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Barry ES, Teunissen P, Varpio L. Followership in interprofessional healthcare teams: a state-of-the-art narrative review. BMJ LEADER 2024; 8:127-133. [PMID: 37696538 DOI: 10.1136/leader-2023-000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Holgaard R, Bruun B, Zingenberg F, Dieckmann P. An interview study about how nurses and physicians talk about the same concepts differently. BMC MEDICAL EDUCATION 2024; 24:698. [PMID: 38926761 PMCID: PMC11210097 DOI: 10.1186/s12909-024-05682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND How healthcare professionals understand and use concepts of social and cognitive capabilities will influence their behaviour and their understanding of others' behaviour. Differing understandings of concepts might lead to healthcare professionals not acting in accordance with other healthcare professionals' expectations. Therefore, part of the problem concerning errors and adverse incidents concerning social and cognitive capabilities might be due to varying understandings of concepts among different healthcare professionals. This study aimed to examine the variations in how educators at the Copenhagen Academy for Medical Education and Simulation talk about social and cognitive capabilities. METHODS The study was conducted using semi-structured interviews and directed content analysis. The codes for the analysis process were derived from existing non-technical skills models and used to show variations in how the participants talk about the same concepts. RESULTS Educators with a background as nurses and physicians, talked differently about leadership and decision-making, with the nurses paying greater attention to group dynamics and external factors when describing both leadership and decision-making, whereas physicians focus on their individual efforts. CONCLUSION We found patterned differences in how the participants described leadership and decision-making that may be related to participants' professional training/background. As it can create misunderstandings and unsafe situations if nurses and physicians disagree on the meaning of leadership and decision-making (without necessarily recognising this difference), it could be beneficial to educate healthcare professionals to be aware of the specificity of their own concepts, and to communicate what exactly they mean by using a particular concept, e.g. "I want you to coordinate tasks" instead of "I want better leadership".
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Affiliation(s)
- Ragnhild Holgaard
- Center for Human Resources, Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Herlev Hospital, 25th floor, Herlev Ringvej 75, Herlev, 2370, Denmark.
| | - Birgitte Bruun
- Center for Human Resources, Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Herlev Hospital, 25th floor, Herlev Ringvej 75, Herlev, 2370, Denmark
| | - Frederik Zingenberg
- Center for Human Resources, Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Herlev Hospital, 25th floor, Herlev Ringvej 75, Herlev, 2370, Denmark
| | - Peter Dieckmann
- Center for Human Resources, Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Herlev Hospital, 25th floor, Herlev Ringvej 75, Herlev, 2370, Denmark
- Department of Public Health, Copenhagen University, Øster Farimagsgade 5, Copenhagen, 1353, Denmark
- Department of Quality and Health Technology, University in Stavanger, Kjell Arholms Gate 43, Stavanger, 4021, Norway
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Rixon A, Elder E, Bull C, Crilly Oam J, Østervan C, Frieslich H, Robertson S, Pink E, Wilson S. Leadership conceptions of nurses and physicians in emergency care: A scoping review. Int Emerg Nurs 2024; 74:101454. [PMID: 38677058 DOI: 10.1016/j.ienj.2024.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The Emergency Department (ED) is a setting where teamwork and leadership is imperative, however, the literature to date is mostly discipline (nursing or medical) specific. This scoping review aimed to map what is known about nurses' and physicians' conceptions of leadership in the ED to understand similarities, differences, and opportunities for leadership development and research. METHOD Guided by the Joanna Briggs Institute approach, and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines, a systematic search of three electronic databases was performed. The Mixed Methods Assessment Tool was used for quality appraisal of included articles. RESULTS In total, 37 articles were included. Four key findings emerged: 1) leadership was rarely explicitly defined; 2) nurse leaders tended to be characterised as agents of continuity whilst physician leaders tended to be characterised as agents of change and continuity; 3) the clarification of expectations from nurse leaders was more evident than expectations from physician leaders; and 4) leadership discourse tended to be traditional rather than contemporary. CONCLUSION Despite the proliferation of studies into ED nurse, physician and interprofessional leadership, opportunities exist to integrate learnings from other sectors to strengthen the development of current and next generation of ED leaders.
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Affiliation(s)
- Andrew Rixon
- Department of Business Strategy and Innovation - Griffith Business School, Griffith University, Gold Coast, Queensland, Australia; Centre for Work, Organisation and Wellbeing, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Elizabeth Elder
- Centre for Work, Organisation and Wellbeing, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Claudia Bull
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Julia Crilly Oam
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Christina Østervan
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Hayley Frieslich
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Shaun Robertson
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Ed Pink
- QEII Hospital, Brisbane, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Samuel Wilson
- Department of Management and Marketing, Swinburne Business School, Swinburne University of Technology, Melbourne, Australia
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Rajeswaran T, Dawdy K, Bishop M, Amiel G, Heneghan K, Khader J, de Vries J, Silva FS, Wiljer D, Szumacher E. An Exploration of the Pillars of Leadership in Cancer Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:288-296. [PMID: 38421568 DOI: 10.1007/s13187-024-02409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Leadership plays a key role in cancer education (CE) and the success of its practices. Leaders in CE must effectively use their leadership skills to be able to communicate, collaborate, and educate their team members. There is a lack of formalized and standardized curriculums for institutions in developing leadership programs, including what themes to focus on in CE. In this article, the authors describe key pillars of leadership in CE that have presented themselves throughout their experience and within the literature. A search was conducted using the Ovid MEDLINE® database and articles were reviewed for eligibility. In this review, thirty articles were selected for their relevance to CE. With this literature search and the authors' reflections, four pillars of leadership in CE were identified: (1) leadership development, (2) collaboration, (3) diversity and equity, and (4) implementation. Within these themes, key areas of importance were discussed further, and barriers to CE leadership were identified. By reflecting upon pillars of leadership in CE, this article may be helpful for developing future leadership programs within CE. It is vital that initiatives continue to be held and barriers are addressed to increase leadership effectiveness within CE.
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Affiliation(s)
- Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Krista Dawdy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- University of Toronto, Department of Radiation Oncology, Toronto, ON, Canada
| | - Maria Bishop
- Division of Hematology and Oncology, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Gilad Amiel
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
| | - Kathleen Heneghan
- Surgical Patient Education, American College of Surgeons, Chicago, IL, USA
| | - Jamal Khader
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Jakob de Vries
- University Medical Center Groningen, Groningen, Netherlands
| | - Filipe Santos Silva
- i3S-Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - David Wiljer
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ewa Szumacher
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
- University of Toronto, Department of Radiation Oncology, Toronto, ON, Canada.
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Duignan M, Drennan J, Mc Carthy VJC. Relationship between work-related psychosocial factors and self-leadership in advanced nurse practitioners: A cross-sectional study. J Adv Nurs 2024; 80:1120-1131. [PMID: 37837195 DOI: 10.1111/jan.15855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 10/15/2023]
Abstract
AIM The aim of this study was to investigate the relationship between advanced nurse practitioners' self-leadership and commitment to the workplace, work engagement and influence at work. BACKGROUND The concept of self-leadership is particularly suited to ANPs, who are required to take responsibility for their work roles. An optimum balance between the ANPs' psychosocial work environment and self-leadership may positively impact work ability in this group and can be compromised by interactions between and among these variables. DESIGN A cross-sectional correlational study was conducted from July 2020 to August 2020 on 153 ANPs across a national health service. METHODS The survey was distributed to respondents online. The revised self-leadership questionnaire was used to measure self-leadership, and three scales from the Copenhagen Psychosocial Questionnaire were used to measure commitment to the workplace, work engagement and influence at work. Multiple linear regression was used to examine the association between self-leadership and the psychosocial variables. RESULTS ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. No relationship was found between self-leadership and influence at work. CONCLUSION Improving self-leadership among ANPs by involving them in strategic leadership activities at an organizational level could be an effective strategy for optimizing the role and facilitating ANPs to contribute at an organizational level beyond the clinical interface. However, organizational support is required to ensure that ANPs practise to the full potential of their training and capability. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT This study provided new evidence of a relationship between ANPs' self-leadership and psychosocial factors. This study found that ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. Policymakers and organizational leaders can optimize the ANP role and facilitate ANPs to contribute strategically to improve care systems. This study identifies a relationship between ANPs' self-leadership and specific psychosocial variables.
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Affiliation(s)
- Martin Duignan
- Our Lady's Hospital, Navan, Co. Meath, Dublin, Ireland
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Hirsh DA, Crampton PES, Osman NY. Applying self-determination theory to stem medical schools' clinical teacher sustainability crisis. MEDICAL EDUCATION 2024; 58:118-128. [PMID: 37593835 DOI: 10.1111/medu.15181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023]
Abstract
THE PROBLEM Medical schools require highly skilled and committed clinical faculty to teach, assess, supervise and mentor students' clinical care. Medical education is facing a crisis in recruiting and sustaining these clinical teachers. Faced with multiple demands and responsibilities in fast-paced clinical environments, teachers may not have the time, resources or stamina to sustain these critical roles. Medical school leaders must commit to and provide structures and processes to attract, sustain and retain clinical teachers. CONCEPTUAL FRAMEWORK The authors use the lens of self-determination theory to frame approaches to support teacher sustainability. Self-determination theory describes sources of human motivation. The theory and its evidence base characterise three human psychological needs: autonomy, competence, and relatedness. This theory can bridge individual psychological and institutional leadership perspectives to help medical school leaders anticipate and respond to their clinical teachers' needs. The authors propose three practical steps: practices to advance employee-centredness, processes to align individual and institutional values, and restructuring education to support clinical teachers' needs alongside student and patient needs. The authors describe limitations to this relational approach that focuses on leadership actions and consider individual agency as another key factor for sustainability. DISCUSSION Medical school leaders can develop and apply theory-driven approaches to advance sustainability. Sustainability now and in the future requires careful attention to the needs of clinical teachers and to their relationships with and within medical schools.
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Affiliation(s)
- David A Hirsh
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Paul E S Crampton
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Nora Y Osman
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Hayashi M, Breugelmans R, Nishiya K. Identity conflicts of student affairs officers in a medical university. MEDICAL EDUCATION ONLINE 2023; 28:2182216. [PMID: 36840965 PMCID: PMC9970241 DOI: 10.1080/10872981.2023.2182216] [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: 07/19/2022] [Revised: 11/24/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Collaboration between student affairs officers and the faculty is important in dealing with the recent rapid changes in medical education, and mutual understanding is essential to ensure that participants become a cohesive social group. This study explores the identity conflicts of student affairs officers in medical universities using the figured worlds theory. METHODS An exploratory qualitative case study was conducted with 24 student affairs officers at a private medical university in Japan. Data were collected through face-to-face, semi-structured interviews and analysed using thematic analysis from the perspective of a social constructivism paradigm. RESULTS Qualitative analysis revealed the following three themes regarding the identity conflicts of student affairs officers: differences in the perception of medical students, difficulties in building trusting relationships with the faculty, and resistance to the medical university's traditional atmosphere. Student affairs officers tended to provide support from a student-centred perspective when interacting with medical students, while the faculty employed a teacher-centred perspective. DISCUSSION To promote understanding between professions, it is necessary to set aside certain professional views and welcome dialogue with other professionals with different values, while also understanding the multi-layered context of medical education, so that conflicts can be handled optimally and relationships can be professionalised for social cohesion.
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Affiliation(s)
- Mikio Hayashi
- Center for Health Professions Education, Kansai Medical University, Osaka, Japan
- Master of Medical Sciences in Medical Education, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Katsumi Nishiya
- Center for Health Professions Education, Kansai Medical University, Osaka, Japan
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Broski J, Tarver S, Krase K, Petersen S, Wolverton A, Winchester M, Berbel G, Zabel T, Warren H, Lineberry M. Integrating simulation and interpretive description to explore operating room leadership: critical event continuing education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1211-1244. [PMID: 37022534 DOI: 10.1007/s10459-023-10212-3] [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: 06/24/2022] [Accepted: 01/22/2023] [Indexed: 06/19/2023]
Abstract
In Obstetrics and Gynecologic operating room emergencies, the surgeon cannot both operate and lead a suddenly expanded and redirected team response. However, one of the most often used approaches to interprofessional continuing education designed to improve teams' ability to respond to unanticipated critical events still emphasizes surgeon leadership. We developed Explicit Anesthesia and Nurse Distributed (EXPAND) Leadership to imagine a workflow that might better distribute emergency leadership task responsibilities and practices. The purpose of this exploratory study was to investigate teams' responses to distributing leadership during an interprofessional continuing education simulated obstetrical emergency. We used interpretive descriptive design in a secondary analysis of teams' post-simulation reflective debriefings. One-hundred sixty providers participated, including OB-Gyn surgeons, anesthesiologists, CRNAs, scrub technicians, and nurses. Using reflective thematic analysis, we identified three core themes: 1) The surgeon is focused on the surgical field, 2) Explicit leadership initiates a nurse transition from follower to leader in a hierarchical environment, and 3) Explicit distributed leadership enhances teamwork and taskwork. Continuing education which uses distributed leadership to improve teams' ability to respond to an obstetric emergency is perceived to enhance team members' response to the critical event . The potential for nurses' career growth and professional transformation was an unexpected finding associated with this continuing education which used distributed leadership. Our findings suggest that healthcare educators should consider ways in which distributed leadership may improve teams' response to critical events in the operating room.
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Affiliation(s)
- Julie Broski
- The Zamierowski Institute of Experiential Learning, The University of Kansas Medical Center, Kansas City, KS, USA.
| | - Stephen Tarver
- Department of Anesthesiology, Pain and Perioperative Medicine, The Zamierowski Institute of Experiential Learning, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kelli Krase
- Department of Obstetrics and Gynecology, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Shariska Petersen
- Department of Obstetrics and Gynecology, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Amy Wolverton
- The Zamierowski Institute of Experiential Learning, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mae Winchester
- Maternal-Fetal Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - German Berbel
- Department of Surgery, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Taylor Zabel
- Medical Student, Harvard Medical School, Boston, MA, USA
| | - Hannah Warren
- BSN, RN, Cardiovascular Intensive Care Nurse at Heart Hospital of Austin, Austin, Texas, USA
| | - Matthew Lineberry
- Department of Population Health, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Lin H, Liu G, Wang X, Xu Q, Guo S, Hu R. A virtual simulation-based training program on birthing positions: a randomized controlled trial. BMC Nurs 2023; 22:318. [PMID: 37715171 PMCID: PMC10503076 DOI: 10.1186/s12912-023-01491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Restricting parturient women in healthcare facilities from choosing positions that provide the greatest comfort and benefit during labor is a global barrier. Several complex factors, including caregiver preference and medical intervention, shape the limitation. Therefore, a practical need exists to train midwives on the knowledge and skills to change this condition. METHODS The study used a parallel, single-blind, randomized controlled trial at a provincial maternity and child health hospital in Fujian, China, from June 1 to December 31, 2019. The midwives in a birth suite were selected and randomly enrolled in a one-month simulation-based hybrid training or face-to-face teaching in September 2019. The four-level Kirkpatrick's model, including reaction, learning, behavior, and results, was used to evaluate training effects before and after the program. Data were analyzed with SPSS 25.0 using Student's t-test, Spearman's correlation test, Mann-Whitney U test, Wilcoxon signed-rank test, and chi-square test analysis of variance. The significance level was set at p < 0.05. RESULTS Forty-two midwives were initially randomized to either the virtual simulation group or the face-to-face group. One midwife was excluded from the analysis due to intervention discontinuation, resulting in a final analysis of 41 midwives (n1 = 21, n2 = 20). Post-intervention, the virtual simulation group exhibited higher satisfaction and learning effects compared to the face-to-face group, while the rate of perineal incision in primiparas was lower (p<0.05). No significant changes or differences were observed in self-rated behavior between the two groups (p>0.05). The virtual simulation group demonstrated an increase in non-supine birth rate (p = 0.030) and a decrease in perineal incision rate among primiparas compared to pre-intervention (p = 0.035). Moreover, knowledge performance was associated with the duration of virtual simulation (r = 0.664, p = 0.001). CONCLUSIONS Virtual simulation is a fascinating innovation that enables midwives to develop birthing positions without practicing on real pregnant women and is one solution to achieve work competency within a shortened training period.
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Affiliation(s)
- Huimin Lin
- The School of Nursing, Fujian Medical University, Fuzhou City, China
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fuzhou City, China
| | - Guihua Liu
- The School of Nursing, Fujian Medical University, Fuzhou City, China
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fuzhou City, China
| | - Xiaoyan Wang
- The School of Nursing, Fujian Medical University, Fuzhou City, China
| | - Qin Xu
- The School of Nursing, Fujian Medical University, Fuzhou City, China
| | - Shengbin Guo
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fuzhou City, China.
| | - Rongfang Hu
- The School of Nursing, Fujian Medical University, Fuzhou City, China.
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Park M, Dlamini BB, Lee H, Jeong M, Giap TTT, Jung J, Bui LK, Kim J, Kim J. Factors Influencing Training Transfer Among Infection Control Professionals Participating in Infectious Disease Training. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:21-27. [PMID: 36728965 DOI: 10.1097/ceh.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Infectious disease training is considered vital in health care systems to improve knowledge, skills, and work performance of infection control professionals. However, the extent to which trainees effectively transfer knowledge, skills, and attitudes that they acquire through training has received little attention. This study aimed to identify factors influencing training transfer of infection control professionals receiving infectious disease training. METHODS This cross-sectional study selected infection control professionals who completed an infectious disease training program provided by Korea Human Resources Development Institute for Health and Welfare. A self-reported questionnaire was used to collect data on sociodemographic variables, trainee characteristics, training design, work environment, and training transfer. Data analysis was conducted using SPSS (version 26.0). RESULTS The mean age of the 139 participants was 41.45 years, and 77% were female participants. Regression analysis indicated that the following factors significantly influenced the training transfer of infection control professionals and thereby decrease morbidity and mortality: for trainee characteristics, transfer experience (β = 0.205, P = 0.012) and motivation to learn (β = 0.196, P =0.016); for training design, learning objectives (β = 0.269, P = 0.021), goals (β = 0.356, P =0.023), and methods (β = 0.365, P = 0.020); and for the work environment, supervisor support (β = 0.275, P =0.024) and colleague support (β = 0.474, P = 0.022). CONCLUSION Future training programs for improving training transfer should focus more on strategies to improve the motivation for training transfer. Trainees should be guided on (1) how to apply training knowledge in specific clinical contexts to improve their performance and (2) potential methods to get support from their supervisors and colleagues during training.
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Affiliation(s)
- Myonghwa Park
- Dr. Park: College of Nursing, Chungnam National University, Daejeon, South Korea. Mr. Dlamini: Department of Nursing, Eswatini Medical Christian University, Mbabane, Eswatini. Dr. Lee: School of Business Administration, Chungnam National University, Daejeon, South Korea. Dr. Jeong: College of Nursing, Joongbu University, Chungcheongnam-do, South Korea. Ms. Giap: College of Nursing, Chungnam National University, Daejeon, South Korea. Ms. Jung: College of Nursing, Chungnam National University, Daejeon, South Korea. Ms. Bui: Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam. Mr. Jahyeon Kim: College of Nursing, Chungnam National University, Daejeon, South Korea. Ms. Jinju Kim: College of Nursing, Chungnam National University, Daejeon, South Korea
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Brewster DJ, Butt WW, Gordon LJ, Sarkar MA, Begley JL, Rees CE. Leadership during airway management in the intensive care unit: A video-reflexive ethnography study. Front Med (Lausanne) 2023; 10:1043041. [PMID: 36873881 PMCID: PMC9980339 DOI: 10.3389/fmed.2023.1043041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Effective leadership is crucial to team performance within the intensive care unit. This novel study aimed to explore how staff members from an intensive care unit conceptualize leadership and what facilitators and barriers to leadership exist within a simulated workplace. It also aimed to identify factors that intersect with their perceptions of leadership. This study was underpinned by interpretivism, and video-reflexive ethnography was chosen as the methodology for the study. The use of both video recording (to capture the complex interactions occurring in the ICU) and team reflexivity allowed repeated analysis of those interactions by the research team. Purposive sampling was used to recruit participants from an ICU in a large tertiary and private hospital in Australia. Simulation groups were designed to replicate the typical clinical teams involved in airway management within the intensive care unit. Twenty staff participated in the four simulation activities (five staff per simulation group). Each group simulated the intubations of three patients with hypoxia and respiratory distress due to severe COVID-19. All 20 participants who completed the study simulations were invited to attend video-reflexivity sessions with their respective group. Twelve of the 20 participants (60%) from the simulations took part in the reflexive sessions. Video-reflexivity sessions (142 min) were transcribed verbatim. Transcripts were then imported into NVivo software for analysis. The five stages of framework analysis were used to conduct thematic analysis of the video-reflexivity focus group sessions, including the development of a coding framework. All transcripts were coded in NVivo. NVivo queries were conducted to explore patterns in the coding. The following key themes regarding participants' conceptualizations of leadership within the intensive care were identified: (1) leadership is both a group/shared process and individualistic/hierarchical; (2) leadership is communication; and (3) gender is a key leadership dimension. Key facilitators identified were: (1) role allocation; (2) trust, respect and staff familiarity; and (3) the use of checklists. Key barriers identified were: (1) noise and (2) personal protective equipment. The impact of socio-materiality on leadership within the intensive care unit is also identified.
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Affiliation(s)
- David J Brewster
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC, Australia.,Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Warwick W Butt
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia
| | - Lisi J Gordon
- Centre for Medical Education, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom
| | - Mahbub A Sarkar
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Jonathan L Begley
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Rees CE, Ottrey E, Kemp C, Brock TP, Leech M, Lyons K, Monrouxe LV, Morphet J, Palermo C. Understanding Health Care Graduates' Conceptualizations of Transitions: A Longitudinal Qualitative Research Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1049-1056. [PMID: 34879008 DOI: 10.1097/acm.0000000000004554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Although transitions have been defined in various ways in the higher education literature (e.g., inculcation, development, becoming), little research exists exploring health care learners' conceptualizations of transitions across their transition from final year to new graduate. How they understand transitions is important because such conceptualizations will shape how they navigate their transitions and vice versa. METHOD The authors conducted a 3-month longitudinal qualitative research study with 35 health care learners from 4 disciplines (medicine, dietetics, nursing, and pharmacy) across their final year to new graduate transition to explore how they conceptualized transitions. Data collection occurred between July 2019 and April 2020 at Monash University in Victoria, Australia. The authors employed framework analysis to interrogate the interview and longitudinal audio diary data cross-sectionally and longitudinally. RESULTS The authors found 10 different conceptualizations of transitions broadly categorized as time bound and linear (one-off events, systems, linear, adaptation, linked to identities), ongoing and complex (ongoing processes, multifaceted, complex), or related to transition shock (labor, linked to emotions). The adaptation conceptualization increased in dominance over time, the linear conceptualization was more apparent in the interviews (time points 1 and 3), and the multifaceted and emotion-linked conceptualizations were more dominant in the longitudinal audio diaries (time point 2). CONCLUSIONS This novel study illustrates conceptualizations of transitions as broadly consistent with existing higher education literature but extends this research considerably by identifying differences in conceptualizations across time. The authors encourage health care learners, educators, and policy makers to develop expanded and more sophisticated understandings of transitions to ensure that health care learners can better navigate often challenging graduate transitions. Further research should explore stakeholders' transition conceptualizations over lengthier durations beyond the new graduate transition.
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Affiliation(s)
- Charlotte E Rees
- C.E. Rees is head of school, School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia, and adjunct professor, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0003-4828-1422
| | - Ella Ottrey
- E. Ottrey is postdoctoral fellow, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-2979-548X
| | - Caitlin Kemp
- C. Kemp is research assistant, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-4056-2230
| | - Tina P Brock
- T.P. Brock is professor of pharmacy education and practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0001-7455-4063
| | - Michelle Leech
- M. Leech is deputy dean and head of medical course, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kayley Lyons
- K. Lyons is Ware fellow for pharmacy education and leadership, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0003-2224-1107
| | - Lynn V Monrouxe
- L.V. Monrouxe is professor for work integrated learning and academic lead of health professions education research, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-4895-1812
| | - Julia Morphet
- J. Morphet is associate professor, Monash Nursing and Midwifery, and affiliate, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0001-7056-6526
| | - Claire Palermo
- C. Palermo is director, Monash Centre for Scholarship in Health Education, and head of education and education research, Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-9423-5067
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Followership: The Missing Link in Surgical Leadership. Ann Surg 2022; 275:e740-e742. [PMID: 35185129 DOI: 10.1097/sla.0000000000005376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Meeuwissen SNE, Gijselaers WH, de Rijk AE, Huveneers WJM, Wolfhagen IHAP, Oude Egbrink MGA. When theory joins practice: A design-based research approach for leader identity development. MEDICAL TEACHER 2022; 44:636-642. [PMID: 34928758 DOI: 10.1080/0142159x.2021.2015532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Inclusive educational leaders promote teacher team functioning. To support leader inclusiveness, we designed and implemented a faculty development programme focusing on leader identity formation. We investigated (1) how participants' leader identity developed throughout the programme and (2) how the design principles contributed to this process, according to participants. METHODS A design-based research approach was followed. Participants were 7 course coordinators, leading an interdisciplinary teacher team. To study leader identity development, participants repeatedly filled out a validated questionnaire. To investigate how design principles contributed, observational field notes, facilitator debriefings, a programme evaluation questionnaire and a semi-structured focus group were used. Thematic analysis was applied for qualitative data. RESULTS Participants gained broader views on leadership, moving from individual dominance towards engaging team members. Most participants initially experienced a deconstruction of their former leader identity and became motivated to improve leadership qualities. Competence-building, reflecting and receiving feedback on workplace experiences, and practicing in a safe environment were perceived to be key for identity development. CONCLUSIONS We developed and evaluated a leader identity programme which can convert teachers' classic leadership views towards views incorporating social interactions and relationships. We demonstrated how social interactions provide opportunities to learn from pe.ers in the work environment.
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Affiliation(s)
- Stephanie N E Meeuwissen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, FHML, Maastricht University, Maastricht, The Netherlands
| | - Wim H Gijselaers
- Department of Educational Research and Development, School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - Angelique E de Rijk
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), FHML, Maastricht, The Netherlands
| | - Wilma J M Huveneers
- Department of Educational Development and Research, FHML, Maastricht University, Maastricht, The Netherlands
| | - Ineke H A P Wolfhagen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, FHML, Maastricht University, Maastricht, The Netherlands
- Institute for Education, FHML, Maastricht University, Maastricht, The Netherlands
| | - Mirjam G A Oude Egbrink
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Institute for Education, FHML, Maastricht University, Maastricht, The Netherlands
- Department of Physiology, FHML, Maastricht University, Maastricht, The Netherlands
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Oates K, Burgess A, Clark T. An interdisciplinary program for emerging leaders in patient safety. CLINICAL TEACHER 2022; 19:323-332. [PMID: 35642287 PMCID: PMC9541880 DOI: 10.1111/tct.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Having previously shown that an interprofessional immersive course, AELPS (Academy for Emerging Leaders in Patient Safety) can change the way young clinicians think about patient safety, we surveyed them between 1 and 5 years later to determine its longer-term influence on careers, relationships with colleagues and with patients. METHODS All alumni from 2016 to 2019 (n = 116) were invited to complete a survey on the usefulness of their AELPS experience in: obtaining their current position; doing patient safety projects; understanding and working with patients; improving communication skills; breaking down hierarchies; networking; mentoring and using new skills in the workplace. Data were analysed using descriptive statistics and thematic analysis. RESULTS Response rate was 56%. Over 85% reported ongoing improvement in medication safety knowledge, communication with patients, use of graded assertiveness, communicating more effectively with colleagues, seeking views of their patients about treatment options and seeing things from the patient perspective. Sixty seven per cent agreed that AELPS helped them in their career choice and 57% agreed it had helped them obtain their current position. Skills transferred to the workplace included ability to make improvements, establish education initiatives and model patient-centred care. Stumbling blocks included a hierarchal culture and lack of accountability for patient safety practices in some hospitals. DISCUSSION An intensive, interdisciplinary program on patient safety can provide future health leaders with ongoing tools to improve communication, understand the patient view and speak up on behalf of the patient, all factors that contribute to improving safety of patients.
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Affiliation(s)
- Kim Oates
- Faculty of Medicine and Health, Sydney Medical School, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Annette Burgess
- Faculty of Medicine and Health, Sydney Medical School, Education Office, The University of Sydney, Sydney, New South Wales, Australia
| | - Tyler Clark
- Faculty of Medicine and Health, Sydney Medical School, Education Office, The University of Sydney, Sydney, New South Wales, Australia
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Vanstone M, Grierson L. Thinking about social power and hierarchy in medical education. MEDICAL EDUCATION 2022; 56:91-97. [PMID: 34491582 DOI: 10.1111/medu.14659] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Social power has been diversely conceptualised in many academic areas. Operating on both the micro (interactional) and macro (structural) levels, we understand power to shape behaviour and knowledge through both repression and production. Hierarchies are one organising form of power, stratifying individuals or groups based on the possession of valued social resources. DISCUSSION Medicine is a highly organised social context where work and learning are contingent on interaction and thereby influenced greatly by social power and hierarchy. Despite the relevance of power to education research, there are many unrealized opportunities to use this construct to expand our understanding of how physicians work and learn. Hierarchy, when considered in our field, is typically gestured to as an omnipresent feature of the clinical environment that harms low-status individuals by repressing their ability to communicate openly and exercise their agency. This may be true in many circumstances, but this conceptualization of hierarchy neglects consideration of other aspects of hierarchy that may be generative for understanding the experiences of medical learners. For example, medical learners may experience the superimposition of multiple hierarchies, some of which are fluid and some of which are calcified, some of which are productive and helpful and some of which are oppressive and harmful. Power may work 'up' and 'across' hierarchical ranks, rather than just from higher status to lower status individuals. CONCLUSION The conceptualizations of how social power shapes human behaviour are diverse. Often paired with hierarchy, or social arrangement, these social scientific ideas have much to offer our collective study of the ways that health professionals learn and practice. Accordingly, we posit that a consideration of the ways social power works through hierarchies to nurture or harm the growth of learners should be granted explicit consideration in the framing and conduct of medical education research.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster FHS Program for Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Grierson
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster FHS Program for Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
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Mnaymneh M, van Oostveen R, Kapralos B, Dubrowski A. Effective Collaboration Through Activity Theory and Knotworking in Clinical Settings. Cureus 2021; 13:e19860. [PMID: 34976487 PMCID: PMC8712195 DOI: 10.7759/cureus.19860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 11/12/2022] Open
Abstract
Healthcare professionals must be able to work in multidisciplinary teams (MDTs). The purpose of this editorial is to explain how healthcare professionals (can) contribute to the effectiveness of MDT, through the use of activity theory (collective work activity shared by others who are motivated by a purpose mediated by tools in order to achieve a specific goal) and the associated idea of knotworking (method of tying, untying, and retying together seemingly separate threads of activity). The leading thesis here is that MDTs benefit from health professionals with well-established leadership skills, and also strong collaborative skills that enable them to transition fluidly between leadership roles as needed to advance patient care. Within activity theory, knotworking is the process of tying and untying various threads of activity and knowledge from across the MDT in order to accomplish specific objectives over time. Knotworking exemplifies the dynamic nature of MDT collaboration, which requires professionals to be productive in their environment. The viewpoints offered in this editorial contribute to a new perspective on MDTs, one that acknowledges distributed leadership and the importance of co-producing a successful partnership in a clinical setting.
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Fennell K. Conceptualisations of Leadership and Relevance to Health and Human Service Workforce Development: A Scoping Review. J Multidiscip Healthc 2021; 14:3035-3051. [PMID: 34737575 PMCID: PMC8558050 DOI: 10.2147/jmdh.s329628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This scoping review was undertaken to determine leadership definitions and approaches relevant to health and human service (H&HS) workforce development. This review provides a preliminary analysis of the potential size and scope of available research literature to inform ongoing research with the ultimate aim to inform a future systematic review in relation to leadership development interventions. METHODS Following the methodology proposed by Arksey and O'Malley and using PRISMA-ScR, a systematic search was conducted using seven databases (PubMed, Health Business Elite, Medline, CINAHL, Ovid, Scopus, and Web of Science). Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize, collate, and make a narrative account of the findings. RESULTS Employing pre-selected criteria, a total of 424 records were identified and 171 full-text articles were assessed. The majority of the papers were studies undertaken by researchers based in North America. Leadership in the H&HS sector was addressed in 35% of the articles. The narrow disciplinary or workforce fields of the nursing and medical professions in hospitals and acute care settings dominated the literature. CONCLUSION The findings suggest that while leadership has been studied extensively in the health system, there is a paucity of leadership development research specific to the broader H&HS sector. This review emphasises the need for further research, including a more critical examination of leadership development interventions and their application to the H&HS sector.
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Affiliation(s)
- Kate Fennell
- Health and Human Services Leadership, University of Tasmania, Tasmanian School of Medicine, College of Health and Medicine, Medical Science Precinct, Hobart, Tasmania, 7000, Australia
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Buckley S, Smith M, Patel J, Gay S, Davison I. Enhanced model for leadership development for trainees and early career health professionals: insights from a national survey of UK clinical scientists. BMJ LEADER 2021; 6:212-218. [DOI: 10.1136/leader-2021-000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/04/2021] [Indexed: 11/04/2022]
Abstract
IntroductionThe importance of shared or distributed leadership in healthcare is recognised; however, trainees, early career professionals and others for whom the exercise of leadership is a recent development report being underprepared for leadership roles. Trainee clinical scientists exemplify such groups, being both early in their career and in a profession for which clinical leadership is less well established. Their insights can inform understanding of appropriate forms of leadership development for health professionals.MethodsWe explored perceptions of leadership and its development for trainee clinical scientists on the UK preregistration Scientist Training Programme through semi-structured interviews with trainees, training officers, academic educators and lead healthcare scientists; and through an online questionnaire based on the UK multiprofessional Clinical Leadership Competency Framework (CLCF). Responses were analysed statistically or thematically as appropriate.ResultsForty interviews were undertaken and 267 valid questionnaire responses received. Stakeholders recognised clinical expertise as integral to leadership; otherwise their perceptions aligned with CLCF domains and ‘shared leadership’ philosophy. They consider learning by ‘doing’ real tasks (leadership activities) key to competency acquisition, with leadership education (eg, observation and theory) complementing these. Workplace affordances, such as quality of departmental leadership, training officer engagement and degree of patient contact affect trainees’ ability to undertake leadership activities.ConclusionsFrom our research, we have developed an enhanced model for leadership development for trainee and early career clinical scientists that may have wider applicability to other health professions and groups not traditionally associated with clinical leadership. To foster their leadership, we argue that improving workplace affordances is more important than improving leadership education.
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Meeuwissen SNE, Gijselaers WH, van Oorschot TD, Wolfhagen IHAP, Oude Egbrink MGA. Enhancing Team Learning through Leader Inclusiveness: A One-Year Ethnographic Case Study of an Interdisciplinary Teacher Team. TEACHING AND LEARNING IN MEDICINE 2021; 33:498-508. [PMID: 33632034 DOI: 10.1080/10401334.2021.1887738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PHENOMENON Developing modern medical curricula requires collaboration between different scientific and clinical disciplines. Consequently, institutions face the daunting task to engage colleagues from different disciplines in effective team collaboration. Two aspects that are vital to the success of such teamwork are "team learning behavior" by all team members and "leader inclusiveness behavior" by the team leader. Team members display team learning behavior when they share information, build upon and integrate each other's viewpoints. The team leader can promote such team learning by exhibiting inclusiveness behavior, which aims to encourage diversity and preserve individual differences for an inclusive workplace, nurturing engagement in teamwork. There is a paucity of in-depth research on leader inclusiveness behavior in the field of medical education. This case study aimed to offer unique insight into how leader inclusiveness behavior manifests itself in a successful interdisciplinary teacher team, demonstrating team learning behavior in undergraduate medical education. APPROACH We conducted a qualitative, ethnographic case study using different but complementary methods, including observations, interviews and a documentary analysis of email communication. By means of purposive sampling, we selected an existing interdisciplinary teacher team that was responsible for an undergraduate medical course at Maastricht University, the Netherlands, and that was known to be successful. Chaired by a physician, the team included planning group members and tutors with medical, biomedical, and social sciences backgrounds as well as student-representatives. In the course of one academic year, 23 meetings were observed and recorded, informal interviews were conducted, and over 100 email conversations were collected. All data were submitted to a directed content analysis based on team learning and leader inclusiveness concepts. FINDINGS Leader inclusiveness behavior became evident from verbal and non-verbal interactions between the team leader and team members. Leader inclusiveness behavior that facilitated team learning behavior manifested itself in five actions undertaken by the team leader: coordinating, explicating, inviting, connecting, and reflecting. Similarly, team members facilitated team learning behavior by participating actively, speaking up behavior, and mimicking leader inclusiveness behavior. These behaviors demonstrated engagement and feelings of inclusion, and reinforced leader inclusiveness behavior by creating additional opportunities for the leader to exhibit such behavior. INSIGHTS This case study responds to the need for inclusive leadership approaches in medical education. Our findings build upon theoretical knowledge on team learning and leader inclusiveness concepts. By studying behaviors, interactions and documents we obtained in-depth information on leader inclusiveness. Our findings are unique in that they demonstrate how leader inclusiveness behavior manifests itself when leaders interact with their team members. This study provides health professionals who are active in education with practical suggestions on how to act as a successful and inclusive leader. Finally, the behaviors identified open up avenues for future professional development initiatives and future research on team leadership. UNLABELLED Supplemental data for this article is available online at here.
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Affiliation(s)
- Stephanie N E Meeuwissen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Wim H Gijselaers
- Department of Educational Research and Development, School of Business and Economics, Maastricht University, Maastricht, the Netherlands
| | - Tiemen D van Oorschot
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ineke H A P Wolfhagen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Mirjam G A Oude Egbrink
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Physiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Ottrey E, Rees CE, Kemp C, Brock TP, Leech M, Lyons K, Monrouxe LV, Morphet J, Palermo C. Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study. MEDICAL EDUCATION 2021; 55:1078-1090. [PMID: 33617656 DOI: 10.1111/medu.14475] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners' solicited and unsolicited conceptualisations of P4P over their early graduate transition. METHODS We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio-diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross-sectionally and longitudinally. RESULTS We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3). DISCUSSION This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders' conceptualisations, and over a duration beyond the early graduate transition.
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Affiliation(s)
- Ella Ottrey
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- College of Science, Health, Engineering & Education, Murdoch University, Murdoch, WA, Australia
| | - Caitlin Kemp
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Tina P Brock
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Michelle Leech
- Medicine, Nursing & Health Sciences Medicine Course, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic, Australia
| | - Kayley Lyons
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Lynn V Monrouxe
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Julia Morphet
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Monash Nursing & Midwifery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia
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Barnes T, Rennie SC. Leadership and surgical training part 1: preparing to lead the way? ANZ J Surg 2021; 91:1068-1074. [PMID: 33825315 DOI: 10.1111/ans.16685] [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: 08/13/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
Every day surgeons lead teams on the wards, in clinics and operating theatres, but most trainees and some surgeons do not consider themselves as leaders. Leadership skills are increasingly important for surgeons, who need knowledge of organizational structure and policy, management strategy and team dynamics to deliver and improve health care in resource-constrained environments. The Royal Australasian College of Surgeons recognizes leadership as one of 10 core surgical competencies but leadership curricula within surgical training programmes are not well defined. There is limited opportunity for formal leadership training and development prior to becoming a consultant.
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Affiliation(s)
- Tracey Barnes
- Department of General Surgery, Dunedin Hospital, Dunedin, New Zealand.,Department of Surgical Sciences, Dunedin School of Medicine, The University of Otago, Dunedin, New Zealand
| | - Sarah C Rennie
- Education Unit, The University of Otago, Wellington, New Zealand
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Barnes T, Yu TCW, Webster CS. Are We Preparing Medical Students for Their Transition to Clinical Leaders? A National Survey. MEDICAL SCIENCE EDUCATOR 2021; 31:91-99. [PMID: 34457869 PMCID: PMC8368867 DOI: 10.1007/s40670-020-01122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Leadership is important for organisational teams and patient safety. We aimed to identify leadership behaviours that medical students are developing and consider whether these prepare new graduates to become leaders. METHODS We conducted a mixed methods study using an online questionnaire comprising the Clinical Leadership Survey and additional free-text questions. All New Zealand fifth-year medical students and junior doctors (postgraduate year one) were invited to participate. Our analysis used non-parametric testing and general thematic analysis. RESULTS Seventy-five students and 43 doctors participated. Participants neither agreed nor disagreed that they were clinical leaders (3 vs 3, n.s.). Students were less sure they used clinical leadership behaviours than doctors (4 vs 3, p = 0.014), but all were using transformational leadership behaviours in clinical environments (60 vs 63 out of a maximum of 75, n.s.). Thirty percent could not give an example of acting as clinical leaders, but 97% described using leadership-type behaviours. Thematic analysis yielded four clinical leadership themes: advocacy, collaboration, leading the way and individualism. DISCUSSION Undergraduates appear to be developing and practicing transformational leadership behaviours and junior doctors associate leadership with their role. Participants were unaware of several important leadership behaviours, which could be further developed within an explicit structured curriculum.
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Affiliation(s)
- Tracey Barnes
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Private Bag 92-019, Auckland, 1142 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, Private Bag 92-019, Auckland, 1142 New Zealand
| | - Craig S. Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Private Bag 92-019, Auckland, 1142 New Zealand
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Varpio L, Teunissen P. Leadership in interprofessional healthcare teams: Empowering knotworking with followership. MEDICAL TEACHER 2021; 43:32-37. [PMID: 32673138 DOI: 10.1080/0142159x.2020.1791318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Healthcare professionals need to be able to collaborate in interprofessional healthcare teams (IHTs). This paper discusses how healthcare professionals (can) contribute to IHT effectiveness. Using cultural historical activity theory and its affiliated concept of knotworking, it argues that healthcare professionals would benefit from developing not just leadership but also followership skills. Moreover, IHT collaborators need the ability to switch fluently between leader and follower roles as appropriate to advance patient care. This fluency is essential for collaborative knotworking. Knotworking refers to the process of tying and retying together individual threads of activity and expertise from across the IHT, over time, to achieve specific objects. Knotworking highlights the dynamic dimensions of IHT collaboration that require professionals to be both effective leaders and followers. The perspectives presented in this paper lead to a different view of IHTs, one that recognizes how leaders and followers co-produce the leadership teams need.
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Affiliation(s)
- Lara Varpio
- School of Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Pim Teunissen
- Educational Development and Research, Maastricht University, Maastricht, The Netherlands
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Meeuwissen SNE, Gijselaers WH, Wolfhagen IHAP, Oude Egbrink MGA. Working beyond disciplines in teacher teams: teachers' revelations on enablers and inhibitors. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:33-40. [PMID: 33351174 PMCID: PMC7809069 DOI: 10.1007/s40037-020-00644-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Health professions education faces transitions from monodisciplinary to integrated education and from soloist teachers to interdisciplinary teacher teams. Interdisciplinary teamwork has been found complex and prone to conflict. Teachers' perceptions of why some teams work and learn as a real interdisciplinary team and others do not are lacking in this setting. We studied the factors that teachers perceive as enabling and/or inhibiting interdisciplinary team learning. METHODS In this exploratory, qualitative study, we conducted 17 semi-structured, vignette-guided interviews with teachers recruited from diverse disciplines in undergraduate health professions programmes at Maastricht University, the Netherlands, through maximum variation sampling. Team learning research informed data collection and template analysis. RESULTS We identified three themes representing the factors that teachers perceived to influence interdisciplinary team learning: 'alignment/misalignment with the educational philosophy' (regarding personal attributes, tendencies and motivation), 'leadership practices' (encompassing team vision, responsibility and reflection), and 'involvement in organisational processes' (covering organisational decision-making, support and learning opportunities). For interdisciplinary team learning in development of integrated education, teachers emphasised their personal ability to move beyond disciplinary boundaries. Shared team leadership enabled the creation of a shared vision, shared responsibility, and team reflection. Lastly, teacher involvement in educational management, peer support and learning was considered important. DISCUSSION To work beyond disciplines in health professions education, teachers should take an interest in integrated education, share responsibility and work in an environment where people continuously learn from others. Organisations can facilitate this by involving teachers in decision-making processes and providing faculty development aimed to foster shared leadership and team reflection.
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Affiliation(s)
- Stephanie N E Meeuwissen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Wim H Gijselaers
- Department of Educational Research and Development, School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - Ineke H A P Wolfhagen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mirjam G A Oude Egbrink
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Physiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Mikkola L, Parviainen H. Identity and relationship frames in medical leadership communication. Leadersh Health Serv (Bradf Engl) 2020; 33:429-443. [PMID: 33635023 DOI: 10.1108/lhs-05-2020-0028] [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: 11/17/2022]
Abstract
PURPOSE A frame is an interpretive scheme of meanings that guide participants' interpretations of social interaction and their actions in social situations (Goffman, 1974). By identifying early-career physicians' identity and relationship frames, this study aims to produce information about socially constructed ways to interpret leadership communication in a medical context. DESIGN/METHODOLOGY/APPROACH The data consist of essays written by young physicians (n = 225) during their specialization training and workplace learning period. The analysis was conducted applying constructive grounded theory. FINDINGS Three identity and relationship frames were identified: the expertise frame, the collegial frame and the system frame. These frames arranged the meanings of being a physician in a leader-follower relationship differently. ORIGINALITY/VALUE The findings suggest that identity questions discussed recently in medical leadership studies can be partly answered with being aware of and understanding socially constructed and somewhat contradictory frames.
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Affiliation(s)
- Leena Mikkola
- Department of Language and Communication Studies, University of Jyväskylä, Jyväskylä, Finland
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Leadership characteristics for interprofessional collaboration in China. J Prof Nurs 2020; 36:356-363. [DOI: 10.1016/j.profnurs.2020.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 11/21/2022]
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Brewster DJ, Butt WW, Gordon LJ, Rees CE. Leadership in intensive care: A review. Anaesth Intensive Care 2020; 48:266-276. [PMID: 32741196 DOI: 10.1177/0310057x20937319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An integrative review of the literature specific to leadership within the intensive care unit was planned to guide future research. Four databases were searched. Study selection was based on predetermined inclusion and exclusion criteria and a quality check was done. Data extraction and synthesis involved developing a preliminary thematic coding framework based on a sample of papers. The coding framework and all selected papers were entered into NVivo software. All papers were then coded to the previously identified themes. Themes were summarised and presented with illustrative quotes highlighting key findings. In total, 1102 relevant quotations were coded across the 28 included papers. Four themes pertaining to leadership were described and analysed: (a) leadership dimensions and discourses; (b) leadership experiences; (c) facilitators and/or barriers to leadership; and (d) leadership outcomes. The literature was found to focus on leader behaviours, as well as the leader dimensions of role allocation, clinical and communication skills and traditional hierarchies. Positive behaviours mentioned included good decision-making, staying calm under pressure and being approachable. Leadership experiences (and outcomes) are typically reported to be positive. Personal individual factors seem the biggest enablers and barriers to leadership within the intensive care unit. Training is considered to be a facilitator of leadership within the intensive care unit. This study highlights the current literature on leadership in intensive care medicine and provides a basis for future research on interventions to improve leadership in the intensive care unit.
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Affiliation(s)
- David J Brewster
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Intensive Care Unit, Cabrini Hospital, Melbourne, Australia
| | - Warwick W Butt
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Intensive Care Unit, Cabrini Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Lisi J Gordon
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Centre for Medical Education, School of Medicine, University of Dundee, Scotland, UK
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,College of Science, Health, Engineering & Education, Murdoch University, Perth, Australia
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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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Snelling I, Benson LA, Chambers N. How trainee hospital doctors lead work-based projects. Leadersh Health Serv (Bradf Engl) 2019. [DOI: 10.1108/lhs-12-2018-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to explore how trainee hospital doctors led work-based projects undertaken on an accredited development programme in England.
Design/methodology/approach
This is a case study of a leadership programme for hospital-based specialty trainees. The programme included participants leading work-based projects which were submitted for academic accreditation. Accounts of 35 work-based projects were thematically analysed to explore how participants led their projects.
Findings
Leadership was often informal and based on a series of individual face-to-face conversations. The establishment of project teams and the use of existing communication processes were often avoided. The reasons for this approach included lack of opportunities to arrange meetings, fear of conflict in meetings and the personal preferences of the participants. The authors discuss these findings with reference to theory and evidence about conversations and informal leadership, highlighting the relevance of complexity theory.
Research limitations/implications
The data are limited and drawn from the best accounts written for a specific educational context. There is therefore limited transferability to the leadership work of hospital-based specialty trainees in general. Future research into medical leadership might explore the micro practices of leadership and change, particularly in informal settings.
Practical implications
Leadership development programmes for trainee hospital doctors might concentrate on developing skills of conversation, particularly where there are or may be perceived power imbalances. Exploring conversations within the theory of complex responsive processes should be considered for inclusion in programmes.
Originality/value
This paper adds some detail to the general understanding of learning leadership in practice.
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Kumar B, Swee ML, Suneja M. The ecology of program director leadership: power relationships and characteristics of effective program directors. BMC MEDICAL EDUCATION 2019; 19:436. [PMID: 31752808 PMCID: PMC6873656 DOI: 10.1186/s12909-019-1869-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Program directors are often perceived as strong and independent leaders within the academic medical environment. However, they are not as omnipotent as they initially appear. Indeed, PDs are beholden to a variety of different agents, including trainees (current residents, residency applicants, residency alumni), internal influencers (departmental faculty, hospital administration, institutional graduate medical education), and external influencers (the Accreditation Council for Graduate Medical Education (ACGME), medical education community, and society-at-large). Altogether, these agents form a complex ecosystem whose dynamics and relationships shape the effectiveness of program directors. MAIN BODY This perspective uses management theory to examine the characteristics of effective PD leadership. We underline the importance of authority, accessibility, adaptability, authenticity, accountability, and autonomy as core features of successful program directors. Additionally, we review how program directors can use the six power bases (legitimacy, referent, informational, expert, reward, and coercive) to achieve positive and constructive change within the complexity of the academic medical ecosystem. Lastly, we describe how local and national institutions can better structure power relationships within the ecosystem so that PD leadership can be most effective. CONCLUSION Keen leadership skills are required by program directors to face a variety of challenges within their educational environments. Understanding power structures and relationships may aid program directors to exercise leadership judiciously towards fulfilling the educational missions of their departments.
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Affiliation(s)
- Bharat Kumar
- Division of Immunology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa USA
| | - Melissa L. Swee
- Division of Immunology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa USA
| | - Manish Suneja
- Division of Immunology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa USA
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Onyura B, Crann S, Freeman R, Whittaker MK, Tannenbaum D. The state-of-play in physician health systems leadership research. Leadersh Health Serv (Bradf Engl) 2019; 32:620-643. [DOI: 10.1108/lhs-03-2019-0017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to review a decade of evidence on physician participation in health system leadership with the view to better understand the current state of scholarship on physician leadership activity in health systems. This includes examining the available evidence on both physicians’ experiences of health systems leadership (HSL) and the impact of physician leadership on health system reform.
Design/methodology/approach
A state-of-the-art review of studies (between 2007 and 2017); 51 papers were identified, analyzed thematically and synthesized narratively.
Findings
Six main themes were identified in the literature as follows: (De)motivation for leadership, leadership readiness and career development, work demands and rewards, identity matters: acceptance of self (and other) as leader, leadership processes and relationships across health systems and leadership in relation to health system outcomes. There were seemingly contradictory findings across some studies, pointing to the influence of regional and cultural contextual variation on leadership practices as well entrenched paradoxical tensions in health system organizations.
Research limitations/implications
Future research should examine the influence of varying structural and psychological empowerment on physician leadership practices. Empirical attention to paradoxical tensions (e.g. between empowerment and control) in HSL is needed, with specific attention to questions on how such tensions influence leaders’ decision-making about system reform.
Originality/value
This review provides a broad synthesis of diverse papers about physician participation in health system leadership. Thus, it offers a comprehensive empirical synthesis of contemporary concerns and identifies important avenues for future research.
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Abstract
To improve patient satisfaction ratings and decrease readmissions, many organizations utilize internal staff to complete postdischarge calls to recently released patients. Developing, implementing, monitoring, and sustaining an effective call program can be challenging and have eluded some of the renowned medical centers in the country. Using collaboration with an outsourced vendor to bring state-of-the-art call technology and staffed with specially trained callers, health systems can achieve elevated levels of engagement and satisfaction for their patients postdischarge.
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Führen optimierte Teamarbeit und Führungsverhalten zu besseren Reanimationsergebnissen? Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ma F, Bai Y, Bai Y, Ma W, Yang X, Li J. Factors influencing training transfer in nursing profession: a qualitative study. BMC MEDICAL EDUCATION 2018; 18:44. [PMID: 29558918 PMCID: PMC5859543 DOI: 10.1186/s12909-018-1149-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 03/09/2018] [Indexed: 02/05/2023]
Abstract
Background There is a growing recognition that training is not translated into performance and the ‘transfer problem’ exists in organization training today. Although factors contributing to training transfer have been identified in business and industry, the factors influencing training transfer in nursing profession remain less clear. Methods A qualitative descriptive study was undertaken in two tertiary referral hospitals in China from February 2013 to September 2013. Purposeful sampling of 24 nursing staffs were interviewed about the factors influencing training transfer. Results Seven themes evolved from the analysis, categorized in 4 main domains, which described the factors influencing training transfer in nursing profession in trainee characteristics, training design, work environment and profession domain. The trainee characteristics domain included attitude and ability. The training design domain included training content and instruction method. The work environment domain included supports as facilitators and opposition as hindrance. The theme pertaining to the profession domain was professional development. Conclusions Health care managers need to understand the factors influencing training transfer for maximizing the benefits of training. The right beliefs and values about training, the rigorous employee selection for training, the relevance of training content, training instructions facilitating learning and transfer, supports from peer, supervisors and the organization, organizational culture such as change, sharing, learning and support, and professional development are key to successful training transfer. Furthermore, managers should be aware of the opposition from co-workers and find ways to prevent it. Electronic supplementary material The online version of this article (10.1186/s12909-018-1149-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fang Ma
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China.,Department of Nursing, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yangjing Bai
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yangjuan Bai
- Department of Nursing, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Weiguang Ma
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Xiangyu Yang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiping Li
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China.
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Papoutsi C, Mattick K, Pearson M, Brennan N, Briscoe S, Wong G. Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06100] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundInterventions to improve the antimicrobial prescribing practices of doctors have been implemented widely to curtail the emergence and spread of antimicrobial resistance, but have been met with varying levels of success.ObjectivesThis study aimed to generate an in-depth understanding of how antimicrobial prescribing interventions ‘work’ (or do not work) for doctors in training by taking into account the wider context in which prescribing decisions are enacted.DesignThe review followed a realist approach to evidence synthesis, which uses an interpretive, theory-driven analysis of qualitative, quantitative and mixed-methods data from relevant studies.SettingPrimary and secondary care.ParticipantsNot applicable.InterventionsStudies related to antimicrobial prescribing for doctors in training.Main outcome measuresNot applicable.Data sourcesEMBASE (via Ovid), MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Web of Science core collection limited to Science Citation Index Expanded (SCIE) and Conference Proceedings Citation Index – Science (CPCI-S) (via Thomson Reuters), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, the Health Technology Assessment (HTA) database (all via The Cochrane Library), Applied Social Sciences Index and Abstracts (ASSIA) (via ProQuest), Google Scholar (Google Inc., Mountain View, CA, USA) and expert recommendations.Review methodsClearly bounded searches of electronic databases were supplemented by citation tracking and grey literature. Following quality standards for realist reviews, the retrieved articles were systematically screened and iteratively analysed to develop theoretically driven explanations. A programme theory was produced with input from a stakeholder group consisting of practitioners and patient representatives.ResultsA total of 131 articles were included. The overarching programme theory developed from the analysis of these articles explains how and why doctors in training decide to passively comply with or actively follow (1) seniors’ prescribing habits, (2) the way seniors take into account prescribing aids and seek the views of other health professionals and (3) the way seniors negotiate patient expectations. The programme theory also explains what drives willingness or reluctance to ask questions about antimicrobial prescribing or to challenge the decisions made by seniors. The review outlines how these outcomes result from complex inter-relationships between the contexts of practice doctors in training are embedded in (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels and application in practice) and the mechanisms triggered in these contexts (fear of criticism and individual responsibility, reputation management, position in the clinical team and appearing competent). Drawing on these findings, we set out explicit recommendations for optimal tailoring, design and implementation of antimicrobial prescribing interventions targeted at doctors in training.LimitationsMost articles included in the review discussed hospital-based, rather than primary, care. In cases when few data were available to fully capture all the nuances between context, mechanisms and outcomes, we have been explicit about the strength of our arguments.ConclusionsThis review contributes to our understanding of how antimicrobial prescribing interventions for doctors in training can be better embedded in the hierarchical and interprofessional dynamics of different health-care settings.Future workMore work is required to understand how interprofessional support for doctors in training can contribute to appropriate prescribing in the context of hierarchical dynamics.Study registrationThis study is registered as PROSPERO CRD42015017802.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, Exeter, UK
| | - Mark Pearson
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Simon Briscoe
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Gordon L, Rees C, Ker J, Cleland J. Using video-reflexive ethnography to capture the complexity of leadership enactment in the healthcare workplace. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1101-1121. [PMID: 28039588 PMCID: PMC5663839 DOI: 10.1007/s10459-016-9744-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/20/2016] [Indexed: 06/01/2023]
Abstract
Current theoretical thinking asserts that leadership should be distributed across many levels of healthcare organisations to improve the patient experience and staff morale. However, much healthcare leadership education focusses on the training and competence of individuals and little attention is paid to the interprofessional workplace and how its inherent complexities might contribute to the emergence of leadership. Underpinned by complexity theory, this research aimed to explore how interprofessional healthcare teams enact leadership at a micro-level through influential acts of organising. A whole (interprofessional) team workplace-based study utilising video-reflexive ethnography occurred in two UK clinical sites. Thematic framework analyses of the video data (video-observation and video-reflexivity sessions) were undertaken, followed by in-depth analyses of human-human and human-material interactions. Data analysis revealed a complex interprofessional environment where leadership is a dynamic process, negotiated and renegotiated in various ways throughout interactions (both formal and informal). Being able to "see" themselves at work gave participants the opportunity to discuss and analyse their everyday leadership practices and challenge some of their sometimes deeply entrenched values, beliefs, practices and assumptions about healthcare leadership. These study findings therefore indicate a need to redefine the way that medical and healthcare educators facilitate leadership development and argue for new approaches to research which shifts the focus from leaders to leadership.
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Affiliation(s)
- Lisi Gordon
- School of Management, University of St Andrews, The Gateway, North Haugh, St Andrews, KY16 9RJ, Scotland, UK.
| | - Charlotte Rees
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jean Ker
- NHS Education for Scotland, East Region Ninewells Hospital, Dundee, Scotland, UK
| | - Jennifer Cleland
- Institute of Education in Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
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Papoutsi C, Mattick K, Pearson M, Brennan N, Briscoe S, Wong G. Social and professional influences on antimicrobial prescribing for doctors-in-training: a realist review. J Antimicrob Chemother 2017; 72:2418-2430. [PMID: 28859445 PMCID: PMC5890780 DOI: 10.1093/jac/dkx194] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022] Open
Abstract
Background Antimicrobial resistance has led to widespread implementation of interventions for appropriate prescribing. However, such interventions are often adopted without an adequate understanding of the challenges facing doctors-in-training as key prescribers. Methods The review followed a realist, theory-driven approach to synthesizing qualitative, quantitative and mixed-methods literature. Consistent with realist review quality standards, articles retrieved from electronic databases were systematically screened and analysed to elicit explanations of antimicrobial prescribing behaviours. These explanations were consolidated into a programme theory drawing on social science and learning theory, and shaped though input from patients and practitioners. Results By synthesizing data from 131 articles, the review highlights the complex social and professional dynamics underlying antimicrobial prescribing decisions of doctors-in-training. The analysis shows how doctors-in-training often operate within challenging contexts (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels, uncertainty about application of knowledge in practice) where they prioritize particular responses (fear of criticism and individual responsibility, managing one's reputation and position in the team, appearing competent). These complex dynamics explain how and why doctors-in-training decide to: (i) follow senior clinicians' prescribing habits; (ii) take (or not) into account prescribing aids, advice from other health professionals or patient expectations; and (iii) ask questions or challenge decisions. This increased understanding allows for targeted tailoring, design and implementation of antimicrobial prescribing interventions. Conclusions This review contributes to a better understanding of how antimicrobial prescribing interventions for doctors-in-training can be embedded more successfully in the hierarchical and inter-professional dynamics of different healthcare settings.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Mark Pearson
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Peninsula Schools of Medicine & Dentistry, Plymouth University, Drake Circus Plymouth, Devon PL4 8AA, UK
| | - Simon Briscoe
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
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Saravo B, Netzel J, Kiesewetter J. The need for strong clinical leaders - Transformational and transactional leadership as a framework for resident leadership training. PLoS One 2017; 12:e0183019. [PMID: 28841662 PMCID: PMC5571931 DOI: 10.1371/journal.pone.0183019] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 07/28/2017] [Indexed: 12/05/2022] Open
Abstract
Background For the purpose of providing excellent patient care, residents need to be strong, effective leaders. The lack of clinical leadership is alarming given the detrimental effects on patient safety. The objective of the study was to assess whether a leadership training addressing transactional and transformational leadership enhances leadership skills in residents. Methods A volunteer sample of 57 residents from postgraduate year one to four was recruited across a range of medical specialties. The residents took part in an interventional controlled trial. The four-week IMPACT leadership training provided specific strategies for leadership in the clinical environment, addressing transactional (e.g. active control, contingent reward) and transformational leadership skills (e.g. appreciation, inspirational motivation). Transactional and transformational leadership skill performance was rated (1) on the Performance Scale by an external evaluator blinded to the study design and (2) self-assessed transformational and transactional leadership skills. Both measures contained items of the Multifactor Leadership Questionnaire, with higher scores indicating greater leadership skills. Results Both scores were significantly different between the IMPACT group and the control group. In the IMPACT group, the Performance Scale increased 15% in transactional leadership skill performance (2.10 to 2.86) (intervention effect, 0.76; 95% CI, 0.40 to 1.13; p < .001, eta2 = 0.31) and 14% in transformational leadership skill performance (2.26 to 2.94) (intervention effect, 0.68; 95% CI, 0.27 to 1.09; p < .001, eta2 = 0.22). The self-assessed transactional skills revealed a 4% increase (3.83 to 4.03) (intervention effect, 0.20; 95% CI, 0.08 to 0.33; p < .001, eta2 = 0.18) and a 6% increase in transformational leadership skills (3.54 to 3.86) (intervention effect, 0.31; 95% CI, 0.02 to 0.40; p< .001, eta2 = 0.53). Discussion and conclusions These findings support the use of the transactional and transformational leadership framework for graduate leadership training. Future studies should incorporate time-latent post-tests, evaluating the stability of the behavioral performance increase.
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Affiliation(s)
- Barbara Saravo
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Janine Netzel
- Center for Leadership and People Management, Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Jan Kiesewetter
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
- * E-mail:
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Affiliation(s)
- Martin Beirne
- Professor of management and organizational Behaviour, Adam Smith Business School, University of Glasgow, Scotland
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Alwazzan L. When we say … leadership, we must also say … followership. MEDICAL EDUCATION 2017; 51:560. [PMID: 28120458 DOI: 10.1111/medu.13228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Lulu Alwazzan
- Department of Medical Education, College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Gordon LJ. Moving beyond being a 'good doctor' to thinking about 'good doctoring processes'. MEDICAL EDUCATION 2017; 51:237-238. [PMID: 28211146 DOI: 10.1111/medu.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Gordon LJ, Rees CE, Ker JS, Cleland J. Leadership and followership in the healthcare workplace: exploring medical trainees' experiences through narrative inquiry. BMJ Open 2015; 5:e008898. [PMID: 26628525 PMCID: PMC4679996 DOI: 10.1136/bmjopen-2015-008898] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To explore medical trainees' experiences of leadership and followership in the interprofessional healthcare workplace. DESIGN A qualitative approach using narrative interviewing techniques in 11 group and 19 individual interviews with UK medical trainees. SETTING Multisite study across four UK health boards. PARTICIPANTS Through maximum variation sampling, 65 medical trainees were recruited from a range of specialties and at various stages of training. Participants shared stories about their experiences of leadership and followership in the healthcare workplace. METHODS Data were analysed using thematic and narrative analysis. RESULTS We identified 171 personal incident narratives about leadership and followership. Participants most often narrated experiences from the position of follower. Their narratives illustrated many factors that facilitate or inhibit developing leadership identities; that traditional medical and interprofessional hierarchies persist within the healthcare workplace; and that wider healthcare systems can act as barriers to distributed leadership practices. CONCLUSIONS This paper provides new understandings of the multiple ways in which leadership and followership is experienced in the healthcare workplace and sets out recommendations for future leadership educational practices and research.
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Affiliation(s)
- Lisi J Gordon
- Medical Education Institute, School of Medicine, University of Dundee, Dundee, UK
| | - Charlotte E Rees
- Faculty of Medicine, Nursing & Health Sciences, HealthPEER (Health Professions Education and Education Research),Monash University, Clayton Campus, Victoria, Australia
| | - Jean S Ker
- Medical Education Institute, School of Medicine, University of Dundee, Dundee, UK
| | - Jennifer Cleland
- Division of Medical and Dental Education (DMDE), School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
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