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Snelling I, Brown H, Hardy L, Somerset L, Bosence S, Thurlow J. UK trainees' perceptions of leadership and leadership development. BMJ LEADER 2024; 8:215-221. [PMID: 37833052 DOI: 10.1136/leader-2023-000771] [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: 02/21/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE This paper reports on trainees' perceptions of leadership and leadership development, to inform the support that may be provided to them. It draws on a formative evaluation of the new role of clinical leadership mentor (CLM), introduced by Health Education England South-West in 2018. CLMs are responsible for 'overseeing the process and progress of leadership development among the trainees within their Trust/Local Education Provider'. METHODS The evaluation was a formative evaluation, based on interviews with CLMs, trainees and trainers and a survey of trainees and trainers. Recruitment was through 8 of the 19 CLMs in the South West. A report for each participating CLM was available to support the development of their individual role. In exploring trainees' perceptions of leadership and leadership development, this paper draws on data from trainees: 112 survey returns which included over 7000 words of free text data and 13 interviews. FINDINGS Our findings suggest a more nuanced understanding of leadership in medical trainees than was previously reported in the literature, and a wider acceptance of their leadership role. We highlight the problem of considering postgraduate doctors as a homogeneous group, particularly with reference to specialty. We also highlight that the organisational context for leadership development can be supportive or non-supportive. Leadership learning through genuine leadership experience with appropriate support from trainers and the wider Trust offers opportunities for both trainees and Trusts. PRACTICAL IMPLICATIONS Trainees are accepting of their roles as leaders. The value of leadership learning through genuine leadership experience was highlighted. Improving the environment for leadership development offers Trusts and trainees opportunities for genuine service improvement.
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Affiliation(s)
- Iain Snelling
- Health Services Management Centre, University of Birmingham School of Social Policy, Birmingham, UK
| | - Hilary Brown
- Health Services Management Centre, University of Birmingham School of Social Policy, Birmingham, UK
| | - Louise Hardy
- Faculty of Medicine & Dentistry, University of Plymouth, Plymouth, UK
| | - Lara Somerset
- Emergency Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Samantha Bosence
- Respiratory Department, North Devon District Hospital, Barnstaple, UK
| | - Jane Thurlow
- Health Education England South West, Bristol, UK
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Alblihed M, Alzghaibi H. Needs Assessment for a Leadership Course in Saudi Medical Schools: The Student Perspective. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:801-813. [PMID: 39246727 PMCID: PMC11380845 DOI: 10.2147/amep.s457187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/23/2024] [Indexed: 09/10/2024]
Abstract
Introduction Leaders in healthcare no longer need to hold formal management positions; instead, leadership is perceived to be the responsibility of all healthcare professionals. Despite changes in curricula and teaching design, however, this review of the content taught in medical colleges in Saudi Arabia reveals a lack of leadership and a failure to equip young graduates to compete on the global stage. Medical students need leadership skills for patient care, cooperation, and navigating the complex healthcare system. Clinical management skills in hospitals require these talents also. The complexity of healthcare and the impact healthcare executives have on people's lives highlight the importance of these skills. Thus, healthcare practitioners must develop non-technical skills like proactivity, motivation, and change management to lead across professional boundaries and negotiate the increasingly complex healthcare landscape. Methods This cross-sectional study combines a quantitative approach with a self-administered questionnaire-based survey. The sampling procedure is a non-probability convenience technique, adapted for 700 male and female undergraduate medical students from four medical colleges. Results Of the students, 75.46% had minimal leadership experience and 22.69% had some leadership experience; 3.02% of 464 students considered themselves highly experienced in leadership. Conclusion As the needs assessment and other relevant factors show, leadership should be introduced as a skilled subject. There will always be a growing demand for competent medical graduates, who are capable of becoming future leaders. Although elementary leadership concepts remain fundamentally the same, curricular development must focus on the needs of society and stakeholders.
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Affiliation(s)
- Mohammed Alblihed
- Department of Microbiology, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Haitham Alzghaibi
- Department of Health Informatics, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
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McConville K, White C. Students' experiences of a GP escape room. EDUCATION FOR PRIMARY CARE 2024:1-9. [PMID: 39077887 DOI: 10.1080/14739879.2024.2364885] [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: 04/15/2024] [Revised: 06/01/2024] [Accepted: 04/29/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Educational escape games have become more common, yet their effectiveness needs to be evaluated to establish whether or not they are a constructive pedagogical tool. AIM This study explored students' experiences of a general practice (GP) based escape game to uncover whether it deserves a place in a medical school's curriculum. DESIGN AND SETTING A mixed methods case study within one Scottish Medical School. METHOD Data were collected during March 2020 via 32 video recordings of an Escape Room Game, combined with participant, post-game questionnaire analysis. Video footage was reviewed in an ethnographic manner and thematic analysis conducted. RESULTS Fourteen team events constituting 718 minutes were analysed. From the footage, five themes with fourteen subthemes emerged. The five main themes were: teamwork, leadership, clinical thinking, numeracy, and gamification. From the student questionnaires (n = 131), it was reported that the GP escape room was predominantly an extremely positive educational experience. CONCLUSION Educational escape games appear invaluable in medical education. They can promote the growth of non-technical skills such as teamwork, leadership, and clinical thinking; all essential to working in a multidisciplinary team and enabling patient safety. Our participants struggled with numeracy in this high-pressured environment, this must be addressed to reduce potential mistakes made in the workplace. Results are supportive of educational escape games being worthy of a space within a medical school's curriculum. A GP-orientated escape room allows for early GP exposure from a different perspective, as well as equipping students with the skills to be successful in this field.
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Affiliation(s)
- Kevin McConville
- Undergraduate General Practice, School of Medicine, University of Dundee, Dundee, UK
| | - Clara White
- School of Medicine, University of Dundee, Dundee, UK
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Rayner S, Richards H, Lee GB, Lee E, Rixon A. Navigating competing tensions: A qualitative study of experiences and perceptions of leadership among emergency medicine doctors. Emerg Med Australas 2024. [PMID: 38987986 DOI: 10.1111/1742-6723.14466] [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: 12/18/2023] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES Emergency medicine (EM) doctors are often required to manage a diverse set of complex challenges; navigating direct patient care, systemic issues and inter-professional interactions. Leadership is well recognised as crucial in optimising both the delivery and the quality of patient care. There is a clear need to gain greater understanding of the reality of EM leadership through exploring doctors' experience and perception of leadership in EM, yet there is a paucity of research focusing on this area. The objective of the present study was to explore the research question: 'What are the experiences and perceptions of leadership by EM doctors?' METHODS This single-site qualitative study was undertaken using semi-structured in-depth individual interviews to collect data. Interviews were audio recorded, transcribed and de-identified. Reflexive thematic analysis was performed by the research team with the aid of DelveTool software. RESULTS Our sample included nine participants incorporating consultants and registrars. Three major themes were identified: (i) situational tensions, (ii) relational tensions and (iii) leadership style tensions. Each of these was further explored with subthemes discussed separately. CONCLUSIONS Leadership within the ED is complex and multifaceted, with doctors required to navigate many competing tensions. The present study highlighted key areas for future leadership development, including situational awareness, emotional intelligence and a fluid approach to leadership styles. The present study provides an important step towards enhancing the development of targeted leadership training for EM doctors.
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Affiliation(s)
- Suzanne Rayner
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Hayden Richards
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Georgie B Lee
- School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
- Western Australia Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Elleanor Lee
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Andrew Rixon
- Department of Business Strategy and Innovation, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
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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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Gallegos P, Salaar Riaz M, Peeters M. Leadership and Followership in Health Professions: A Systematic Review. Innov Pharm 2024; 15:10.24926/iip.v15i2.5987. [PMID: 39166139 PMCID: PMC11333097 DOI: 10.24926/iip.v15i2.5987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024] Open
Abstract
Objective: Leadership discussion, including leadership development programs, is common. However, discussion of followership as a component of leadership seems less frequently discussed. With a focus on leadership and followership, this investigation reviewed the health-professions education literature and characterized leadership-followership within health-professions education. Methods: Using PubMed, ERIC, and Google Scholar, two investigators independently and systematically searched health-professions education literature for articles related to leadership and followership. Reports were categorized based on the articles by type, application, profession, leadership, and followership qualities. Results: Eighty-one articles were included. More than half [59% (48/81)] were theoretical, 27% (22/81) empirical, 7% (6/81) commentaries, and 6% (5/81) letters-to-the-editor). Empirical studies did not share outcomes that could be meaningfully combined quantitatively by meta-analysis; however, the vast majority (96%) of theoretical articles discussed a healthcare-related application of leadership and followership (e.g., improving patient care, improving communication, improving organizational efficiency). Thus, a qualitative review was completed. Of the 81 articles, 57% (n=46) involved multiple professions, while 43% (n=35) focused on a specific profession [Nursing (n=16), Medicine (n=7), Others (n=5) Surgery (n=3), Pharmacy (n=2), Veterinary Medicine (n=2)]. While most articles (75%) discussed leadership qualities (with top qualities of effective communication, visionary, and delegating tasks), fewer (57%) discussed followership qualities (with top qualities of being responsible, committed, and supportive). Of note, some qualities overlapped in both leadership and followership (with top qualities of effective communication, being supportive, and providing/receiving feedback). Conclusions: Leadership-Followership was described in many health-professions' education literature. However, Pharmacy and Veterinary Medicine had substantially fewer articles published on this topic. Notably, followership did not receive nearly as much attention as leadership. Leadership has a dynamic and complex interaction with followership highlighting that an effective leader must know how to be an effective follower and vice versa. To improve leadership within healthcare teamwork, education should focus on both leadership-followership.
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Kainth R, Reedy G. Transforming Professional Identity in Simulation Debriefing: A Systematic Metaethnographic Synthesis of the Simulation Literature. Simul Healthc 2023; Publish Ahead of Print:01266021-990000000-00072. [PMID: 37335122 DOI: 10.1097/sih.0000000000000734] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
SUMMARY STATEMENT There continues to be a lack of detailed understanding of how debriefing works and how it enables learning. To further our understanding and simultaneously illuminate current knowledge, a metaethnographic qualitative synthesis was undertaken to address the research question: how are interactions in simulation debriefing related to participant learning? Ten databases were searched (up to November 2020) and 17 articles were selected for inclusion.Initial interpretive synthesis generated 37 new concepts that were further synthesized to produce a new theoretical framework. At the heart of the framework is a concept of reflective work, where participants and faculty recontextualize the simulation experience bidirectionally with clinical reality: a process that facilitates sensemaking. This occurs in a learning milieu where activities such as storytelling, performance evaluation, perspective sharing, agenda setting, and video use are undertaken. The outcome is conceptualization of new future roles, clinical competence, and professional language development-a process of transforming professional identity.
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Affiliation(s)
- Ranjev Kainth
- From the Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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Kneissl SM, Tichy A, Mitlacher SF. Flipped Classroom to Facilitate Deeper Learning in Veterinary Undergraduate Students: An Educational Change Pilot Study Limited to the Imaging Module Bones. Animals (Basel) 2023; 13:ani13091540. [PMID: 37174577 PMCID: PMC10177558 DOI: 10.3390/ani13091540] [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: 03/29/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023] Open
Abstract
In a flipped classroom, learners study at home and do the 'homework' in class. This approach respects the limitations of memory and allows more interaction between learners. The overall vision is self-paced activities for learners with decreased boredom and greater task value, which should facilitate deeper learning. To implement a flipped classroom, a bumpy incremental change process characterized by periods of relative stillness punctuated by the acceleration of pace was planned. All veterinary undergraduate students used an existing eLearning platform to access relevant text and selected image examples before class. Only for the randomly selected students in the flipped classroom (FC) was this content amended with purposeful audio content and concrete tasks. Further, FC learners discussed their opinions in an online class forum. To measure the educational change, a pre- and post-class formative test and a standardized questionnaire for students in the FC versus in the traditional classroom (TC) were performed. To assess engagement, students were invited to measure all learning activities, categorized into attendance, or self-study. The educational change project resulted in more commitment and less resistance from teachers. The FC consisted of 20 students, while the TC had 40. The mean pre-class scores difference between FC students and TC students was +1.7/20 points, and the mean post-class scores difference was +3/20 points. The chance of answering item 10 of the formative test (describe site of the fracture) correctly was about seven times higher for FC compared to TC learners (OR = 6.96; p = 0.002). The questionnaire revealed more satisfaction and greater task value in the FC compared to TC (p = 0.048). FC students invested 21 h into the course on average, while TC students invested 16 h. The results of this pilot agree with previous reports: A transparent process was helpful to initiate mainly positive interactions between teachers and students. Higher scores, higher chance to give the correct answer, greater task value, and more positive emotions are observed in the FC compared to the TC. Higher measures of learning time are not expected to affect exam results but indicate more engagement.
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Affiliation(s)
- Sibylle Maria Kneissl
- Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, 1210 Vienna, Austria
| | - Alexander Tichy
- Platform Bioinformatics and Biostatistics, Department for Biomedical Services, University of Veterinary Medicine, 1210 Vienna, Austria
| | - Sophie Felicia Mitlacher
- eLearning and New Media, Vicerectorate for Teaching Affairs and Clinical Veterinary Medicine, University of Veterinary Medicine, 1210 Vienna, Austria
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Dikun JA, Bouldin AS, Holmes ER, Rosenthal MM. A Qualitative Approach to Investigating Developmental Opportunities Among Leaders and Followers. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8691. [PMID: 34716134 PMCID: PMC10159467 DOI: 10.5688/ajpe8691] [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: 04/14/2021] [Accepted: 10/15/2021] [Indexed: 05/06/2023]
Abstract
Objective. To understand and identify developmental opportunities by exploring students' evolving views of leadership, including the emergence of leadership and self-identification, among students considered to be leaders and those considered to be followers.Methods. An exploratory qualitative study using semi-structured interviews was conducted, investigating developmental differences among leaders and followers. Fourteen students/residents were selected to participate in interviews. Student responses were analyzed using qualitative thematic analysis.Results. In discissions, four themes surfaced: motivations for exploring and engaging in leadership, perceptions of ideal leaders and followers, the value of coalition building, and a leader's role in sustainability. Leader respondents indicated that a potential barrier to helping others develop was their difficulty in delegation. Further, stress on leaders may contribute to a self-serving perspective on their responsibilities to help others develop.Conclusion. In comparison to their leader counterparts, followers may require a more individualized approach to their development and may become more deeply attached to their responsibilities, giving them a greater desire to promote sustainability in an organization or endeavor. Schools of pharmacy should be poised to support faculty, advisors, mentors, and student leaders with the tools to identify and develop active followers who may not seek out traditional leadership experiences.
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Affiliation(s)
- Joseph A Dikun
- The University of Mississippi School of Pharmacy, University, Mississippi
| | - Alicia S Bouldin
- The University of Mississippi School of Pharmacy, University, Mississippi
| | - Erin R Holmes
- The University of Mississippi School of Pharmacy, University, Mississippi
| | - Meagen M Rosenthal
- The University of Mississippi School of Pharmacy, University, Mississippi
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Barry ES, Bader-Larsen KS, Meyer HS, Durning SJ, Varpio L. Leadership and Followership in Military Interprofessional Health Care Teams. Mil Med 2021; 186:7-15. [PMID: 34724052 DOI: 10.1093/milmed/usab118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The U.S. Military has long been aware of the vital role effective leaders play in high-functioning teams. Recently, attention has also been paid to the role of followers in team success. However, despite these investigations, the leader-follower dynamic in military interprofessional health care teams (MIHTs) has yet to be studied. Although interprofessional health care teams have become a topic of increasing importance in the civilian literature, investigations of MIHTs have yet to inform that body of work. To address this gap, our research team set out to study MIHTs, specifically focusing on the ways in which team leaders and followers collaborate in MIHTs. We asked what qualities of leadership and followership support MIHT collaboration? MATERIALS AND METHODS This study was conducted using semi-structured interviews within a grounded theory methodology. Participants were purposefully sampled, representing military health care professionals who had experience working within or leading one or many MIHTs. Thirty interviews were conducted with participants representing a broad range of military health care providers and health care specialties (i.e., 11 different health professions), ranks (i.e., officers and enlisted military members), and branches of the U.S. Military (i.e., Army, Navy, and Air Force). Data were collected and analyzed in iterative cycles until thematic saturation was achieved. The subsets of data for leadership and followership were further analyzed separately, and the overlap and alignment across these two datasets were analyzed. RESULTS The insights and themes developed for leadership and followership had significant overlap. Therefore, we present the study's key findings following the two central themes that participants expressed, and we include the perspectives from both leader and follower viewpoints to illustrate each premise. These themes are as follows: (1) a unique collaborative dynamic emerges when team members commit to a shared mission and a shared sense of responsibility to achieve that mission; and (2) embracing and encouraging both leader and follower roles can benefit MIHT collaboration. CONCLUSIONS This study focused on ways in which team leaders and followers on MIHTs collaborate. Findings focused on qualities of leadership and followership that support MIHT's collaboration and found that MIHTs have a commitment to a shared mission and a shared sense of responsibility to achieve that mission. From this foundational position of collective responsibility to achieve a common goal, MIHTs develop ways of collaborating that enable leaders and followers to excel to include (1) understanding your role and the roles of others; (2) mutual respect; (3) flexibility; and (4) emotional safety. The study data suggest that MIHT members work along a continuum of leadership and followership, which may shift at any moment. Military interprofessional health care teams members are advised to be adaptive to these shared roles and contextual changes. We recommend that all members of MIHTs acquire leadership and followership training to enhance team performance.
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Affiliation(s)
- Erin S Barry
- Department of Military & Emergency Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Karlen S Bader-Larsen
- Center for Health Professions Education, The Uniformed Services University, Bethesda, MD 20814, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Holly S Meyer
- Center for Health Professions Education, The Uniformed Services University, Bethesda, MD 20814, USA
| | - Steven J Durning
- Center for Health Professions Education, The Uniformed Services University, Bethesda, MD 20814, USA
| | - Lara Varpio
- Center for Health Professions Education, The Uniformed Services University, Bethesda, MD 20814, USA
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Kuo YL, Lee JT, Yeh MY. Intergenerational Narrative Learning to Bridge the Generation Gap in Humanistic Care Nursing Education. Healthcare (Basel) 2021; 9:healthcare9101291. [PMID: 34682971 PMCID: PMC8535847 DOI: 10.3390/healthcare9101291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/10/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The development of nursing students’ ability to practice humanistic care is extremely important. Methods: This study explored students’ learning experience when providing humanistic care for older adults with chronic diseases while employing intergenerational narrative learning. An exploratory descriptive qualitative study design was adopted. Results: We analyzed evaluations from 35 students who completed the course, in which intergenerational narrative learning was employed. Evaluations contained open-ended questions that asked students to reflect upon their experiences and describe their perceptions, thoughts, and feelings after the course. Three main themes were revealed by thematic analysis: direct interaction supersedes knowledge in books, the framework for improving humanistic caring, and internalization of the importance of humanistic care in nursing. Conclusion: An awareness of patients’ perspectives inspired the students in their development toward a more profound caring attitude. The intergenerational narrative learning teaching strategy could foster professional and humanistic-centered care in nursing students.
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Affiliation(s)
- Yu-Lun Kuo
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 970, Taiwan;
| | - Jian-Tao Lee
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Nursing Department, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Mei-Yu Yeh
- College of Health and Nursing, Mei Ho University, Pingtung 912, Taiwan
- Correspondence: ; Tel.: +886-8-7799821 (ext. 8398)
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Akamine Y, Imafuku R, Saiki T, Lee-Jayaram J, Berg BW, Suzuki Y. Physicians' perceptions of followership in resuscitation in Japan and the USA: a qualitative study. BMJ Open 2021; 11:e047860. [PMID: 34373302 PMCID: PMC8354256 DOI: 10.1136/bmjopen-2020-047860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While leadership is accepted as a crucial aspect of a successful resuscitation team, the role of followership has not been sufficiently explored. This study aims to explore physicians' perceptions of common favourable followership in resuscitation teams in two different countries. DESIGN A qualitative study with interviews and a reflexive thematic analysis. SETTING The authors individually interviewed critical care and emergency physicians whose clinical experience exceeded 6 years in Japan and the USA. PARTICIPANTS A total of 18 physicians participated in a face-to-face, semistructured and in-depth interviews. RESULTS Five themes and nine subthemes related to followership in resuscitation were identified. Under technical skills, two themes (being knowledgeable and skilled) and three subthemes (understanding guidelines/algorithms, clinical course and being competent with procedural skills), were generated. Under non-technical skills, three themes (assuming roles, team communication and flattening hierarchy) and six subthemes (taking roles spontaneously, calm tone of voice, sharing information, closed-loop communication, respectful attitude and speaking up), were generated. Each generated theme involved commonly perceived favourable attributes of followership in resuscitation teams by experienced critical care and emergency physicians in both countries. CONCLUSIONS This study clarified physicians' perception of common favourable followership attributes in resuscitation teams, both in Japan and in the USA. The results of this study shed light on followership-focused resuscitation education, where followership skills are generally underestimated.
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Affiliation(s)
- Yoko Akamine
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Rintaro Imafuku
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Takuya Saiki
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Jannet Lee-Jayaram
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Benjamin W Berg
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Yasuyuki Suzuki
- Division of Medical Education, Graduate School of Medicine, Gifu University, Gifu, Japan
- Medical Education Development Center, Gifu University, Gifu, Japan
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Boardman N, Munro-Berry J, McKimm J. The leadership and followership challenges of doctors in training during the COVID-19 pandemic. Br J Hosp Med (Lond) 2021; 82:1-9. [PMID: 33646028 DOI: 10.12968/hmed.2021.0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Research carried out in 2016 by the authors investigated the challenges that doctors in training experience around leadership and followership in the NHS. The study explored contemporary healthcare leadership culture and the role of followership from the perspective of early career doctors. It found that the leadership and followership challenges for these doctors in training were associated with issues of social and professional identity, communication, the medical hierarchy, and relationships with senior colleagues (support and trust). These challenges were exacerbated by the busy and turbulent clinical environment in which they worked. To cope with various clinical situations and forms of leadership, doctors in training engage in a range of different followership behaviours and strategies. The study raised implications for medical education and training and suggested that followership should be included as part of formal training in communication and team working skills. The importance of both leadership and followership in the delivery of safe and effective patient care has been brought sharply into focus by the COVID-19 pandemic. This article revisits these challenges in light of the pandemic and its impact on the experiences of doctors in training.
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Affiliation(s)
- Nathan Boardman
- Department of General Internal Medicine, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | | | - Judy McKimm
- Department of Medical Education, Swansea University, Swansea, UK
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Weber LA, Bush A, Hartzell J. Walk Before You Run: Why Followership Should Be the Cornerstone of Your Leadership Curriculum. Am J Med 2021; 134:142-145. [PMID: 33035500 DOI: 10.1016/j.amjmed.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Lauren A Weber
- Walter Reed National Military Medical Center, Bethesda, MD.
| | - Allison Bush
- Walter Reed National Military Medical Center, Bethesda, MD
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Mangrulkar RS, Tsai A, Cox SM, Halaas GW, Nelson EA, Nesse RE, Silvestri RC, Radabaugh CL, Skochelak S, Beck Dallaghan GL, Steiner B. A Proposed Shared Vision for Leadership Development for all Medical Students: A Call from a Coalition of Diverse Medical Schools. TEACHING AND LEARNING IN MEDICINE 2020; 32:561-568. [PMID: 32363950 DOI: 10.1080/10401334.2020.1754835] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Issue: Despite clear relevance, need, descriptive literature, and student interest, few schools offer required curriculum to develop leadership skills. This paper outlines a proposed shared vision for leadership development drawn from a coalition of diverse medical schools. We advocate that leadership development is about self (looking inward), teams (not hierarchy), and change (looking outward). We propose that leadership development is for all medical students, not for a subset, and we believe that leadership curricula and programs must be experiential and applied. Evidence: This paper also draws on the current literature and the experience of medical schools participating in the American Medical Association's (AMA) Accelerating Change in Medical Education Consortium, confronts the common arguments against leadership training in medical education, and provides three cross-cutting principles that we believe must each be incorporated in all medical student-centered leadership development programs as they emerge and evolve at medical schools. Implications: By confronting common arguments against leadership training and providing a framework for such training, we give medical educators important tools and insights into developing leadership training for all students at their institutions.
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Affiliation(s)
- Rajesh S Mangrulkar
- Departments of Internal Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Antonius Tsai
- Leadership Development and Education Strategy, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Susan M Cox
- Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Gwen W Halaas
- Academic Affairs, Washington State University, Spokane, WA, USA
| | - Elizabeth A Nelson
- Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Robert E Nesse
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronald C Silvestri
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie L Radabaugh
- Medical Education Programs, American Medical Association, Chicago, Illinois, USA
| | - Susan Skochelak
- Medical Education, American Medical Association, Chicago, Illinois, USA
| | - Gary L Beck Dallaghan
- Educational Scholarship, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Beat Steiner
- Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Harper R, Ward L, Silburn K. The sum of us. Implementing a Person Centred Care Bundle - A narrative inquiry. Appl Nurs Res 2020; 55:151276. [PMID: 32713671 PMCID: PMC7529392 DOI: 10.1016/j.apnr.2020.151276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/06/2020] [Accepted: 04/29/2020] [Indexed: 10/26/2022]
Abstract
AIM This study is a narrative inquiry that aims to better understand the experience of nurses implementing a Person-Centred Care (PCC) bundle onto an acute care ward in a large hospital in Melbourne, Australia. BACKGROUND The PCC includes five key focus areas aimed at streamlining nursing practice 1) Nursing assessment and care planning, 2) bedside handover, 3) patient safety rounding, 4) patient whiteboards, and 5) safety huddles. The PCC bundle outlines a nursing care process that is interactional with the patient, focused on information sharing, safety and respect. METHOD A narrative inquiry was used to explore the nurse's experiences implementing the PCC. Surveys and focus groups were used to collect data and thematic analysis was used to identify any key themes. RESULTS The three themes were; Passing the baton; Keeping the cogs moving when time poor; and Deep interpersonal relating-The sum of us.
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Affiliation(s)
- Ruth Harper
- Royal Melbourne Hospital, Melbourne, Parkville, 3050, Australia.
| | - Louise Ward
- George Singer Building room 3/327, College of Science Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Kate Silburn
- Australian Institute for Primary Care and Aging, College of Science Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia.
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Maile E, McKimm J, Till A. Exploring medical leader identity and its formation. Leadersh Health Serv (Bradf Engl) 2019; 32:584-599. [PMID: 31612786 DOI: 10.1108/lhs-12-2018-0066] [Citation(s) in RCA: 4] [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
PURPOSE "Becoming" a doctor involves the acquisition of medical knowledge, skills and professional identity. Medical professional identity formation (MPIF) is complex, multi-factorial and closely linked to societal expectations, personal and social identity. Increasingly, doctors are required to engage in leadership/management involving significant identity shift. This paper aims to explore medical professional identity (MPI) and MPIF in relation to doctors as leaders. Selected identity theories are used to enrich the understanding of challenges facing doctors in leadership situations and two concepts are introduced: medical leader identity (MLI) and medical leader identity formation (MLIF) and consideration given to how they can be nurtured within medical practice. DESIGN/METHODOLOGY/APPROACH A rapid conceptual review of relevant literature was carried out to identify a set of relevant concepts and theories that could be used to develop a new conceptual framework for MLI and MLIF. FINDINGS MLIF is crucial for doctors to develop as medical leaders, and, like MPIF, the process begins before medical school with both identities influenced, shaped and challenged throughout doctors' careers. Individuals require support in developing awareness that their identities are multiple, nested, interconnected and change over time. ORIGINALITY/VALUE This paper draws on concepts from wider literature on professional identity, in relation to how doctors might develop their MLI alongside their MPI. It offers a new perspective on MPI in the light of calls on doctors to "become and be healthcare leaders" and introduces the new concepts of MLI and MLIF.
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Affiliation(s)
- Emily Maile
- Health Education England East Midlands, Nottingham, UK
| | - Judy McKimm
- School of Medicine, Swansea University , Swansea, UK
| | - Alex Till
- Health Education England North West, Manchester, UK and School of Medicine, Swansea University , Swansea, UK
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Mokshagundam S, Pitkin J, Dekhtyar M, Santen S, Hammoud M, Skochelak SE. Engaging Medical Students in Leadership Development. MEDICAL SCIENCE EDUCATOR 2019; 29:849-853. [PMID: 34457550 PMCID: PMC8368442 DOI: 10.1007/s40670-019-00754-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Leadership development plays a critical role in preparing collaborative, systems-based physicians. Medical schools across the globe have dedicated significant effort towards programming for medical student leadership development. Students report a variety of existing leadership opportunities, ranging from formal didactics to leadership positions within the community. Students identify lack of time, funding, and the hierarchy of medicine as significant barriers for engaging in leadership opportunities. Students favor a formal leadership curriculum coupled with hands-on opportunities to practice leadership skills. In order to train medical students to be engaged physician leaders, it is imperative to foster practical opportunities for leadership development.
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Affiliation(s)
| | - Julia Pitkin
- Vanderbilt University School of Medicine, Nashville, TN USA
- University of Colorado, Aurora, CO USA
| | | | - Sally Santen
- Virginia Commonwealth University, Richmond, VA USA
| | - Maya Hammoud
- American Medical Association, Chicago, IL USA
- University of Michigan Medical School, Ann Arbor, MI USA
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Mokshagundam S, Pitkin J, Dekhtyar M, Santen S, Hammoud M, Skochelak SE. Engaging Medical Students in Leadership Development. MEDICAL SCIENCE EDUCATOR 2019; 29:849-853. [PMID: 34457550 PMCID: PMC8368442 DOI: 10.1007/s40670-019-00754-w#citeas] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Leadership development plays a critical role in preparing collaborative, systems-based physicians. Medical schools across the globe have dedicated significant effort towards programming for medical student leadership development. Students report a variety of existing leadership opportunities, ranging from formal didactics to leadership positions within the community. Students identify lack of time, funding, and the hierarchy of medicine as significant barriers for engaging in leadership opportunities. Students favor a formal leadership curriculum coupled with hands-on opportunities to practice leadership skills. In order to train medical students to be engaged physician leaders, it is imperative to foster practical opportunities for leadership development.
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Affiliation(s)
| | - Julia Pitkin
- Vanderbilt University School of Medicine, Nashville, TN USA
- University of Colorado, Aurora, CO USA
| | | | - Sally Santen
- Virginia Commonwealth University, Richmond, VA USA
| | - Maya Hammoud
- American Medical Association, Chicago, IL USA
- University of Michigan Medical School, Ann Arbor, MI USA
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van de Riet MCP, Berghout MA, Buljac-Samardžić M, van Exel J, Hilders CGJM. What makes an ideal hospital-based medical leader? Three views of healthcare professionals and managers: A case study. PLoS One 2019; 14:e0218095. [PMID: 31185051 PMCID: PMC6559653 DOI: 10.1371/journal.pone.0218095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/24/2019] [Indexed: 11/29/2022] Open
Abstract
Medical leadership is an increasingly important aspect of hospital management. By engaging physicians in leadership roles, hospitals aim to improve their clinical and financial performances. Research has revealed numerous factors that are regarded as necessary for ‘medical leaders’ to master, however we lack insights into their relative importance. This study investigates the views of healthcare professionals and managers on what they consider the most important factors for medical leadership. Physicians (n = 11), nurses (n = 10), laboratory technicians (n = 4) and managers (n = 14) were interviewed using Q methodology. Participants ranked 34 statements on factors elicited from the scientific literature, including personal features, context-specific features, activities and roles. By-person factor analysis revealed three distinct views of medical leadership. The first view represents a strategic leader who prioritizes the interests of the hospital by participating in hospital strategy and decision making. The second view describes a social leader with strong collaboration and communication skills. The third view reflects an accepted leader among peers that is guided by a clear job description. Despite these differences, all respondents agreed upon the importance of personal skills in collaboration and communication, and having integrity and a clear vision. We find no differences in views related to particular healthcare professionals, managers, or departments as all views were defined by a mixture of departments and participants. The findings contribute to increased calls from both practice and literature to increase conceptual clarity by eliciting the relative importance of medical leadership-related factors. Hospitals that wish to increase the engagement of physicians in improving clinical and financial performances through medical leadership should focus on selecting and developing leaders who are strong strategists, socially skilled and accepted by clinical peers.
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Affiliation(s)
- Merlijn C. P. van de Riet
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Mathilde A. Berghout
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Martina Buljac-Samardžić
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Carina G. J. M. Hilders
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Nzinga J, McGivern G, English M. Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens. Health Policy Plan 2018; 33:ii27-ii34. [PMID: 30053035 PMCID: PMC6037084 DOI: 10.1093/heapol/czx167] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 12/21/2022] Open
Abstract
Clinical leadership is recognized as a crucial element in health system strengthening and health policy globally yet it has received relatively little attention in low and middle income countries (LMICs). Moreover, analyses of clinical leadership tend to focus on senior-level individual leaders, overlooking a wider constellation of middle-level leaders delivering health care in practice in a way affected by their health care context. Using the theoretical lens of ‘distributed leadership’, this article examines how middle-level leadership is practised and affected by context in Kenyan county hospitals, providing insights relevant to health care in other LMICs. The article is based on empirical qualitative case studies of clinical departmental leadership in two Kenyan public hospitals, drawing on data gathered through ethnographic observation, interviews and focus groups. We inductively and iteratively coded, analysed and theorized our findings. We found the distributed leadership lens useful for the purpose of analysing middle-level leadership in Kenyan hospitals, although clinical departmental leadership was understood locally in more individualized terms. Our distributed lens revealed medical and nursing leadership occurring in parallel and how only doctors in leadership roles were able to directly influence behaviour among their medical colleagues, using inter-personal skills, power and professional expertize. Finally, we found that Kenyan hospital contexts were characterized by cultures, norms and structures that constrained the way leadership was practiced. We make a theoretical contribution by demonstrating the utility of using distributed leadership as a lens for analysing leadership in LIMC health care contexts, revealing how context, power and inter-professional relationships moderate individual leaders’ ability to bring about change. Our findings, have important implications for how leadership is conceptualized and the way leadership development and training are provided in LMICs health systems.
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Affiliation(s)
- Jacinta Nzinga
- Health Services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, 197 Lenana Place, Nairobi, Kenya
| | - Gerry McGivern
- Warwick Business School, University of Warwick, Coventry, UK
| | - Mike English
- Health Services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, 197 Lenana Place, Nairobi, Kenya.,Nuffield Department of Medicine and Department of Paediatrics, University of Oxford, Oxford, UK
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Discursively framing physicians as leaders: Institutional work to reconfigure medical professionalism. Soc Sci Med 2018; 212:68-75. [PMID: 30014983 DOI: 10.1016/j.socscimed.2018.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 11/22/2022]
Abstract
Physicians are well-known for safeguarding medical professionalism by performing institutional work in their daily practices. However, this study shows how opinion-making physicians in strategic arenas (i.e. national professional bodies, conferences and high-impact journals) advocate to reform medical professionalism by discursively framing physicians as leaders. The aim of this article is to critically investigate the use of leadership discourse by these opinion-making physicians. By performing a discursive analysis of key documents produced in these strategic arenas and additional observations of national conferences, this article investigates how leadership discourse is used and to what purpose. The following key uses of medical leadership discourses were identified: (1) regaining the lead in medical professionalism, (2) disrupting 'old' professional values, and (3) constructing the 'modern' physician. The analysis reveals that physicians as 'leaders' are expected to become team-players that work across disciplinary and organizational boundaries to improve the quality and affordability of care. In comparison to management that is negatively associated with NPM reform, leadership discourse is linked to positive institutional change, such as decentralization and integration of care. Yet, it is unclear to what extent leadership discourses are actually incorporated on the work floor and to what effect. Future studies could therefore investigate the uptake of leadership discourses by rank and file physicians to investigate whether leadership discourses are used in restricting or empowering ways.
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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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Rees CE, Crampton P, Kent F, Brown T, Hood K, Leech M, Newton J, Storr M, Williams B. Understanding students' and clinicians' experiences of informal interprofessional workplace learning: an Australian qualitative study. BMJ Open 2018; 8:e021238. [PMID: 29666140 PMCID: PMC5905730 DOI: 10.1136/bmjopen-2017-021238] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While postgraduate studies have begun to shed light on informal interprofessional workplace learning, studies with preregistration learners have typically focused on formal and structured work-based learning. The current study investigated preregistration students' informal interprofessional workplace learning by exploring students' and clinicians' experiences of interprofessional student-clinician (IPSC) interactions. DESIGN A qualitative interview study using narrative techniques was conducted. SETTING Student placements across multiple clinical sites in Victoria, Australia. PARTICIPANTS Through maximum variation sampling, 61 participants (38 students and 23 clinicians) were recruited from six professions (medicine, midwifery, nursing, occupational therapy, paramedicine and physiotherapy). METHODS We conducted 12 group and 10 individual semistructured interviews. Themes were identified through framework analysis, and the similarities and differences in subthemes by participant group were interrogated. RESULTS Six themes relating to four research questions were identified: (1) conceptualisations of IPSC interactions; (2) context for interaction experiences; (3) the nature of interaction experiences; (4) factors contributing to positive or negative interactions; (5) positive or negative consequences of interactions and (6) suggested improvements for IPSC interactions. Seven noteworthy differences in subthemes between students and clinicians and across the professions were identified. CONCLUSIONS Despite the results largely supporting previous postgraduate research, the findings illustrate greater breadth and depth of understandings, experiences and suggestions for preregistration education. Educators and students are encouraged to seek opportunities for informal interprofessional learning afforded by the workplace.
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Affiliation(s)
- Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Paul Crampton
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Research Department of Medical Education, University College London, London, UK
| | - Fiona Kent
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Ted Brown
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Kerry Hood
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michelle Leech
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennifer Newton
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Storr
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Brett Williams
- Department of Community Emergency Health and Paramedic Practice, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
- Division of Paramedicine, University of Tasmania, Hobart, Tasmania, Australia
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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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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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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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Abstract
Medical education fails to prepare young doctors for the nature of the work they will encounter. Doctors face a rapidly changing medical landscape, which relies more and more upon interprofessional collaboration to optimise patient outcomes and upon non-clinical skills to provide care efficiently and cost effectively. The current response to change is a reactive and resource-intensive effort, where established doctors are directed towards new ways of working. A better response would be interprofessional clinical and non-clinical training, incorporating a philosophy and style that accommodate innovation, communication and change. This preparative training should be overseen by a single educational enterprise that links undergraduate and postgraduate instruction. Improved training might enable better design of the healthcare system from within.
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Affiliation(s)
- Josephine S Thomas
- Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, University of Adelaide, Australia
| | - Toby R Gilbert
- Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, University of Adelaide, Australia
| | - Campbell H Thompson
- Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, University of Adelaide, Australia
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