Implementation of a Clinical Leadership Curriculum for Pediatric Residents

INTRODUCTION

Clinical leadership is an essential skill for physicians, empowering them to lead and coordinate teams, communicate clearly under various conditions, model positive behaviors, display emotional intelligence, and ultimately improve patient care outcomes. However, there are currently no standardized residency curricula or competency-based assessments for clinical leadership, as residents often assimilate leadership skills through trial-and-error or observation of their clinical faculty. By utilizing a comprehensive needs assessment and synthesizing evidence-based practices, we developed and implemented a longitudinal and skills-based clinical leadership curriculum for pediatric residents.

METHODS

We modeled our clinical leadership curriculum after Kern's 6-step approach to curricular development and the Accreditation Council for Graduate Medical Education competency requirements for professionalism. We identified topics based on a resident needs assessment and synthesized evidence from published practices. The curriculum was implemented through both monthly facilitated group sessions and independent learning modules.

RESULTS

44 postgraduate year-2 (PGY-2) and PGY-3 pediatric residents participated in at least one monthly session of the clinical leadership curriculum. 27 (61%) completed the survey to evaluate the efficacy of the curriculum. Of the respondents, 23 (85%) residents found the leadership sessions useful, 4 (15%) were neutral, and none (0%) rated the sessions as not useful. 26 (96%) residents reported that the sessions should be continued.

CONCLUSION

The clinical leadership curriculum has been received favorably by senior pediatric residents at our institution. Our next steps are to pilot the curriculum within residency programs of different specialties at our own institution as well as with pediatric residencies at other institutions.

A qualitative study of hospital clinical staff perceptions of their interactions with healthcare middle managers

PURPOSE

The authors explored clinical staff perceptions of their interactions with middle management and their experiences of the uncongeniality of their working environment.

DESIGN/METHODOLOGY/APPROACH

Semi-structured interviews of clinical staff from an Australian public health service's Emergency, Surgery and Psychiatry departments. Volunteer interview transcripts were inductively coded using a reflexive thematic content analysis.

FINDINGS

Of 73 interviews, 66 participants discussed their interactions with management. Most clinicians considered their interactions with middle management to be negative based on a violation of their expectations of support in the workplace. Collectively, these interactions formed the basis of clinical staff perceptions of management's lack of capacity and fit for the needs of staff to perform their roles.

PRACTICAL IMPLICATIONS

Strategies to improve management's fit with clinicians' needs may be beneficial for reducing uncongenial workplaces for healthcare staff and enhanced patient care.

ORIGINALITY/VALUE

This article is among the few papers that discuss interactions with management from the perspective of clinical staff in healthcare. How these perspectives inform the perception of workplace uncongeniality for clinicians contributes greater understanding of the factors contributing to adversarial relationships between clinicians and managers.

Providers' perspectives on the performance of primary healthcare centres in India: The missing link

BACKGROUND

Primary healthcare centres (PHCs) form the foundation of the Indian public health system, and thus their effective functioning is paramount in ensuring the population's health. The World Health Organisation (WHO) has set six aspects of performance assessment for general health systems, which are hardly applicable to the PHC setup in a low- and middle-income country. The Primary Health Care Performance Initiative (PHCPI) has prescribed a framework with five domains consisting of 36 indicators for primary healthcare performance assessment from a policy point of view. For the assessment to be realistic, it should include inputs from stakeholders involved in care delivery, so this study examines the perspectives of healthcare providers at PHCs in India.

METHODOLOGY

The authors used qualitative research methodology in the form of responsive evaluations of healthcare provider's interviews to understand the indicators of PHC performance.

RESULTS AND CONCLUSION

The study results showed that healthcare providers considered efficient teamwork, opportunities for enhancing provider skills and knowledge, job satisfaction, effective PHC administration, and good community relationship as PHC performance assessment. These domains of performance could be considered the 'missing link' in PHC assessment, since they are deemed important by providers and did not coincide with the WHO aspects and the PHCPI performance assessment framework.

Shared leadership in a medical division of an academic hospital

PURPOSE

The purpose of this paper is to describe a successful model of shared medical leadership within an academic division of an urban children's hospital.

DESIGN/METHODOLOGY/APPROACH

Experience and outcomes were tracked over a three-year period during which two physicians shared the role of interim division chief of pediatric endocrinology and diabetes, resulting in a working model of shared leadership.

FINDINGS

An evolutionary trajectory occurred over three years in which the strengths of the leaders were combined to optimize decision making in a complex medical division. Improvements in team satisfaction and additional positive outcomes were achieved.

PRACTICAL IMPLICATIONS

Benefits of and challenges tackled by the strategic approach to shared leadership are identified to inform other medical institutions, particularly those with many team members or combined programs that include strong clinical and research components.

ORIGINALITY/VALUE

Little has been written within medical literature regarding shared leadership. The shared leadership model described in this paper can be implemented by others in a complex academic setting and will hopefully lead to more robust divisions.

What does professionalism mean to the physician?

Professionalism, which is a core competency for physicians, can be described as a spectrum of behaviors and may have a significant impact on the problems in today's changing health care climate. In this article, we discuss the meaning of professionalism and its role in the Southern California Permanente Medical Group (SCPMG) and consider how it may be applied to integrated care delivery systems such as Kaiser Permanente. To understand professionalism, one must consider Stern's definition, which consists of four principles: excellence, humanism, accountability, and altruism. SCPMG has taken three of these principles-excellence, accountability, and altruism-and divided the fourth, humanism, into another three principles similar to those identified by the University of California Los Angeles Task Force on Professionalism: humanitarianism, respect for others, and honor and integrity. SCPMG has a rich history and culture of promoting clinical excellence and professionalism, as evidenced by the programs and initiatives described throughout this article. Indeed, the SCPMG experience validates professionalism as a core physician competency comprising a set of behaviors that are continually refined.

Aged Care Informatics

Aged care is projected to be the fastest-growing sector within health and community care industries Strengthening the care-giving workforce, compliance, delivery and technology is not only vital to our social infrastructure and improving the quality of care, but also has the potential to drive long-term economic growth and contribute to the GDP. This paper examines the role of knowledge management (KM) in aged care organizations to assist in the delivery of aged care. With limited research related to KM in aged care, this paper advances knowledge and offers a unique view of KM from the perspective of 22 aged care stakeholders. Using in-depth interviewing, this paper explores the definition of knowledge in aged care facilities, the importance of knowledge planning, capture and diffusion for accreditation purposes and offers recommendations for the development of sustainable knowledge management practice and development. The paper culminates in an offering a checklist for aged care facilities and advances the discourse in this sector.

Teaching medical students to recognise their strengths and limitations in leadership, teamwork and communication by military led tutorials

OBJECTIVES

The General Medical Council has stipulated that greater importance must be placed on undergraduate students developing their ability to lead and work effectively as part of a team. Wales Universities' Officer Training Corps have attempted to meet this requirement through a third year interactive tutorial which aims to encourage students to recognise their strengths and limitations in the six outcomes of leadership, teamwork, accountability, management, feedback and communication.

METHODS

16 tutorial groups of 10-15 students were each led by one officer who divided the tutorial group into three teams. The teams worked on complex planning exercises with an intrateam constructive feedback discussion to raise students' awareness of their strengths and limitations as individuals during the task, as perceived by others.

RESULTS

The student perception was that all six learning outcomes were achieved by the session. 163 students returned feedback questionnaires and learning outcomes 1-4 were felt to have been addressed effectively or very effectively by 90%, 91%, 90% and 86% respondents, respectively. The fifth and sixth outcomes were less well achieved with only 66% and 64% respondents agreeing that the outcomes were achieved effectively or very effectively.

CONCLUSIONS

Students commended the instructor's demonstration of leadership and the novel teaching method but improvements could be made in reinforcing why these skills are important.