intended to acclimatize health professional trainees to shared-care in the practice settings they will ultimately join. However, IPE activities typically reside outside actual organizational and social systems in which interprofessional care is delivered. We aimed to explore how pharmacist trainees experience collaborator and communicator competency roles during team-based workplace-based learning. Participants maintained written diaries reflecting on interprofessional collaboration and communication during an eight-week hospital clerkship. Diary entries and transcripts from semi-structured follow-up interviews were analyzed from the social constructivist perspective using reflective thematic analysis. Participant accounts of on-ward activities represented most collaborator and communicator roles outlined in pharmacy and interprofessional competency frameworks, but were predominantly between the pharmacist trainee and physicians. Pharmacist trainees did not routinely engage with other health professions on a daily basis. Additionally, reported encounters with other team members were typically information exchanges and not episodes of authentic interdependent or shared care. Interactions were almost completely devoid of perceived interpersonal or role conflict. These findings offer insight into how pharmacist trainees perceive and develop competencies for team-based care. Further work is required to understand how such limited scope of interprofessional communication and collaboration might ultimately impair quality patient care.

Unobserved Observers: Nurses' Perspectives About Sharing Feedback on the Performance of Resident Physicians

PURPOSE

Postgraduate training programs are incorporating feedback from registered nurses (RNs) to facilitate holistic assessments of resident performance. RNs are a potentially rich source of feedback because they often observe trainees during clinical encounters when physician supervisors are not present. However, RN perspectives about sharing feedback have not been deeply explored. This study investigated RN perspectives about providing feedback and explored the facilitators and barriers influencing their engagement.

METHOD

Constructivist grounded theory methodology was used in interviewing 11 emergency medicine and 8 internal medicine RNs at 2 campuses of a tertiary care academic medical center in Ontario, Canada, between July 2019 and March 2020. Interviews explored RN experiences working with and observing residents in clinical practice. Data collection and analysis were conducted iteratively. Themes were identified using constant comparative analysis.

RESULTS

RNs felt they could observe authentic day-to-day behaviors of residents often unwitnessed by supervising physicians and offer unique feedback related to patient advocacy, communication, leadership, collaboration, and professionalism. Despite a strong desire to contribute to resident education, RNs were apprehensive about sharing feedback and reported barriers related to hierarchy, power differentials, and a fear of overstepping professional boundaries. Although infrequent, a key stimulus that enabled RNs to feel safe in sharing feedback was an invitation from the supervising physician to provide input.

CONCLUSIONS

Perceived hierarchy in academic medicine is a critical barrier to engaging RNs in feedback for residents. Accessing RN feedback on authentic resident behaviors requires dismantling the negative effects of hierarchy and fostering a collaborative interprofessional working environment. A critical step toward this goal may require supervising physicians to model feedback-seeking behavior by inviting RNs to share feedback. Until a workplace culture is established that validates nurses' input and creates safe opportunities for them to contribute to resident education, the voices of nurses will remain unheard.

Deconstructing the ABC’s of leadership for successful curriculum development and implementation in residency education

Purpose

Leadership decisions occur frequently throughout the day, yet as clinicians, who balance multiple roles and responsibilities, the authors seldom label them explicitly. This translates to missed opportunities to foster the requisite skill sets junior trainees to require in their current and future contexts. While there is clear evidence for a purposeful leadership curriculum, developing, implementing and assessing these competencies remains challenging. The purpose of this paper is to provide educators with a curricular approach to incorporate leadership opportunities in their own teaching and supervisory practices.

Design/methodology/approach

A dyadic “teaching and assessment” strategy may overcome leadership curricular challenges. The authors propose a new framework that breaks down leadership opportunities into their requisite learning settings. Like fine wine and cheese, these learning experiences are paired with assessment strategies to provide further formative and summative feedback, all in the context of educational theories and frameworks.

Findings

In this paper, the authors recommend six unique learning environments for educators to consider, captured in the abbreviation ABC’S3 for administrative, bedside, classroom, simulation, self-awareness and summarization, all of which lend themselves to leadership development opportunities for resident physicians. The authors provide tested examples and pair these teaching options with a variety of assessment strategies to choose from.

Practical implications

Three practical implications are put forth in this paper, namely, leadership competencies are needed for everyone, not just for those with leadership titles or positions; multiple learning settings (and all aspects of work) can be harnessed to provide diverse leadership opportunities; and advancement beyond Miller’s knows is needed to create opportunities to hone practical leadership competencies in the shows how and does levels.

Originality/value

This paper uniquely pairs learning opportunities with assessment strategies across diverse practical settings and environments. These techniques and opportunities will serve to stimulate ideas and kick-start dialogue about incorporating a practical leadership curriculum within clinical training programs.

Leadership Training and Undergraduate Medical Education: a Scoping Review

The purpose of this scoping review is to fill the gap in understanding the current status of intervention-based studies regarding leadership training in undergraduate medical education. As of late, there is an increased focus on the role of physicians as leaders in their fields, and communities. In order to evaluate these studies, both the PubMed and ERIC databases were searched, and an ultimate total of 35 articles methodologies were evaluated for their general methodology, curricular content, specific teaching methods, and evaluation methodologies. There were a number of trends identified, as well as remaining gaps.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01308-9.

Team member expectations of trainee communicator and collaborator competencies - so shines a good deed in a weary world?

BACKGROUND

Workplace-based assessment may be further optimized by drawing upon the perspectives of multiple assessors, including those outside the trainee's discipline. Interprofessional competencies like communication and collaboration are often considered suitable for team input.

AIM

We sought to characterize multidisciplinary expectations of communicator and collaborator competency roles.

METHODS

We adopted a constructivist grounded theory approach to explore perspectives of multidisciplinary team members on a clinical teaching unit. In semi-structured interviews, participants described expectations for competent collaboration and communication of trainees outside their own discipline. Data were analyzed to identify recurring themes, underlying concepts and their interactions using constant comparison.

RESULTS

Three main underlying perspectives influenced interprofessional characterization of competent communication and collaboration: (1) general expectations of best practice; (2) specific expectations of supportive practice; and (3) perceived commitment to teaching practice. However, participants seemingly judged trainees outside their discipline according to how competencies were exercised to advance their own professional patient care decision-making, with minimal attention to the trainee's specific skillset demonstrated.

CONCLUSION

While team members expressed commitment to supporting interprofessional competency development of trainees outside their discipline, service-oriented judgement of performance loomed large. The potential impact on the credibility of multidisciplinary sources for workplace-based assessment requires consideration.

"You are in Some Sort of Occupational Adolescence": An Exploratory Study to Understand Knowledge, Skills, and Experiences of CanMEDS Leader Role in Psychiatry

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.

How do Lebanese patients perceive the ideal doctor based on the CanMEDS competency framework?

BACKGROUND

During their training, Lebanese medical students develop a high medical expertise but are not focusing on other competencies such as communication, collaboration, erudition, professionalism, leadership and health promotion. There is also insufficient data about patients' preference for these skills. This study describes the different weights patients attribute to these physician's competencies.

METHODS

This is a cross-sectional study based on a questionnaire distributed to 133 Lebanese patients. It included 15 questions assessing how patients prioritize the physician's competencies, with open-ended questions asking them to define "the good doctor". Krippendorff's alpha coefficient was used to analyze the reliability of the competencies' classification.

RESULTS

One hundred twenty five patients completed the questionnaire in this cross-sectional study. Their mean age was 48 ± 16.76 years. When classifying competencies, 73.6% opted for medical expertise as first choice and 48% put communication as second. Based on the Krippendorff's coefficient, we identified a moderate agreement for the seven choices (alpha = 0.44). In open-ended questions, patients defined the good doctor in 325 answers: 64.3% mentioned medical expertise, 34.1% high ethics and 26.2% communication.

CONCLUSIONS

This patient-centered study concurs well with the worldwide practice that puts medical expertise at the center of medical education. However Lebanese patients don't perceive equally other competencies and favor professionalism and communication that should be integrated in priority in students' curricula.