Leadership training programs in graduate medical education: a systematic review

Leadership development programmes in healthcare research: a systematic review, meta-analysis and meta-aggregation

BACKGROUND

Academic institutions benefit from researchers adopting leadership positions and, subsequently, leadership development programmes are of increasing importance. Despite this, no evaluation of the evidence basis for leadership development programmes for healthcare researchers has been conducted. In this study, the authors reviewed leadership development programmes for healthcare researchers and aimed to identify their impact and the factors which influenced this impact.

METHODS

The authors searched MEDLINE, EMBASE, CINAHL and PsycINFO between January 2000 and January 2023 for evaluations of leadership development programmes with healthcare researchers. The authors synthesised results through exploratory meta-analysis and meta-aggregation and used the Medical Education Research Study Quality Instrument (MERSQI) and Joanna Briggs Institute (JBI) Checklist for Qualitative Studies to identify higher-reliability studies.

RESULTS

48 studies met inclusion criteria, of which approximately half (22) met the criteria for higher reliability. The median critical appraisal score was 10.5/18 for the MERSQI and 3.5/10 for the JBI. Common causes of low study quality appraisal related to study design, data analysis and reporting. Evaluations principally consisted of questionnaires measuring self-assessed outcomes. Interventions were primarily focused on junior academics. Overall, 163/168 categorised programme outcomes were positive. Coaching, experiential learning/project work and mentoring were associated with increased organisational outcomes.

CONCLUSION

Educational methods appeared to be more important for organisational outcomes than specific educational content. To facilitate organisational outcomes, educational methods should include coaching, project work and mentoring. Programmes delivered by external faculty were less likely to be associated with organisational outcomes than those with internal or mixed faculty, but this needs further investigation. Finally, improving evaluation design will allow educators and evaluators to more effectively understand factors which are reliably associated with organisational outcomes of leadership development.

Utilizing Complexity Leadership Theory to Promote Faculty Mentorship and Resident Leadership

OBJECTIVE

To create and evaluate a structured combined faculty mentorship/resident leadership program based on complexity leadership theory.

DESIGN

In 2021, a logic model was used to create a 5 part bi-monthly resident leadership series utilizing administrative, adaptive, and enabling components of complexity leadership theory. Each of the 5 sessions had a nationally prominent senior faculty member mentor 3 junior faculty in creation of an interactive workshop that was delivered to resident physicians during scheduled didactics. Validated surveys were used to assess faculty post-mentorship experience and resident self-perception of leadership skills pre-and post-series. Descriptive statistics and 2-way ANOVA were performed; text comments underwent content analysis.

SETTING

A large academic OB/GYN department at Baylor College of Medicine in Houston, Texas.

PARTICIPANTS

Five faculty mentors, 15 junior faculty, and 48 residents participated in this program. All faculty mentors (5/5) and 87% (13/15) of mentees completed the post-mentorship survey. Resident response rate was 60% (29/48) pre-series and 63% (30/48) post-series.

RESULTS

Both mentors and mentees rated the experience favorably (4.62 versus 5.29, p = 0.51). In open-ended comments, enabling components of mentorship process, such as approachability and expertise of the mentors, were most often noted as positive. Both mentees and mentors suggested administrative changes to the experience, such as longitudinal relationships between mentors and mentees. The mean score on the resident leadership questionnaire improved from 3.82 to 3.96 (5-point Likert scale, p = 0.30) with self-reported leadership skills improving in 8/9 domains, although none reaching statistical significance. Open-ended comments revealed that residents also most desired administrative changes in the leadership series, such as increased leadership opportunities and more interactive workshops.

CONCLUSIONS

A structured combined faculty mentorship/resident leadership program formed utilizing complexity leadership theory was positively received. Participants most liked the enabling components of the series, with requested administrative changes in the future.

Leadership Development in Medicine: A Review

The complex and unique challenges of healthcare require physicians who are competent leaders. Leadership is shaped by complex dynamic processes and various factors. Such factors include intrapersonal (leadership identity, cognitive abilities, and self-leadership) and interpersonal factors (vision and mission development and team building). The purpose of this paper is to review current thinking and advancements in leader and leader development by drawing on the administrative literature and discussing how it may apply to medicine, focusing on the contemporary approaches, challenges, and opportunities in this field. More specifically, this review analyses the intrapersonal and interpersonal development of medical leadership, beginning with a consideration of the current state of medical education and practice. It also covers the current challenges affecting medical leadership, as well as the implications for practice, policy, and research. In this paper, it was found that leader and leadership development are both essential for leader growth and to enhance leaders' competencies and effectiveness. The latter leads to improved organizational performance. The paper also highlights the importance of integrating various methods of teaching and learning to optimize leadership development programs.

Effective Behaviors of Leaders During Clinical Emergencies: A Qualitative Study of Followers' Perspectives

BACKGROUND

To manage a clinical emergency effectively, physicians need well-developed leadership skills, yet limited structured leadership training is available for critical care trainees. To develop an effective curriculum, leadership competencies first must be defined.

RESEARCH QUESTION

During clinical emergencies, what leadership behaviors do followers value?

STUDY DESIGN AND METHODS

We conducted qualitative interviews with members of multidisciplinary critical care teams at a large academic health system, with participants including resident physicians, nurses, and respiratory therapists (N = 15). Thematic analysis was used to categorize leadership behaviors that followers perceived to be effective.

RESULTS

We identified three themes related to leadership during clinical emergencies: control, collaboration, and common understanding. Participants described behaviors they believed resulted in both effective and ineffective leadership. For effective leaders, control, the most dominant theme, included behaviors that clearly established roles for the leader and followers, allowing the leader to guide care during a clinical emergency. Collaboration referenced the ability of a leader to maintain a collegial environment. Finally, common understanding reflected a leader's ability to manage communication in a way that fostered a shared mental model across team members.

INTERPRETATION

During clinical emergencies, followers value leaders who assert themselves while also maintaining positive team interaction and encouraging an organized flow of information. Our findings provide a potential framework to develop a leadership curriculum for critical care trainees.

Creation of a sustainable longitudinal women in Leadership Development (WILD) curriculum focused on graduate medical education trainees

BACKGROUND

Although women comprise the majority of medical students, gender disparities emerge early and remain at the highest levels of academia. Most leadership courses focus on faculty or students rather than women graduate medical education (GME) trainees.

AIM

To promote the leadership development of women GME trainees through empowerment, community building, networking and mentorship, and concrete leadership skills development.

SETTING

University of California, San Francisco.

PARTICIPANTS

359 women residents and fellows from 41 specialties.

PROGRAM DESCRIPTION

A longitudinal curriculum of monthly workshops designed to support leadership development for women trainees. Sessions and learning objectives were designed via needs assessments and literature review.

PROGRAM EVALUATION

A mixed-methods evaluation was performed for 3 years of WILD programming. Quantitative surveys assessed participant satisfaction and fulfillment of learning objectives. Structured interview questions were asked in focus groups and analyzed qualitatively.

DISCUSSION

23% of invited participants attended at least one session from 2018 to 2021, despite challenging trainee schedules. Surveys demonstrated acceptability and satisfaction of all sessions, and learning objectives were met at 100% of matched sessions. Focus groups highlighted positive impact in domains of community-building, leadership skills, mentorship, and empowerment. This program has demonstrated WILD's longitudinal sustainability and impact for women trainees.

The Chief Residency in U.S. and Canadian Graduate Medical Education: A Scoping Review

PHENOMENON

Despite the nearly universal presence of chief residents within U.S. and Canadian residency programs and their critical importance in graduate medical education, to our knowledge, a comprehensive synthesis of publications about chief residency does not exist. An understanding of the current state of the literature can be helpful to program leadership to make evidence-based improvements to the chief residency and for medical education researchers to recognize and fill gaps in the literature.

APPROACH

We performed a scoping review of the literature about chief residency. We searched OVID Medline, PsycINFO, ERIC, and Web of Science databases through January 2023 for publications about chief residency. We included publications addressing chief residency in ACGME specialties in the U.S. and Canada and only those using the term "chief resident" to refer to additional responsibilities beyond the typical residency training. We excluded publications using chief residents as a convenience sample. We performed a topic analysis to identify common topics among studies.

FINDINGS

We identified 2,064 publications. We performed title and abstract screening on 1,306 and full text review on 208, resulting in 146 included studies. Roughly half of the publications represented the specialties of Internal Medicine (n = 37, 25.3%) and Psychiatry (n = 30, 20.5%). Topic analysis revealed six major topics: (1) selection of chief residents (2) qualities of chief residents (3) training of chief residents (4) roles of chief residents (5) benefits/challenges of chief residency (6) outcomes after chief residency.

INSIGHTS

After reviewing our topic analysis, we identified three key areas warranting increased attention with opportunity for future study: (1) addressing equity and bias in chief resident selection (2) establishment of structured expectations, mentorship, and training of chief residents and (3) increased attention to chief resident experience and career development, including potential downsides of the role.

A Growing Mandate in American Medicine: Teaching Our Internal Medicine Residents About Healthcare Administration and Leadership

Leadership training during residency is essential for the successful development of contemporary physicians. Creating a curriculum for healthcare leadership and administration for internal medicine residents is particularly challenging due to the heterogeneity of leadership curricula across programs, the emphasis on individual advancement rather than collective leadership, and the scarcity of published research on the topic. A healthcare administration and leadership rotation for medical residents is a valuable experience that emphasizes the importance of contextualizing education on leadership and building relationships to achieve organizational goals.

French-speaking Swiss physician's perceptions and perspectives regarding their competencies and training need in leadership and management: a mixed-methods study

INTRODUCTION

Effective leadership and management (L&M) are essential to the success of health care organizations. Young medical leaders often find themselves ill-prepared to take on these new responsibilities, but rarely attend training in L&M skills. The aims of this study were to evaluate physician's self-perceived competencies and training needs for L&M, to identify available regional L&M training, and to highlight opportunities, challenges and threats regarding physicians' training in medical L&M in the French-speaking part of Switzerland.

METHODS

We conducted a mixed methods study in three steps: (1) a survey on perceived L&M competencies and training needs (5 dimensions) to all physicians of a Swiss University Hospital (N = 2247); (2) a mapping of the Swiss French speaking L&M training programs through analysis of hospital websites and interviews; and (3) semi-structured interviews with L&M program coordinators about the programs' strengths and weaknesses as well as the opportunities and challenges to include physicians in such training. We used analysis of variance to compare differences in perceived competences between physicians of different hierarchical status and used Cramer's V to measure the association's degree between physicians' training needs and prior training in L&M and hierarchical status. We analysed semi-structured interviews using thematic analysis.

RESULTS

Five-hundred thirty-two physicians responded (24%). Physicians perceived themselves as rather competent in most leadership dimensions. More experienced physicians reported a higher sense of competence in all dimensions of leadership (e.g. Working with others: F = 15.55, p < .001; Managing services: F = 46.89, p < .001). Three competencies did not vary according to the hierarchical status: emotional intelligence (F = 1.56, p = .20), time management (F = 0.47, p = .70) and communicating (F = 1.97, p = .12). There was a weak to moderate association between the responders' self-perceived needs for training and their hierarchal status for all competencies (Cramer's V ∈ [0.16;0.35]). Physicians expressed a strong desire to seek out training for all competencies, especially for knowing one's leadership style (82%), managing teams (83%), and managing conflict (85%). Although existing local L&M training programs covered most relevant topics, only a forth of responders had attended any type of training. L&M program coordinators identified several facilitators and barriers to physician attendance on institutional (matching reality and training), relational (managing collective intelligence), and individual levels (beliefs and self-perceived identity).

CONCLUSIONS

French-speaking Swiss hospital physicians clearly express training needs for L&M skills although they only rarely attend such training programs. Reasons for non-attendance to such programs should be explored in order to understand physicians' low participation rates in these trainings.

Profiling leadership: Attitudes, knowledge and training in the biological sciences

The development and practice of good leadership skills (distinct from management skills) enhances both an individual's career development, and their organization. However, universities are known to present unique issues around the development, and practice, of good leadership. Good leadership skills should be considered essential for university staff who train (and mentor) staff or students. Currently, there is no clear evidence that staff in the biological (life) sciences undergo formal (routine) leadership skills training (or appraisal). Furthermore, what leadership training this group needs, or wants, is unknown. A questionnaire was designed to explore leadership dimensions (roles, training, perceptions, and attitudes), and incorporated the Leadership Attitudes and Belief scale (LABS) instrument. Including LABS allows evaluation of leadership attitudes as either Systemic (individual responsibility) or Hierarchical (chain-of-command). Self-selecting biological science academics and staff were recruited using an online survey. Analysis focused on academic staff (lecturer/Assistant professor, and above), and explored the relationship of leadership dimensions with key categories (career stage, gender, age, role, and professional experience). Staff were found to be knowledgeable about what leadership is, but strongly desire formal training in leadership skills and practice. Importantly, staff did not have access to specific leadership training (but did have access to management training), but felt strongly that gaining leadership skills would improve their professional skill set. Analysis found that academics in the biological sciences were oriented towards Systemic leadership, a more collective and supportive approach. It was clear that while good leadership skills are highly valued by academic staff, in practice these skills are underprovided in the biological sciences workplace. This work provides a profile, and benchmark, of leadership (current skills, and desired needs) in the biological sciences. These results provide evidence for the need to embed specific leadership skills training into professional development (and teaching) programmes in the biological sciences.

Leadership and work community - views of graduating dental students

PURPOSE

This study aims to explore what kind of perceptions dental students at graduation stage have on leadership and work communities, and themselves as leaders and work community members after completing a leadership course tailored for them.

DESIGN/METHODOLOGY/APPROACH

The research material comprised reflective essays written by fifth-year dental students who had participated in a leadership course. The essays were analyzed using qualitative content analysis.

FINDINGS

Most students reported that they had not considered seeking a leadership position before the course, but their views of leadership had grown more positive as a result of completing the course. Students perceived interpersonal communication competence as the most important factor for leaders, the whole work community and for themselves. They assessed that their biggest strengths were found in this area. The biggest challenges in adapting to a work community concerned the students' professional identities, which were still taking shape at the time of graduation.

ORIGINALITY/VALUE

The need for leaders in health-care professions is growing due to ongoing reforms, multidisciplinary teamwork, the development of new technologies and patient demands. Therefore, undergraduate leadership education is needed to ensure that students have knowledge of leadership. Graduating dental students' perceptions concerning leadership and work communities have not been widely explored. Students' perceptions of leadership were positive after the course and helped students to realize their own potential in this area.

Current Trends in Subspecialty Fellowship Training for 1691 Academic Neurological Surgeons

OBJECTIVE

Neurosurgical subspecialty fellowship training has become increasingly popular in recent decades. However, few studies have evaluated recent trends in postgraduate subspecialty education. This study aims to provide a detailed cross-sectional analysis of subspecialty fellowship training completion trends and demographics among U.S. academic neurosurgeons.

METHODS

Academic clinical faculty (M.D. or D.O.) teaching at accredited neurosurgery programs were included. Demographic, career, and fellowship data were collected from departmental physician profiles and the American Association of Neurological Surgeons (AANS) membership database. Relative citation ratio scores were retrieved using the National Institutes of Health iCite tool.

RESULTS

This study included 1691 surgeons (1756 fellowships) from 125 institutions. The majority (79.13%) reported fellowship training. Fellowship completion was more common among recent graduates (residency year >2000), as was training in multiple subspecialties (P < 0.0001). Spine was the most popular subspecialty (16.04%), followed by pediatrics (11.18%), and cerebrovascular (9.46%). The least common were trauma/critical care (2.52%) and peripheral nerve (1.26%). Spine, neuroradiology, and endovascular subspecialties grew in popularity over time. Pediatrics and spine were the most popular for females and males, respectively. Epilepsy and cerebrovascular had the most full professors, while endovascular and spine had the most assistant professors. Stereotactic/functional and epilepsy had the most Ph.Ds. Fellowship training correlated with higher weighted, but not mean, relative citation ratio scores among associate (P = 0.002) and full professors (P = 0.005).

CONCLUSIONS

There is an emerging proclivity for additional fellowship training among young neurosurgeons, often in multiple subspecialties. These findings are intended to help guide professional decision-making and optimize the delivery of postgraduate education.

The evaluation of health care leadership development programmes: a scoping review of reviews

PURPOSE

The purpose of this paper is to report a scoping review of reviews which investigated HLDP evaluations to determine: how the conceptualisation of leadership development programmes (HLDPs), and despite growing calls for robust evaluations of their pedagogic design, delivery and effectiveness, there are concerns regarding the quality of data associated with their evaluation. This scoping review of reviews investigated the reporting of HLDP evaluations to determine: how the conceptualisation of leadership underpinning HLDPs influence their evaluation; how the pedagogical approaches within HLDPs influence their evaluation; and the evaluation designs and measures used to assess HLDPs.

DESIGN/METHODOLOGY/APPROACH

The scoping review was conducted on reviews of HLDPs. Searches were performed on four databases and on the grey literature. Data were extracted and a narrative synthesis was developed.

FINDINGS

Thirty-one papers were included in the scoping review of reviews. A great deal of heterogeneity in HLDPs was identified. Evaluations of HLDPs were affected by poor data quality, and there were limitations in the evidence about "what works". Leadership was conceptualised in different ways across HLDPs, and consequently, there was a lack of consistency as to what is being evaluated and the methods used to assess HLDPs.

ORIGINALITY/VALUE

This review of reviews summarises the current evidence on the evaluation of HLDPs. Evaluations of HLDPs need to explicitly account for the complexity of health systems, how this complexity impacts on the development and articulation of leadership practice, and how the underlying conceptualisation of leadership and the associated theory of change articulate a set of assumptions about how HLDPs support leaders to affect change within complex systems.

The Doctors in the House: Examining Physician Legislators in the US Congress from 2011 to 2020

OBJECTIVES

Legislation dictating federal healthcare policy is drafted largely by members of the US Senate and House of Representatives. As such, their personal and professional backgrounds play important roles in setting the national healthcare agenda. We examine the professional and legislative records of the 28 federal physician legislators with voting privileges between 2011 and 2020.

METHODS

Two researchers compiled the names of every federal legislator in both the US Senate and the US House of Representatives who served at any time between 2011 and 2020. The researchers used publicly available records to abstract information regarding their professional and legislative records. Data were then analyzed using descriptive statistics.

RESULTS

The majority of the 28 federal physician legislators are Doctor of Medicine graduates (96%), Republican (86%), represent southern states (71%), were in private practice before serving as legislators (78.5%), and have not previously held elected positions as legislators (57%). Approximately 15% of the bills that they sponsor are related to health policy. Obstetrics/Gynecology, Surgery, and Family Medicine are the most common specialties. On average, it takes 25 years from medical school graduation to election to their federal legislative position. Approximately half represent states, or districts within states, in which they attended medical school or completed residency.

CONCLUSIONS

To engage in meaningful healthcare policy advocacy, professional organizations must support and encourage leadership training for physicians, increase the geographic and professional diversity of physician legislators, prioritize the election of physicians from both political parties, and inculcate deep and lasting professional relationships to physicians in Congress.

Achieving Entrustable Professional Activities During Fellowship

BACKGROUND AND OBJECTIVES

Entrustable Professional Activities (EPAs) were developed to assess pediatric fellows. We previously showed that fellowship program directors (FPDs) may graduate fellows who still require supervision. How this compares with their expectations for entrustment of practicing subspecialists is unknown.

METHODS

We surveyed US FPDs in 14 pediatric subspecialties through the Subspecialty Pediatrics Investigator Network between April and August 2017. For each of 7 common pediatric subspecialty EPAs, we compared the minimum level of supervision that FPDs required for graduation with the level they expected of subspecialists for safe and effective practice using the Friedman rank sum test and paired t test. We compared differences between subspecialties using linear regression.

RESULTS

We collected data from 660 FPDs (response rate 82%). For all EPAs, FPDs did not require fellows to reach the level of entrustment for graduation that they expected of subspecialists to practice (P < .001). FPDs expected the least amount of supervision for the EPAs consultation and handovers. Mean differences between supervision levels for graduation and practice were smaller for clinical EPAs (consultation, handovers, lead a team) when compared with nonclinical EPAs (quality improvement, management, lead the profession and scholarship; P = .001) and were similar across nearly all subspecialties.

CONCLUSIONS

Fellowship graduates may need continued development of clinical and nonclinical skills in their early practice period, underscoring a need for continued assessment and mentoring. Graduation readiness must be based on clear requirements, with alignment of FPD expectations and regulatory standards, to ensure quality care for patients.

Leadership Development Programs for Radiology Residents: A Literature Review

PURPOSE

Leadership development has become increasingly important in medical education, including postgraduate training in the specialty of radiology. Since leadership skills may be acquired, there is a need to establish leadership education in radiology residency training. However, there is a paucity of literature examining the design, delivery, and evaluation of such programs. The purpose of this study is to collate and characterize leadership training programs across postgraduate radiology residencies found in the literature.

METHODS

A scoping review was conducted. Relevant articles were identified through a search of Ovid MEDLINE, Ovid EMBASE, Cochrane, PubMed, Scopus, and ERIC databases from inception until June 22, 2020. English-language studies characterizing leadership training programs offered during postgraduate radiology residency were included. A search of the grey literature was completed via a web-based search for target programs within North America.

RESULTS

The literature search yielded 1168 citations, with 6 studies meeting inclusion criteria. Four studies were prospective case series and two were retrospective. There was heterogeneity regarding program structure, content, teaching methodology, and evaluation design. All programs were located in the United States. Outcome metrics and success of the programs was variably reported, with a mix of online and in person feedback used. The grey literature search revealed 3 American-based programs specifically catered to radiology residents, and none within Canada.

CONCLUSION

The review highlighted a paucity of published literature describing leadership development efforts within radiology residency programs. The heterogeneity of programs highlighted the need for guidance from regulatory bodies regarding delivery of leadership curricula.