Five hats of effective leaders: teacher, mentor, coach, supervisor and sponsor

BACKGROUND/AIM

Teaching, mentoring, coaching, supervising and sponsoring are often conflated in the literature. In this reflection, we clarify the distinctions, the benefits and the drawbacks of each approach. We describe a conceptual model for effective leadership conversations where leaders dynamically and deliberately 'wear the hats' of teacher, mentor, coach, supervisor and/or sponsor during a single conversation.

METHODS

As three experienced physician leaders and educators, we collaborated to write this reflection on how leaders may deliberately alter their approach during dynamic conversations with colleagues. Each of us brings our own perspective and lens.

RESULTS

We articulate how each of the 'five hats' of teacher, mentor, coach, supervisor and sponsor may help or hinder effectiveness. We discuss how a leader may 'switch' hats to engage, support and develop colleagues across an ever-expanding range of contexts and settings. We demonstrate how a leader might 'wear the five hats' during conversations about career advancement and burn-out.

CONCLUSION

Effective leaders teach, mentor, coach, supervise and sponsor during conversations with colleagues. These leaders employ a deliberate, dynamic and adaptive approach to better serve the needs of their colleagues at the moment.

Telemetry Bed Usage for Patients with Low-Risk Chest Pain: An Updated Review of the Literature for the Clinician

BACKGROUND

Telemetry monitoring in patients with low-risk chest pain continues to be highly used despite a 2011 literature review and recommendations by the Clinical Practice Committee (CPC) of the American Academy of Emergency Medicine that did not find quality data to support its use.

OBJECTIVE

To update the medical literature review on the utility of telemetry monitoring in patients with low-risk chest pain and to offer evidence-based recommendations to emergency physicians.

METHODS

A PubMed literature search was performed for systematic reviews in English relevant to low-risk chest pain between 2011 and 2019 and then expanded to all citations by removing the systematic review criteria. Studies identified then underwent a structured review from which results could be evaluated in the context of the associated 2011 literature review and CPC recommendations.

RESULTS

The initial search yielded 2 potentially relevant studies, although none directly addressed telemetry. The expanded search resulted in 76 abstracts that were screened. Two addressed telemetry, including the last CPC statement, which were reviewed and recommendations given.

CONCLUSIONS

No further quality data were identified to support the use of telemetry monitoring in patients with low-risk chest pains. Telemetry monitoring is unlikely to benefit patients with low-risk chest pain with a low-risk HEART Score.

Becoming a coach: experiences of faculty educators learning to coach medical students

BACKGROUND

Despite the growth of coaching in medical education, many questions remain about the process of becoming a coach for medical students. We sought to understand the process through which faculty acclimated to this new role, and what benefits and challenges they experienced.

METHODS

A multi-phase qualitative focus group study was conducted with 20 faculty at one medical school in the United States during the initial year coaching was implemented. Focus group transcripts were analyzed using the constant comparative approach to inductively identify themes from the data.

RESULTS

Four main benefits were reported by faculty: student guidance, identifying student issues early, helping students develop work-life balance, and fostering clinician connectivity, which was seen as benefitting both students and faculty. The two main challenges were uncertainty regarding how adaptive the coaching sessions should be, and difficulty engaging in some of the roles simultaneously, like mentoring and supervision.

CONCLUSIONS

Schools that develop academic medical student coaching programs should design faculty support around coaching and recognize that the process of becoming a coach may not be or feel straightforward for faculty. Overall, faculty found coaching to be rewarding despite challenges they experienced.

Alpha Omega Alpha Honor Medical Society: A Commitment to Inclusion, Diversity, Equity, and Service in the Profession of Medicine

With a motto of "Be Worthy to Serve the Suffering," Alpha Omega Alpha Honor Medical Society (AΩA) supports the importance, inclusion, and development of a culturally and ethnically diverse medical profession with equitable access for all. The underrepresentation of minorities in medical schools and medicine continues to be a challenge for the medical profession, medical education, and AΩA. AΩA has worked, and continues to work, to ensure the development of diverse leaders, fostering within them the objectivity and equity to be inclusive servant leaders who understand and embrace diversity in all its forms.Inclusion of talented individuals from different backgrounds benefits patient care, population health, education, and scientific discovery. AΩA values an inclusive, diverse, fair, and equitable work and learning environment for all and supports the medical profession in its work to achieve a welcoming, inclusive environment in teaching, learning, caring for patients, and collaboration.The diversity of medical schools is changing and will continue to change. AΩA is committed to continuing to work with its members, medical school deans, and AΩA chapters to assure that AΩA elections are unbiased and based on the values of AΩA and the profession of medicine in service to patients and the profession.Progress toward diversity, inclusion, and equity is more than simply checking off a box or responding to criticism-it is about being and developing diverse excellent physicians. AΩA and all those in the medical profession must continue to guide medicine to be unbiased, open, accepting, inclusive, and culturally aware in order to "Be Worthy to Serve the Suffering."

A Conceptual Model for Navigating a Career Path in Medical School Leadership

There is a paucity of literature providing guidance to physicians hoping to attain a position as a medical school dean. Realizing this gap, the Society for Academic Emergency Medicine (SAEM) Faculty Development Committee organized an educational session focused on offering faculty guidance for obtaining a position in medical school leadership. The session involved panelists who are nationally known leaders in medical school administration and was successfully presented at the SAEM 2018 annual meeting in Indianapolis, Indiana. Knowledge and perspective gained both during this session and through literature review was analyzed using a conceptual thinking skills framework. This process offered insights that promoted the development of a conceptual model informed by current evidence and expert insight and rooted in educational, economic, and cognitive theory. This model provides a step-by-step guide detailing a process that physicians can use to create a plan for professional development that is informed, thoughtful, and individualized to their own needs to optimize their future chances of advancing to a career in medical school leadership.

Neurology Concepts: Young Women and Ischemic Stroke-Evaluation and Management in the Emergency Department

OBJECTIVE

Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g., premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting.

METHODS

A panel of six board-certified emergency physicians, one with fellowship training in stroke and one with training in sex- and sex-based medicine, along with one vascular neurologist were coauthors involved in the paper. Each author used various search strategies (e.g., PubMed, PsycINFO, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors.

RESULTS

Estimates on the incidence of ischemic stroke in premenopausal women range from 3.65 to 8.9 per 100,000 in the United States. Several risk factors for ischemic stroke exist for young women including oral contraceptive (OCP) use and migraine with aura. Pregnancy and the postpartum period (up to 12 weeks) is also an important transient state during which risks for both ischemic stroke and cerebral hemorrhage are elevated, accounting for 18% of strokes in women under 35. Current evidence regarding the management of acute ischemic stroke in young women is also summarized including use of thrombolytic agents (e.g., tissue plasminogen activator) in both pregnant and nonpregnant individuals.

CONCLUSION

Unique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment of this population.

A Full-Capacity Protocol Allows for Increased Emergency Patient Volume and Hospital Admissions

PROBLEM

Our hospital was encountering problems with ED crowding. We sought to determine the impact of implementing a full-capacity protocol to respond to anticipated or actual crowding conditions. Our full-capacity protocol is based on collaboration among multiple hospital units.

METHODS

We completed a quality improvement initiative using a pre/post analysis of all ED patient encounters after implementing a full-capacity protocol with a corresponding period from the prior year. The principal outcomes measured were patient volume, admission rate, patient left without being seen (LWBS) rate, length of stay, and ambulance diversion hours.

RESULTS

In the post-full-capacity protocol period, a 7.4% increase in emergency patient encounters (P < .001) and an 11.9% increase in admissions (P < .001) were noted compared with the corresponding period in 2013. Also noted in the study period were a 10.2% decrease in LWBS rate (P = .29), an increase in length of stay of 34 minutes (P < .001), and a 92% decrease in ambulance diversion hours (111 fewer hours, P < .001).

IMPLICATIONS FOR PRACTICE

The collaborative full-capacity protocol was effective in reducing LWBS and ambulance diversion, while accommodating a significant increase in ED volume and increased hospital admission rates at our institution.

Health Supply Utilization at a Boy Scout Summer Camp: An Evaluation for Improvement and Preparedness

OBJECTIVE

To describe the health conditions treated by a health services center at a Boy Scout summer camp and make recommendations for appropriate resources and supplies.

METHODS

We conducted a retrospective review of health center utilization at a Boy Scout camp in central Missouri during the summers of 2012 and 2013. Health logbook data were compiled and analyzed using descriptive and comparative statistics.

RESULTS

During the study period 19,771 camp participants made 1586 visits to the health care center. The overall incidence rate of health center visits was 6.20 visits per 1000 camp days. Two-thirds of visits were for illness and the remainder for injury. Over 90% of patients were returned to camp, 7.3% were transferred to another health facility, and 1.6% were advised to leave camp and return home. The most common treatments were rehydration (17.8 %) and administration of analgesics (13.4%) and topical creams (12.3%).

CONCLUSIONS

Summer camps need to be prepared for a wide range of conditions and injuries in youth campers, leaders, and staff members. Over 90% of presenting complaints were managed on site, and the majority of conditions were easily treatable minor injuries and illnesses. We provide recommendations for appropriate medical supplies and suggest opportunities for improvement to aid health centers in planning and treatment.

Dental-related Emergency Department Visits and Community Dental Care Resources for Emergency Room Patients

BACKGROUND: The number and cost of dental-related visits to Emergency Departments (ED) is a significant issue nationwide. A better understanding of the treatment provided to ED patients presenting with dental complaints and community dental resources is needed. METHODS: A three-tiered approach included: 1) a 12-month retrospective chart review for dental-related ICD-9 visit codes at an urban academic ED in Kansas City; 2) surveys of 30 providers at the same ED regarding the dental patient process and treatment; and 3) telephone surveys of 16 Kansas City area safety net clinics regarding service access. RESULTS: Out of 49,276 ED visits, 676 were related to dental conditions (70 were repeat dental ED visits). Most patients were female (54%), white (45%), age 20-39 (65%), and self-pay (56%). The most prevalent codes utilized were dental disorder not otherwise specified (NOS; 57%), periapical abscess (22%), and dental caries NOS (15%). Nearly all providers (97%) felt comfortable seeing patients with dental complaints. Chart review indicated that patients received a dental screen/exam during 80% of the encounters, with medication provided to 90% of the patients. Over two-thirds of the providers (N = 23/30) regularly prescribed antibiotics and pain medications for their ED dental patients. ED providers performed dental procedures in 63% of the patient cases. The most common procedures included dental blocks (N = 16 providers) and incision and drainage (N = 4 providers). Only two of the 16 safety net clinics provided comprehensive dental care, almost all (94%) clinics required patients to call to schedule an appointment, and there was a two to six month waiting period for 31% of the clinics. CONCLUSION: The limited scope of dental treatment in the ED, coupled with poor availability of safety-net dental resources, may result in dental exacerbations and suboptimal patient clinical outcomes. The enhancement of safety-net dental service accessibility is crucial to reducing dental ED visits and improving dental health, particularly among low-income, self-pay populations.

Overnight and postcall errors in medication orders

OBJECTIVE

To compare the error rates in medication orders by physicians who were off call, on overnight call, and postcall.

METHODS

This was a retrospective review of inpatient medication orders, pharmacy records, and resident physician work schedules in a university-affiliated community teaching hospital with residency programs in emergency medicine, family practice, internal medicine, obstetrics, pediatrics, and surgery. The authors calculated error rates, odds ratios (ORs), and 95% confidence intervals (95% CIs) for physicians during April 2000.

RESULTS

In 8,195 medication orders, there were 177 errors (2.16% overall error rate). There was an increased error rate for overnight and postcall orders (2.71%, OR 1.44, 95% CI = 1.06 to 1.95) in comparison to orders written by off-call physicians (1.90%). Error rates were significantly higher on the medical/surgical wards during the overnight (3.91%, OR 1.89, 95% CI = 1.22 to 2.92) and postcall (3.41%, OR 1.64, 95% CI = 1.10 to 2.43) periods compared with the off-call (2.11%) period, and postgraduate year 1 (PGY1) physicians had a higher overnight error rate (4.23%, OR 2.28, 95% CI = 1.44 to 3.61). Error rates were also higher on the medical/surgical wards compared with critical care units (2.62% vs. 1.22%, OR 2.17, 95% CI = 1.48 to 3.18). The PGY1 physicians had error rates similar to those of the PGY2-5 physicians when off call, but were significantly higher on overnight call (4.23% vs. 0.52%, OR 8.47, 95% CI = 2.00 to 35.82).

CONCLUSIONS

Medication-ordering error rates were higher for overnight and postcall physicians, particularly on the general medical/surgical wards, and in PGY1 physicians during the overnight period.