Medical leadership: An important and required competency for medical students

Do health-care institutions perform better under leaders with medical or non-medical backgrounds? A scoping review

PURPOSE

This study aims to summarize studies that compared the performance of health-care institutions led by leaders with medical background versus those with no medical background.

DESIGN/METHODOLOGY/APPROACH

A systematic search was conducted on three databases: PubMed, Ovid Medline and Google Scholar to identify relevant peer-reviewed studies using the keywords "performance," "impact," "physician," "medical," "doctor," "leader," "healthcare institutions" and "hospital." Only quantitative studies that compared the performance of health-care institutions led by leaders with medical background versus non-medical background were included. Articles were screened and assessed for eligibility before the relevant data were extracted to summarize, appraise and make a narrative account of the findings.

FINDINGS

A total of eight studies were included, four were based in the USA, two in the UK and one from Germany and one from the Arab World. Half of the studies (n = 4) reported overall better health-care institutional performance in terms of hospital quality ranking such as clinical effectiveness and patient safety under leaders with medical background, whereas one study showed poorer performance. The remaining studies reported mixed results among the different performance indicators, especially financial performance.

PRACTICAL IMPLICATIONS

While medical background leaders may have an edge in clinical competence to manage health-care institutions, it will be beneficial to equip them with essential management skills to optimize leadership competence and enhance organizational performance.

ORIGINALITY/VALUE

The exclusive inclusion of quantitative empirical studies that compared health-care institutional performance medical and non-medical leaders provides a clearer link between the relationship between health-care institutional performance and the leaders' background.

Training future leaders: A qualitative study exploring leadership development in predoctoral dental curricula

PURPOSE/OBJECTIVE

Commission on Dental Accreditation (CODA) accreditation standard 2-19 states predoctoral dental schools must assess students' ability to function successfully as the leader of the oral health care team. This study aimed to explore how dental schools incorporate leadership training into their curriculum to better understand the leadership skills students learn, the ways students engage in leadership training, and the opportunities students have to practice leadership skills with their peers.

METHODS

The aim of this 2022 qualitative phenomenology study was to use semi-structured interviews with academic Deans at CODA-accredited dental schools and one subject matter expert to uncover types of cognitive, behavioral, and environmental factors influencing leadership training through the lens of social cognitive theory. All interviews were recorded on Zoom, transcribed, de-identified, and analyzed for recurring themes using NVivo. Eight academic Deans and one subject matter expert participated in the study.

RESULTS

Four major themes emerged from the data: leadership is essential for dental professionals, leadership is incorporated into the curricula in diverse ways, students most often engage in leadership training opportunities with dental peers and interprofessional opportunities could be expanded, and dental schools often face barriers to incorporating leadership training. Vertically integrated case presentations and team-based practice management simulations are meaningful leadership development activities. Prominent barriers include time constraints, lack of faculty champions with teaching leadership expertise, and prioritizing the development of hand skills.

CONCLUSION

Standard practices for student leadership development and assessment do not appear to exist across dental school curricula. Findings support the need for a leadership development framework.

Analysis of leadership and team management skills of middle-level healthcare managers of Valsad district, Gujarat

Background

The healthcare managers need to develop the managerial skills and use it for better healthcare delivery. A manager requires leadership skill to empower employees and motivate them to work in an efficient manner to achieve organizational goal. Motivating employees/subordinates and developing positive attitude toward them is one of the crucial skills that the leader needs to develop. The way health team works as a unit affects the outcome and needs good leader. With this background, the current study tends to explore the managerial skills of middle-level managers.

Objectives

1. To assess the leadership and team management skills of middle-level managers and 2. To find out motivational factors used by managers.

Materials and Methods

A cross-sectional study was conducted among district-level healthcare managers and medical officers. Data collection was performed via semistructured and scale-based questionnaire and analyzed using Microsoft office excel.

Results

60% of managers had participative leadership style. Team work skills were fair enough among the managers. 53% of medical officers were freshly appointed with experience of less than one year. The middle-level managers used appreciation of work (41.8%) as major motivator of the team.

Conclusions

The middle-level healthcare managers have good leadership quality as well as teamwork skills. Appreciation of work is commonly used motivator.

Leadership Training Curriculum for Otolaryngology-Head and Neck Surgery Residents: A Scoping Review

OBJECTIVE

Otolaryngologists take on various leadership roles throughout their daily practice, but specific training focused on leadership development during otolaryngology-head and neck surgery (OHNS) residency is not well-defined. This project explores the current state of leadership curricula for OHNS residents.

DATA SOURCES

Google Scholar, Embase, PubMed, and MedEdPORTAL.

REVIEW METHODS

A scoping review was performed on English-language, full-text, peer-reviewed articles that describe leadership curricula for OHNS residents. Investigators reviewed curriculum settings, content, delivery methods, and assessment; curriculum effectiveness was evaluated using Kirkpatrick effectiveness scores and article quality was assessed using the Best Evidence in Medical Education (BEME) index.

CONCLUSION

Three thousand four hundred sixteen articles met search criteria, 198 articles were included for full-text review, and 4 articles met inclusion criteria. Curriculum content and delivery methods were diverse. Curriculum cadence ranged from 2-day immersion trainings to year-long longitudinal programs. Only one of the included studies utilized a needs assessment to inform curriculum development. Two articles achieved Kirkpatrick effectiveness scores of 2, indicating changes in the attitudes or perceptions among participants and a quality measure of 3, indicating clear conclusions drawn from the results.

IMPLICATIONS FOR PRACTICE

The current state of leadership training in OHNS residency is limited and nonuniform. These data align with descriptions of leadership training in other surgical residencies which are reported as heterogenous and lacking in effectiveness. This review highlights the need for standardized leadership training for OHNS residents. The high-quality leadership development initiatives within graduate medical education are reviewed to inform future directions for effective curriculum development and assessment.

The Military Medical Officer's Current-Day Professional Identity: An Enhanced Model

BACKGROUND

As the landscapes of war have evolved, so too has the role of the military medical officer (MMO). Colonel (Retired) Barry Wolcott developed a "vector" model in the 1990s, illustrating the dual professional role of the MMO. Since then, propelled by the War on Terror, MMOs have adapted to treating patients in volatile, uncertain, complex, and ambiguous operational environments. This study, therefore, aimed to explore modern-day aspects of the MMO's role in order to enhance Wolcott's depiction of the MMO's professional identity in contemporary operational environments.

MATERIALS AND METHODS

We used the qualitative phenomenological tradition to design our study. We interviewed military physicians from a variety of specialties in order to explore their experiences and professional identity as MMOs. Our research team then coded each of these interview transcripts. We organized these codes into categories, which served as the themes of our study.

RESULTS

The following themes emerged from our data regarding the role of the MMO in the operational environment: Primary roles (officer, physician, educator, and diplomat) and aptitudes (innovation, advocacy, cultural competency, and leadership). The MMO's roles as officer and physician often intersect, with dual foci on the mission and the patient. The MMO also serves as an educator to medics and line officers. In addition, they act as diplomats both outside and within the military. Within each of these primary roles, the MMO innovatively prepares for future landscapes of war and advocates for both the individual warfighter and the unit/command. Finally, the MMO navigates both foreign and internal cultural differences and demonstrates leadership in enabling the military's mission.

CONCLUSIONS

The role of the MMO is complex and multifaceted. The recognition of the contemporary MMO's unique skill set is essential for the effective education and training of future military health care leaders. The value of capitalizing on this unique skill set has been demonstrated in recent civ-mil responses. Because their intricate skill set is specialized for the operational environment, long-term retention of MMOs is key to force readiness.

Psychological Stress Experienced by First-Year Medical Undergraduates: A Cross-Sectional Study From Eastern India

Background While medical education is vital for producing competent physicians, its rigorous curriculum can harm students' mental well-being. This study focuses on assessing psychological stress in first-year medical students in Eastern India and aims to identify its primary causes. Methods This cross-sectional study involved 125 first-year MBBS students in a tertiary care medical teaching institution in eastern India. They completed the Medical Student Stressor Questionnaire (MSSQ-40) questionnaire to measure stress and provided academic records to be reviewed.  Results Among the 125 students included in the study, male students demonstrated greater academic and interpersonal stress. The findings revealed that a substantial proportion (79%) of the student population experienced high to severe levels of academic stress, followed by 88% who reported moderate to high levels of social-related stress. Furthermore, it was observed that those students who experienced high to severe stress across all six domains tended to perform poorly during the initial half of their academic year. Conclusion The high levels of stress experienced by medical students can have significant implications for their academic performance. However, the nature of our study limits us to only highlight the existence of a correlation between the two. Future studies on the same should be conducted to assess the causal relation between these factors.

Perceived leadership quality and empathy among Indian undergraduate medical students

BACKGROUND

Efficient leaders from the medical fraternity may understand healthcare in depth. Empathy is important for patient care, job satisfaction, and the psychological well-being of doctors. Empathic leadership is concerned with an interest in the people around them. This study aimed to observe the perceived leadership quality and empathy among Indian medical undergraduate students, find any correlation between them, and assess age, sex, and semester of study as predictor variables for leadership and empathy.

MATERIALS AND METHODS

An online cross-sectional survey was conducted on Google Forms with undergraduate medical students in India with a convenient snowball sample. The Abbreviated Self Leadership Quality (ASQL) was used to find the leadership quality and the eight-item Empathy Quotient (EQ-8) to find the empathy. Spearman's correlation coefficient was calculated between ASQL and EQ-8 score. Age, sex, and semester were used as predictor variables in regression analysis with leadership and empathy as dependent variables.

RESULT

A total of 439 (50.8% male, 49.2% female) Indian undergraduate students participated in the study. Males showed higher leadership qualities. There was no gender difference in empathy. Leadership was positively correlated (rs =0.13, P = .006) with empathy in the overall sample. The age (P = .001), sex (P < .0001), and semester of study (P < .0001) successfully predicts leadership (F = 57.167, P < .0001). Although age, sex, and semester combined successfully predict empathy (F = 5.31, P = .001), individually, only a semester of study (P = .009) significantly contributes to the prediction.

CONCLUSION

Male and female medical students show a similar level of empathy but male shows higher leadership quality. Leadership and empathy are positively correlated; hence, students with higher leadership quality would show higher empathy and vice versa. The age, sex, and semester of study are determinants of leadership whereas semester of study is the determinant of empathy.

[Leadership from the perspective of next generation ophthalmologists]

Managers in the healthcare system play a critical role in ensuring high quality patient care, optimization of resources, management of complex situations, creation of a positive work environment and promotion of continuous progress. They set clear goals, support interdisciplinary collaboration, ensure patient safety and quality care, and assist in the development of future leaders. To accomplish these multiple tasks, important qualities such as integrity, communication skills, self-awareness, ability to learn, influence, empathy, courage, respect, ability to delegate and gratitude are essential. We conducted a survey among the followers and members of the Young-DOG to find out their desired characteristics of leaders. In this survey modern aspects of leadership styles such as communication, loyalty, support, reliability and trust were particularly important to young medical professionals. Classical attributes such as expertise and assertiveness were rated as somewhat less significant. This finding underlines the importance of leadership programs such as the Leadership Academy of the German Society of Ophthalmology (DOG) or the European Leadership Development Program of the European Society of Ophthalmology (SOE). The latter is briefly presented in an excursus.

Developing Leadership Among Dental Residents: An Exploratory Study

INTRODUCTION

Today's healthcare requires leaders to lead and improve the healthcare sector. CanMEDS framework is the one defining the competencies required for all Saudi residency programs, including dental specialty. Senior residents should demonstrate readiness to transition to practice as a leader. It is imperative to understand the notion of medical education and its influence on the training of future dentists. The major significance of this study is exploring the current leadership development and the integrated training into the Saudi Board Dental Residency Program that has not been systematically studied.

METHODS

This was a qualitative study employing the phenomenological approach. The theoretical saturation point determined the sample size using a purposeful sampling technique. Semi-structured interviews were used for data collection using a semi-structured interview guide. A descript platform was used for the recordings' transcription. Ongoing thematic data analysis was done using Nvivo computer software by QSR International. Themes were generated, and the data were interpreted within supported with the most relevant quotations.

RESULTS

Sixteen senior residents were required to serve the study purpose. Three themes emerged: awareness of leadership, educational experience, and factors that impacted leadership development. Awareness of residents about the leader's role was limited. Residents developed leadership under the training program with inconsistency and lack of structure. Summative reports were received as part of the assessment, whereas no integral protocol for formative feedback. Specialties, training centers, and coaching were identified as factors that impacted leadership development.

CONCLUSION

This study highlighted leadership development during the residency period. The residents struggled and varied in developing leadership skills relying on their educational experience and learning environment. Residency programs may verify equivalent "leader role" education for all specialties and training centers in residency training in Saudi Arabia. Dovetailing leadership coaching with daily teaching workflow and implementing faculty development initiatives to allow for appropriate feedback and assessment of these skills are advised.

Knowledge, attitudes, and practice of leadership skills among undergraduate medical students

BACKGROUND AND AIM

Medical knowledge alone is insufficient to provide excellent medical care. Modern healthcare challenges require that all physicians have leadership skills in order to better cooperate and collaborate with other healthcare professionals and effectively lead their teams to provide the best possible care to their patients. The objective of this study was to describe medical students' prior knowledge of leadership concepts, to assess their common practice of its main skills and to explore their general perception of its application by their seniors.

METHODS

Non-graduated medical students enrolled in the 5th year of medicine or above were invited to fill-in an anonymous online questionnaire. 267 students (66% women) from different medical faculties took part in the study.

RESULTS

44% of the participants had a vague idea about leadership and 29% were completely ignorant of the concept. 52% of them thought that leadership was not to be expected from medical students, and 65% did not know that leadership in healthcare would benefit the patient. In their responses to simulated situations, the participants presented optimal attitudes embracing leadership attributes regarding self-awareness, receiving feedback, teamwork, stress and conflict management, however they present more contrasting attitudes when it came to time management and questioning oneself. Seniors with good leadership skills were perceived as few by half the participants.

CONCLUSIONS

This survey highlighted the need of introducing specific leadership training programs within the curriculum of medical studies in Morocco.

ASCO's Leadership Development Program: Focusing on the Next Generation of Leaders in Asia Pacific

PURPOSE

The demand for high-quality and more comprehensive oncology care will continue to rise globally. Effective leadership is particularly important.

METHODS

The evolving endeavor of ASCO to reach out globally has covered the development of the next-generation leaders from Asia Pacific. Through the Leadership Development Program, the untapped talent of the region and the future leaders in oncology will gain the knowledge and skill sets, which prepares them to navigate the complex dynamics of oncology health care.

RESULTS

The region is the largest and the most populous with more than 60% of the world's population. It has 50% of cancer cases and is estimated to account for 58% of cancer deaths worldwide. The demand for high-quality and more comprehensive oncology care will continue to rise in the years to come. This growth will intensify the need for capable leaders. Leadership styles and behaviors are different. These are shaped within the context of cultural and philosophical views and beliefs. The pan-Asian interdisciplinary group of young leaders are expected to gain knowledge and skillsets through the Leadership Development Program. They will learn to work on strategic projects within a team and gain knowledge about advocacy. Communication and presentation skills and conflict management are also important components of the program. Through learning culturally relevant skills, participants can effectively collaborate with others, build relationships, and lead within their own institutions and societies and within ASCO.

CONCLUSION

Institutions and organizations need to have a deeper and more sustained focus on leadership development. Successfully addressing the challenges on leadership development in Asia Pacific is important.

Debriefing or Feedback: Exploring the Impact of Two Post-Scenario Discussion Methods in the Acquisition and Retention of Non-Technical Skills

INTRODUCTION

There is a paucity of quantitative studies objectively comparing debriefing and feedback as methods for post-scenario discussion and its impact on healthcare teams' acquisition and retention of non-technical skills. The main purpose of this study is to provide some insight on this research question, using a sample of medical students. A secondary objective explores students' opinion and preference on the post-scenario discussion.

MATERIAL AND METHODS

Forty-five medical students were distributed among 15 teams, and randomly allocated to two groups. Each team participated in three different simulated scenarios, with similar levels of difficulty and opportunities to apply specific non-technical skills: leadership, communication, and task management. To assess the acquisition and retention of skills, scenarios occurred on days one (baseline), two (acquisition) and 20 (retention). Team performance was objectively evaluated by an observer, using scenario recordings. Students individually assessed different aspects of debriefing and feedback.

RESULTS

Both debriefing and feedback groups showed similar overall increase in objective scores, with significant increase between days one and two (acquisition), and a smaller increase between days two and 20 (retention). Students indicated debriefing as the preferred discussion method.

CONCLUSION

Debriefing and feedback are effective post-scenario discussion methods, promoting acquisition and retention of non-technical skills, by undergraduate students. Allying debriefing reflexive practice with feedback directive style, and shifting appropriately between facilitation and instruction, can be a good compromise to achieve a timely and educationally meaningful discussion.

Leadership Curriculum in Medical Education: Exploring Student and Faculty Perceptions in a US Medical School in Qatar

Purpose

Leadership has long been recognized as a core competency required to excel in medical practice. This qualitative study investigates the extent to which leadership competencies are incorporated in the curriculum of a US medical college in Qatar and examines the perceptions of medical students and faculty about leadership in the medical curriculum.

Methods

The study uses a student survey, faculty interviews, and a student focus group to gather data.

Results

The study found that 79% of the survey respondents perceive leadership as a core competency while 55% feel that leadership skills are not adequately taught to students. The focus group and interviews revealed that students believe more importance should be given to leadership training whereas faculty assert that, while leadership can be beneficial, leadership training is implicit, and more research is required for further implementation.

Conclusion

This study shows the need for an increased emphasis on developing leadership curricula in undergraduate medical education and highlights ways to address certain obstacles to implementation. Further research on exploring medical alumni’s perceptions and optimal teaching methods to implement leadership training is needed.

The Perception of Nursing Leaders toward Communication and Relationship Management Competencies in Using Digital Platforms during COVID-19 in Qatar: A Cross-Sectional Study

Aim

To evaluate nursing leaders' perception of communication and relationship management competencies while using digital platforms during the COVID‐19 pandemic.

Background

Nursing leaders can achieve effective leadership by mastering these competencies leading to an overall improvement in the quality of nursing care. The COVID‐19 pandemic has brought numerous challenges in communication, and digital platforms have been widely used in healthcare settings to mitigate contagion.

Design

Cross‐sectional.

Methods

The study was conducted between February and March 2021. A survey was adopted from the American Organization of Nurse Executives (AONE) and was sent to nursing leaders in Qatar through email.

Results

A total of 250 nurse leaders were invited to participate, but only 116 responded (RR 46.4%). The male participants represented a more significant proportion of 64.10%. Influencing behaviour, relationship management and effective communication had the lowest scores, which indicates low competency.

Conclusions

Despite obtaining satisfying scores, nursing leaders in Qatar should strive for professional development and knowledge acquisition to improve their communications and relationship management competencies.

Implications for Nursing Management

Healthcare organizations must understand that nursing leaders should strive for professional development and knowledge acquisition to improve their communication and management.

Building Communication and Conflict Management Awareness in Surgical Education

OBJECTIVE

A group of surgeons and a medical educator constructed a curriculum to strengthen communication and emotional intelligence skills in the surgical setting.

DESIGN

The curriculum consisted of a small group discussion series occurring during medical students' eight-week surgery clerkship. The curriculum targeted the following objectives: building team rapport, exploring self-management strategies in team communication, recognizing communication styles, diagnosing conflict, identifying opportunities in professional and personal development, and discussing professionalism in medicine. Students completed pre-post Likert style tests about their knowledge and understanding of the above-mentioned topics.

SETTING

Texas A&M University College of Medicine, Surgical Clerkship at Baylor Scott and White Medical Center, a level 1 trauma center, in Temple, TX.

PARTICIPANTS

Twenty-four students in their third year of medical school completed the communication curriculum.

RESULTS

Wilcoxon sign test was used to analyze the non-parametric data and multiple repeat tests required the significance level (p-Value) be adjusted to 0.003. Students showed significant increase in understanding of conflict management, their ability to communicate effectively, and their awareness of communication preferences (p < 0.001). In addition, they recognized better ways to engage with other students, residents, and staff on their rotation (p = 0.002) and felt more confident in their ability to handle feedback (p = 0.001). Open-ended responses on the post-test had overwhelmingly positive feedback with themes of awareness, psychological safety, and team rapport. Finally, students requested that the curriculum be taught longitudinally throughout their third-year clerkships.

CONCLUSIONS

Our curriculum enabled students to improve their awareness of communication, conflict management, team dynamics, and professionalism. These important competencies will support students throughout their training and in their practice as future surgeons.

An analysis of student essays on medical leadership and its educational implications in South Korea

To examine medical students’ perceptions of leadership and explore their implications for medical leadership education. We conducted a qualitative analysis of the essays submitted by students in the medical leadership course from 2015 to 2019. We categorised the essays by the characteristics of the selected model leaders (N = 563) and types of leadership (N = 605). A statistically significant proportion of students selected leaders who were of the same gender as themselves (P < 0.001), graduate track students chose leaders in science (P = 0.005), while; military track students chose leaders in the military (P < 0.001). Although the highest proportion of students chose politicians as their model leaders (22.7%), this number decreased over time (P < 0.001), and a wider range of occupational groups were represented between 2015 and 2019. Charismatic leadership was the most frequently selected (31.9%), and over time there was a statistically significant (P = 0.004) increase in the selection of transformational leadership. Students tended to choose individuals whose acts of leadership could be seen and applied. Medical leadership education should account for students’ changing perceptions and present a feasible leadership model, introducing specific examples to illustrate these leadership skills.

Testing the contextual Interaction theory in a UHC pilot district in South Africa

BACKGROUND

World-wide, there is growing universal health coverage (UHC) enthusiasm. The South African government began piloting policies aimed at achieving UHC in 2012. These UHC policies have been and are being rolled out in the ten selected pilot districts. Our study explored policy implementation experiences of 71 actors involved in UHC policy implementation, in one South African pilot district using the Contextual Interaction Theory (CIT) lens.

METHOD

Our study applied a two-actor deductive theory of implementation, Contextual Interaction Theory (CIT) to analyse 71 key informant interviews from one National Health Insurance (NHI) pilot district in South Africa. The theory uses motivation, information, power, resources and the interaction of these to explain implementation experiences and outcomes. The research question centred on the utility of CIT tenets in explaining the observed implementation experiences of actors and outcomes particularly policy- practice gaps.

RESULTS

All CIT central tenets (information, motivation, power, resources and interactions) were alluded to by actors in their policy implementation experiences, a lack or presence of these tenets were explained as either a facilitator or barrier to policy implementation. This theory was found as very useful in explaining policy implementation experiences of both policy makers and facilitators.

CONCLUSION

A central tenet that was present in this context but not fully captured by CIT was leadership. Leadership interactions were revealed as critical for policy implementation, hence we propose the inclusion of leadership interactions to the current CIT central tenets, to become motivation, information, power, resources, leadership and interactions of all these.

Leadership development for orthopaedic trauma surgeons in Latin America: opportunities for and barriers to skill acquisition

Introduction

There is growing interest in leadership courses for physicians. Few opportunities are available in global regions with limited resources. This study describes orthopaedic trauma surgeons' desired leadership skill acquisition, opportunities, and barriers to course participation in Latin America.

Methods

Latin American orthopaedic trauma surgeons from the Asociación de Cirujanos Traumatólogos de las Americas (ACTUAR) network were surveyed. This survey solicited and gauged the surgeons' level of interest in leadership topics and their relative importance utilizing a 5-point Likert-scale. Additionally, comparisons were calculated between middle-income countries (MICs) and high-income countries (HICs) to ascertain if needs were different between groups. The survey included demographic information, nationality, level of training, years in practice, leadership position, needs assessment, and perceived barriers for leadership educational opportunities.

Results

One hundred forty-four orthopaedic surgeons completed the survey, representing 18 countries across Latin America; 15 MICs and 3 HICs. Participants had more than 20 years in practice (49%) and held leadership positions (81%) in hospital settings (62%), national orthopaedic societies (45%), and/or clinical settings (40%). Sixty-three percent had never attended a leadership course due to lack of opportunities/invitations (69%), difficulty missing work (24%), and costs (21%). Ninety-seven percent expressed interest in attending a leadership course. No difference in needs was determined between respondents from MICs and HICs. Professional Ethics, Crisis Management/Organizational Change Management, and High Performing Team-Building were identified as the most important leadership topics.

Conclusion

Orthopaedic surgeons in Latin America demonstrate an interest in acquiring additional leadership skills but have few opportunities. Identifying interests, knowledge gaps, and core competencies can guide the development of such opportunities.

Leadership Matters: Needs Assessment and Framework for the International Federation for Emergency Medicine Administrative Leadership Curriculum

OBJECTIVES

The objective was to research and develop a novel curriculum on administrative leadership development within the discipline of emergency medicine (EM) with the goal of establishing and implementing it through the world's EM professional organizations.

METHODS

From 2016 to 2018 an assessment of different administrative and leadership programs was performed by researching and reviewing previously outlined curricula. Using the data from this assessment, a questionnaire was developed, that was subsequently sent to members of the International Federation for Emergency Medicine's (IFEM) listserv.

RESULTS

A total of 377 people from 38 different countries participated in the survey. The majority of respondents identified themselves as EM specialists (81%, 306/377), while others identified themselves as EM resident physicians (9.5%, 36/377) and non-EM specialist physicians (4.5%, 17/377). A large majority of respondents articulated that there was a paucity of developed curricula focusing on leadership, administrative, and management principles within their institution, training program, or professional organization. Across all topic areas, fewer than 30% of polled individuals indicated that they had formal education related to individual and programmatic leadership development, change management, assessment methodology, negotiation skills, financial analysis, media relations, and health care policy. Quality improvement (QI) was the only curricular element that a majority of respondents had integrated into their clinical practice (61%). Qualitative data analysis of the narrative comments was performed with further evaluation of thematic components.

CONCLUSIONS

The results of this study further support the findings that the majority of EM providers queried do not have a longitudinal curriculum that fosters administrative and leadership development nor advocate for its importance in relation to the quality of care. Given this gap, we propose that medical education at all levels-medical schools, EM resident/specialty training programs, and professional organizations-should consider creating administrative and leadership development programs. Additionally, development of any curriculum should require a global understanding of health care systems and awareness of the unique contexts of a given location and its available resources.

Innovation in Leadership Development in Undergraduate Medical Education

In response to the need for physician leaders, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell developed the Klar Leadership Development and Innovation Management program. This novel program leverages its partnership with a large Northeast health system to longitudinally provide students with leadership fundamentals and mentored experiences.

Academic background, professional experience, and research achievements of United States academic ophthalmology leadership

PURPOSE

To characterize the academic background, professional experience, and scholarly achievements of United States (US) academic ophthalmologists serving in leadership positions.

METHODS

This is a cross-sectional study. An online search of publicly available resources was conducted for demographics, background, research productivity, and academic appointments of academic ophthalmologists in leadership positions: chairperson (CP), vice chair (VC), service director (SD), and program director (PD).

RESULTS

Five hundred and fifty-one academic ophthalmologists in leadership positions were analyzed. A male predominance was found in all positions, ranging from 86% male CPs to 68% of SDs. Eighty-nine percent were graduates of US medical schools, and 97% completed their residency in a US ophthalmology program. Harvard Medical School and The Johns Hopkins University School of Medicine and their affiliated programs were the most frequently attended by leaders. The most common subspecialties among leaders were surgical retina (21%), cornea (18%), and glaucoma (16%). Overall, 18% of leaders are endowed professors, 34% are full professors, 25% are associate professors, and 20% are assistant professors. Overall, 28% of department leaders were residents and 16% were fellows in their current program. Chairpersons, followed by their vice, are the most academically proficient leaders within their departments, having the largest number of publications and h, hc, hm, and AWCR bibliometric indices.

CONCLUSIONS

Ophthalmology leaders in all positions are highly accomplished with an established interest in research. Typically, CPs and their VCs have a longer duration of professional experience with a greater research output and a superior median academic appointment. Gender discrepancies within leadership positions are evident.

Managerial Strategies for Long-Term Care Organization Professionals: COVID-19 Pandemic Impacts

This paper aims to analyze the strategies that healthcare professionals have adopted during the coronavirus pandemic (COVID-19) in long-term care organizations in Rio de Janeiro city, Brazil, by investigating their competencies—mainly managerial ones. To reach its goals, this paper performs empirical research and theoretical research. For the empirical research, the plans of professionals during COVID-19 pandemic in long-term care organizations are observed, and a questionnaire is applied to analyze observed data integrity. The data are analyzed through the Python and IBM SPSS Statistic programming languages, and descriptive analyses use descriptive statistic proportions, rates, minimum, maximum, mean, median, standard deviation, and coefficient of variation (CV). A non-parametric approach performs repeated measure comparisons using Wilcoxon’s test, while the McNemmar test is used to repeat the categorical variables. Statistical significance is assumed at the 5% level. For the theoretical research, a literature review is developed using scientific databases. The results show that for the searched period, the number of deaths and the number of people infected by COVID-19 in these organizations are low when compared to general statistics of Rio de Janeiro city. This paper concludes that these strategical adoptions have brought significant benefits to long-term care organizations, and it might motivate researchers to develop future studies related to long-term care organizations, helping to fill the literature gap on the subject.

Perceived barriers to medical leadership training and methods to mitigate them in the undergraduate medical curriculum: A mixed-methods study of final-year medical students at two medical schools

Introduction

Effective leadership is vital for high-quality healthcare. Despite progress in leadership development for junior doctors, studies reflect perceptions that junior doctors feel underprepared for leadership. This study aims to understand medical students' perceptions about barriers to effective leadership training and how to mitigate these.

Methods

This was a mixed-methods study utilising focus group interviews structured using four trigger questions. Qualitative narrative responses underwent quantitative inductive coding applied by two independent coders. Commonly occurring codes underwent thematic analysis to understand underpinning themes.

Results

Thirty-one students were interviewed from King's College London (n=24) and St George's, University of London (n=7). Cohen's kappa statistic of inter-rater reliability was 0.73. The priority areas were the equity of teaching, implemented approaches and methods of assessing competency. The study presents a driver diagram summarising findings.

Conclusion

This study presents medical students' perceptions about barriers to effective leadership training in current undergraduate curriculum and interventions to mitigate these.

Achieving universal health coverage in sub-Saharan Africa: the role of leadership development

Countries world-wide are striving towards Universal Health Coverage (UHC). Financial resources are extremely limited in developing countries and many developing countries are in the midst of multiple interconnected social, economic, epidemiologic, demographic, technological, institutional, environmental and political transitions. According to the World Health Organization (WHO), accelerating progress towards UHC in Africa will require strong leadership. At the recent Global Conference on Primary Health Care (PHC), the Astana Declaration, the world recommitted to comprehensive Primary Health Care as a keystone of Universal Health Coverage. There is evidence that PHC works. Countries that followed the Alma Ata PHC principles have demonstrated population health outcomes and reduced inequalities at low costs as seen in Chile, Cuba, Ethiopia and Rwanda. What seems to be missing is leadership to apply and uphold these PHC principles. There is consensus that if Astana is to be realized, strong political, economic, education, health, science, institutional, and community leaders are needed to make PHC work this time around. Governments and leaders in Africa have been conveying a constant message, that those leading and managing health systems are not sufficiently prepared to succeed in leadership roles they now occupy. Africa has had different leaders with the same results for decades. Leadership development efforts made to date seem not to be producing desired results. Students taken out of Africa to be trained in leadership at western universities, seem to go back home and carry on as usual. Many students have been taken to the West for education, developed great visions and ideas of how they can transfer knowledge learnt, got home and got swallowed by the system. Pumping more money into a health system with no leadership development will not help us achieve ‘Health for All’ in sub-Saharan Africa. How can accountable leadership with a sense of consciousness for social justice be developed successfully in these contexts? If leadership is key for Universal Health Coverage to be achieved in sub-Saharan Africa, is it not high time attention is paid to leadership development approaches.

The Importance of Leadership Development in Medical Curricula: A UK Perspective (Stars are Aligning)

"Medical leadership and management" describes the engagement of doctors in the leadership and management of both individual patient care and of the departments, organizations and systems within which they work. Around the world, doctors are generally accepted as the leaders of clinical teams, holding ultimate accountability for individual patient care. However, the role of doctors as organizational and system leaders within healthcare, despite evidence of benefit, shows considerable variation. In this article, we briefly explore the history of leadership development for doctors, and then, taking a UK perspective on recent developments in undergraduate education and postgraduate training, consider the opportunities and challenges for medical schools, educators and doctors in implementing these. The future of medical leadership and management development is promising although there is still a lack of evidence on the longer-term outcomes and impact on patients of current interventions. It is clear, however, that faculty need to be skilled in holding effective developmental conversations and structuring formative experiences for those they educate, and that leadership development must be integrated longitudinally throughout a doctor's career, with undergraduate development being a critical stage for helping medical students recognize and understand their wider responsibility to the system, as well as the patient in front of them.

What makes an ideal hospital-based medical leader? Three views of healthcare professionals and managers: A case study

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.