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Ricotta DN, Freed JA, Hale AJ, Targan E, Smith CC, Huang GC. A Resident-as-Leader Curriculum for Managing Inpatient Teams. TEACHING AND LEARNING IN MEDICINE 2023; 35:73-82. [PMID: 35023796 DOI: 10.1080/10401334.2021.2009347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
PROBLEM Leading inpatient teams is a foundational clinical responsibility of resident physicians and leadership is a core competency for inpatient physicians, yet few training programs have formal leadership curricula to realize this clinical skill. INTERVENTION We implemented a 4-module curriculum for PGY1 internal medicine residents. The program focused on the managerial skills necessary for daily clinical leadership, followed by clinical coaching. Interns were first introduced to foundational concepts and then given the opportunity to apply those concepts to real-world practice followed by clinical coaching. CONTEXT Using direct-observations and a previously published checklist for rounds leadership, this study sought to evaluate the workplace behavior change for novice residents leading inpatient teams for the first time. We conducted a prospective cohort study (March 2016 and August 2018) of internal medicine residents at a large tertiary academic medical center in Boston, MA. Trained faculty raters performed direct observations of clinical rounding experiences using the checklist and compared the findings to historical and internal controls. Questionnaires were distributed pre- and post- curriculum to assess satisfaction and readiness to lead a team. IMPACT We trained 65 PGY1 residents and raters conducted 140 direct observations - 36 in the intervention group and 104 among historical controls. The unadjusted mean score in rounds leadership skills for the intervention group was 19.0 (SD = 5.1) compared to 16.2 (SD = 6.2) for historical controls. Adjusting for repeated measures, we found significant improvement in mean scores for behaviors linked to the curricular objectives (p = 0.008) but not for general behaviors not covered by the curriculum (p = 0.2). LESSONS LEARNED A formal curriculum to train residents as leaders led to behavior change in the workplace in domains essential to rounds leadership. We also found that the curriculum was highly regarded in that all interns indicated they would recommend the curriculum to a peer. Moreover, the program may have assuaged some anxiety during the transition to junior year as 90% of interns surveyed felt more ready to start PGY2 year than historical trainings. We learned that while a robust, multi-faceted modular curriculum and clinical coaching successfully resulted in behavior change, the resources required to manage this program are significant and difficult to sustain. Future iterations could include asynchronous material and potentially peer-observation of rounds leadership to reduce the burden on faculty and program curricular time.
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Affiliation(s)
- Daniel N Ricotta
- Carl J. Shapiro Institute for Education and Research, Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jason A Freed
- Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andrew J Hale
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Elizabeth Targan
- Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - C Christopher Smith
- Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Grace C Huang
- Carl J. Shapiro Institute for Education and Research, Department of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Jankelová N, Joniaková Z, Romanová A. The need for management education of healthcare management employees. Int J Health Plann Manage 2021; 37:301-317. [PMID: 34585433 DOI: 10.1002/hpm.3325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/09/2021] [Accepted: 08/23/2021] [Indexed: 11/09/2022] Open
Abstract
Given the wide professional discussion on the dominating professional focus of healthcare managers at the expense of management knowledge, the main goal of this paper is to verify the extent, to which management education of healthcare workers affects the level of their management skills. METHODOLOGY The Descriptive statistics methods have been used to answer research questions regarding the differences in the perception of the managerial skills and their disposition importance between managers with a completed management education and without it. Emphasis was placed on people management skills and communication skills. The research sample consisted of 253 healthcare managers. RESULTS Managers with a completed specialized management study are characterized by higher values of entrepreneurial competences and communication skills. They also have exceptional skills in the area of initiator of change. Another significant difference is the higher adaptation of roles and low critique of their subordinates. They are oriented at workers and relationships with them. CONCLUSION Our results show that management education of healthcare managers significantly contributes to the implementation of newer approaches to people management and the use of the necessary management skills, which are a source of higher efficiency in the context of the present world of work and its challenges.
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Affiliation(s)
- Nadežda Jankelová
- Department of Management, University of Economics in Bratislava, Bratislava, Slovakia
| | - Zuzana Joniaková
- Department of Management, University of Economics in Bratislava, Bratislava, Slovakia
| | - Anita Romanová
- Department of Information Management, University of Economics in Bratislava, Bratislava, Slovakia
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James E, Evans M, Mi M. Leadership Training and Undergraduate Medical Education: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2021; 31:1501-1509. [PMID: 34026307 PMCID: PMC8131083 DOI: 10.1007/s40670-021-01308-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 05/09/2023]
Abstract
The purpose of this scoping review is to fill the gap in understanding the current status of intervention-based studies regarding leadership training in undergraduate medical education. As of late, there is an increased focus on the role of physicians as leaders in their fields, and communities. In order to evaluate these studies, both the PubMed and ERIC databases were searched, and an ultimate total of 35 articles methodologies were evaluated for their general methodology, curricular content, specific teaching methods, and evaluation methodologies. There were a number of trends identified, as well as remaining gaps. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01308-9.
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Affiliation(s)
- Eric James
- Oakland University, William Beaumont School of Medicine, Rochester, MI USA
| | - Mallory Evans
- Oakland University, William Beaumont School of Medicine, Rochester, MI USA
| | - Misa Mi
- Department of Foundational Medical Studies, Oakland University, William Beaumont School of Medicine, Rochester, MI USA
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Barnes T, Yu TCW, Webster CS. Are We Preparing Medical Students for Their Transition to Clinical Leaders? A National Survey. MEDICAL SCIENCE EDUCATOR 2021; 31:91-99. [PMID: 34457869 PMCID: PMC8368867 DOI: 10.1007/s40670-020-01122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Leadership is important for organisational teams and patient safety. We aimed to identify leadership behaviours that medical students are developing and consider whether these prepare new graduates to become leaders. METHODS We conducted a mixed methods study using an online questionnaire comprising the Clinical Leadership Survey and additional free-text questions. All New Zealand fifth-year medical students and junior doctors (postgraduate year one) were invited to participate. Our analysis used non-parametric testing and general thematic analysis. RESULTS Seventy-five students and 43 doctors participated. Participants neither agreed nor disagreed that they were clinical leaders (3 vs 3, n.s.). Students were less sure they used clinical leadership behaviours than doctors (4 vs 3, p = 0.014), but all were using transformational leadership behaviours in clinical environments (60 vs 63 out of a maximum of 75, n.s.). Thirty percent could not give an example of acting as clinical leaders, but 97% described using leadership-type behaviours. Thematic analysis yielded four clinical leadership themes: advocacy, collaboration, leading the way and individualism. DISCUSSION Undergraduates appear to be developing and practicing transformational leadership behaviours and junior doctors associate leadership with their role. Participants were unaware of several important leadership behaviours, which could be further developed within an explicit structured curriculum.
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Affiliation(s)
- Tracey Barnes
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Private Bag 92-019, Auckland, 1142 New Zealand
- Department of General Surgery, Dunedin Hospital, Dunedin, New Zealand
| | - Tzu-Chieh Wendy Yu
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Private Bag 92-019, Auckland, 1142 New Zealand
| | - Craig S. Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Private Bag 92-019, Auckland, 1142 New Zealand
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Alzahrani SH, Baig M, Omer AR, Algethami MR. Medical Students' perceptions and attitudes toward Medical Leadership and Management. Pak J Med Sci 2020; 37:223-228. [PMID: 33437281 PMCID: PMC7794128 DOI: 10.12669/pjms.37.1.2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: To find out medical students’ perceptions and attitudes toward medical leadership and management (MLM). Methods: A total of 336 medical students from the 2nd to 6th academic years from King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia (KSA), were included in this cross-sectional study. This study was conducted in January-February 2020. The students were asked about their perceptions, attitudes, and interests in the leadership of medical care and clinicians. A four-part questionnaire was used for collecting data. SPSS-21 was used for analysis. Results: The participants included 172 (51.2%) males and 164 (48.8%) females. In total, 105 (31.3%) participants agreed that they had been very well educated about their perception, behavior, and interest in the field of medical leadership and clinic management, and 175 (52.1%) students agreed that clinicians should influence management decisions in a healthcare setting. Overall, 167 (49.7%) students agreed that management/leadership skills are important for clinicians. In total, 145 students (43.2%) desired to have more leadership training in medical school, and 129 (38.4%) students agreed to seek additional leadership/management training in their postgraduate research studies. When asked about their self-perception of good leadership skills, the students indicated that good leadership skills included integrity (47.9%), conflict resolution (46.7%), organization (44.4%), confidence (41.9%), communication (40.5%), self-reflection (40.2%), time management (33.6%), the ability to motivate others (36.9%), and the ability to keep calm under stress (33.3%). Conclusion: Many students were well aware of the MLM concepts. However, students agreed that management/leadership skills are important for clinicians, and there should be more leadership training in medical schools.
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Affiliation(s)
- Sami Hamdan Alzahrani
- Dr. Sami Hamdan Alzahrani, SBFM, ABFM. Assistant Professor, Consultant, Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mukhtiar Baig
- Dr. Mukhtiar Baig, PhD. Department of Clinical Biochemistry/Medical Education, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anoud R Omer
- Dr. Anoud Rashad Omer, MD. Clinical Research Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohammed R Algethami
- Dr. Mohammed Ridha Algethami, MD. Preventive Medicine Resident, Joint Program Ministry of Health, Saudi Arabia
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Mangrulkar RS, Tsai A, Cox SM, Halaas GW, Nelson EA, Nesse RE, Silvestri RC, Radabaugh CL, Skochelak S, Beck Dallaghan GL, Steiner B. A Proposed Shared Vision for Leadership Development for all Medical Students: A Call from a Coalition of Diverse Medical Schools. TEACHING AND LEARNING IN MEDICINE 2020; 32:561-568. [PMID: 32363950 DOI: 10.1080/10401334.2020.1754835] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Issue: Despite clear relevance, need, descriptive literature, and student interest, few schools offer required curriculum to develop leadership skills. This paper outlines a proposed shared vision for leadership development drawn from a coalition of diverse medical schools. We advocate that leadership development is about self (looking inward), teams (not hierarchy), and change (looking outward). We propose that leadership development is for all medical students, not for a subset, and we believe that leadership curricula and programs must be experiential and applied. Evidence: This paper also draws on the current literature and the experience of medical schools participating in the American Medical Association's (AMA) Accelerating Change in Medical Education Consortium, confronts the common arguments against leadership training in medical education, and provides three cross-cutting principles that we believe must each be incorporated in all medical student-centered leadership development programs as they emerge and evolve at medical schools. Implications: By confronting common arguments against leadership training and providing a framework for such training, we give medical educators important tools and insights into developing leadership training for all students at their institutions.
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Affiliation(s)
- Rajesh S Mangrulkar
- Departments of Internal Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Antonius Tsai
- Leadership Development and Education Strategy, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Susan M Cox
- Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Gwen W Halaas
- Academic Affairs, Washington State University, Spokane, WA, USA
| | - Elizabeth A Nelson
- Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Robert E Nesse
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronald C Silvestri
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie L Radabaugh
- Medical Education Programs, American Medical Association, Chicago, Illinois, USA
| | - Susan Skochelak
- Medical Education, American Medical Association, Chicago, Illinois, USA
| | - Gary L Beck Dallaghan
- Educational Scholarship, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Beat Steiner
- Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Lee TC, Reyna C, Shah SA, Lewis JD. The road to academic surgical leadership: Characteristics and experiences of surgical chairpersons. Surgery 2020; 168:707-713. [PMID: 32660864 DOI: 10.1016/j.surg.2020.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/07/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The evolving landscape of academic surgery demands leaders who are not only effective clinicians and researchers, but also administrators able to navigate complex hospital organizations, financial pressures in the era of quality measures, and inclusion of an increasingly diverse workforce. The aim of this study was to characterize achievements and assess perspectives in becoming a surgical chair in order to guide young surgeons in their career trajectories to surgical leadership. METHODS A survey encompassing demographics, surgical training, nonmedical advanced degrees, academic advancement, and leadership experiences was sent via electronic mail to members of the American College of Surgeons Society of Surgical Chairs in December 2018. RESULTS Of 191 Society of Surgical Chairs members, 52 (27.2%) completed the survey, with 6 (11.5%) women, 40 (76.9%) white, and the majority becoming chair between ages 46 and 60 (n = 39, 75.0%). Training beyond residency included fellowships (n = 41, 78.8%) and advanced nonmedical degrees (n = 15, 28.8%). Median H-index was 47 (range 10-120) with 126 (5-500) research publications, and grants received was 2 (0-38) for federal and 5 (0-43) for industry. Female chairs appear to have fewer nonmedical degrees (n = 1) and no difference in age at becoming chair (66.7% vs 79.6% between ages 46 and 60), H-index (26 [10-41] vs 49 [17-120]), or publications (93 [10-189] vs 150 [5,500]). Prior educational (n = 36, 69.2%) and clinical (n = 44, 84.6%) leadership roles were common, with 30 chairs (57.7%) having held both roles. Experiences which respondents felt have most helped them function as chair included serving as a clinical division director (n = 37, 71.2%), residency program director (n = 28, 53.8%), leadership courses (n = 28, 53.8%), a research career (n = 22, 42.3%), and being a vice/interim chair (n = 15, 28.8%). Personal traits felt to be most important in becoming a successful chair included being effective at communication (n = 37, 71.2%), collaborative (n = 35, 67.3%), trustworthy (n = 30, 57.7%), and a problem-solver (n = 27, 51.9%). CONCLUSION Becoming a department surgical chair often involves not only surgical subspecialty expertise, but also nonmedical training and prior leadership roles, which help facilitate development of skills integral to navigating the collaborative and diverse nature of academic surgery in the current era.
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Affiliation(s)
- Tiffany C Lee
- Department of Surgery, University of Cincinnati College of Medicine, OH
| | - Chantal Reyna
- Department of Surgery, University of Cincinnati College of Medicine, OH
| | - Shimul A Shah
- Department of Surgery, University of Cincinnati College of Medicine, OH
| | - Jaime D Lewis
- Department of Surgery, University of Cincinnati College of Medicine, OH.
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Ricotta DN, Ranchoff BL, Beltran CP, Hale AJ, Freed JA, Huang GC. The Mindful Manager: Validation of a Rounding Leadership Instrument for Residents. J Gen Intern Med 2020; 35:1161-1166. [PMID: 31898139 PMCID: PMC7174453 DOI: 10.1007/s11606-019-05348-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In the context of inpatient general medicine, "rounding" refers to the process of seeing, assessing, and caring for patients as a team. The clinical leadership skills required of residents to lead rounds are essential to inpatient care and clinical education. Assessment of these skills has relevance to developing competent physicians; however, there is an absence of widely accepted tools to specifically measure this competency. OBJECTIVE To develop and collect validity evidence for a direct observation instrument of internal medicine residents' leadership skills during daily inpatient care rounds for future formative assessment. DESIGN Prospective observational study. PARTICIPANTS PGY2 and PGY3 internal medicine residents. MAIN MEASURES The authors collected inferences of validity evidence according to Kane's validity model. They performed direct observations of PGY2 and PGY3 residents by individual faculty and trained raters and measured inter-rater reliability, using the kappa statistic. Mixed linear regression models were used to compare PGY2 and PGY3 residents. Surveys captured faculty perceptions about value of the instrument. KEY RESULTS A total of 223 observations were performed in 92 unique individuals. Twenty-four faculty used the observation instrument, of which 18 (75%) completed the post-survey, and 100% agreed that the instrument represented the resident's global leadership abilities. Inter-rater reliability was strong, with an overall kappa statistic equaling 0.82. The mean performance for PGY2 and PGY3 residents was 15.9 (SD 5.1) and 17.7 (SD 4.1), respectively. Adjusting for repeated measures, there was no statistically significant difference between groups. CONCLUSIONS The authors reported evidence for all four stages of validity and use of the instrument in clinical practice. Their work provides a codification of best practices of rounding leadership, which directly impacts the education of trainees, care of hospitalized patients, and use for formative assessment. The instrument also has the potential to be used for summative assessment.
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Affiliation(s)
- Daniel N Ricotta
- Department of Medicine Beth, Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Carl J. Shapiro Institute for Education and Research, Boston, MA, USA.
| | - Brittany L Ranchoff
- Department of Medicine Beth, Israel Deaconess Medical Center, Boston, MA, USA
- Carl J. Shapiro Institute for Education and Research, Boston, MA, USA
| | - Christine P Beltran
- Department of Medicine Beth, Israel Deaconess Medical Center, Boston, MA, USA
- Carl J. Shapiro Institute for Education and Research, Boston, MA, USA
| | - Andrew J Hale
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Jason A Freed
- Department of Medicine Beth, Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Grace C Huang
- Department of Medicine Beth, Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Carl J. Shapiro Institute for Education and Research, Boston, MA, USA
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Barnes T, Yu TCW, Webster CS. Preparedness of medical students and junior doctors for their role as clinical leaders: A systematic review. MEDICAL TEACHER 2020; 42:79-85. [PMID: 31566997 DOI: 10.1080/0142159x.2019.1665632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction: Clinical leadership skills are essential across all levels of a healthcare organization and must be employed by those most appropriate to the situation, regardless of position or profession. However, most medical students and junior doctors remain unaware of how leadership can be assimilated into their everyday clinical practice.Aim: To investigate the perceived preparedness of medical students and junior doctors for their role as clinical leaders.Methods: A systematic search was performed of the MEDLINE, ERIC and PubMed databases. Papers pertaining to medical students and junior doctors that included primary data on preparedness for clinical leadership or behaviors associated with being a clinical leader were included.Results: Sixteen papers were included and analyzed after screening 254. No studies specifically assessed the transition to clinical leader. Evidence suggests that new graduates perceive leadership as individualistic and hierarchical, and that they are only partially prepared to fill this role. Preparedness for clinical leadership was associated with increasing responsibility, experience and time-served.Conclusions: New graduates are unlikely to question senior colleagues as they lack leadership-specific communication skills. Further research is required into how to actively promote leadership in medical students and ease the transition to leadership roles within clinical teams.
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Affiliation(s)
- Tracey Barnes
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
- Department of General Surgery, Dunedin Hospital, Dunedin, New Zealand
| | - Tzu-Chieh Wendy Yu
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
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Vitous CA, Shubeck S, Kanters A, Mulholland M, Dimick JB. Reflections on a leadership development program: Impacts on culture in a surgical environment. Surgery 2019; 166:721-725. [DOI: 10.1016/j.surg.2019.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/08/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
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Zyblewski SC, Callow L, Beke DM, Jain P, Madathil SB, Schwartz S, Tabbutt S, Bronicki RA. Education and Training in Pediatric Cardiac Critical Care: International Perspectives. World J Pediatr Congenit Heart Surg 2019; 10:769-777. [PMID: 31663839 DOI: 10.1177/2150135119881369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric cardiac intensive care is an evolving and maturing field. There have been advances in education and training in recent years, specifically progress toward standardization of curricula, competencies, and certifications. International partnerships have fostered similar advancements in less resourced countries. For all disciplines and levels of expertise, simulation remains a versatile and effective modality in education. Although there is improved standardization for the training of physicians and nurses, the certification process remains undetermined.
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Affiliation(s)
- Sinai C Zyblewski
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Louise Callow
- Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Dorothy M Beke
- Cardiac Intensive Care, Boston Children's Hospital, Boston, MA, USA
| | - Parag Jain
- Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | - Steven Schwartz
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Tabbutt
- Division of Critical Care Medicine, Benioff Children's Hospital, University of California, San Francisco, CA, USA
| | - Ronald A Bronicki
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Myers CG, Sutcliffe KM, Ferrari BT. Treating the "Not-Invented-Here Syndrome" in Medical Leadership: Learning From the Insights of Outside Disciplines. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1416-1418. [PMID: 31274525 DOI: 10.1097/acm.0000000000002860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Physicians are being increasingly called upon to engage in leadership at all levels of modern health organizations, leading many to call for greater research and training interventions regarding physician leadership development. Yet, within these calls to action, the authors note a troubling trend toward siloed, medicine-specific approaches to leadership development and a broad failure to learn from the evidence and insight of other relevant disciplines, such as the organizational sciences. The authors describe how this trend reflects what has been called the "not-invented-here syndrome" (NIHS)-a commonly observed reluctance to adopt and integrate insights from outside disciplines-and highlight the pitfalls of NIHS for effective physician leadership development. Failing to learn from research and interventions in the organizational sciences inhibits physician leadership development efforts, leading to redundant rediscoveries of known insights and reinventions of existing best practices. The authors call for physician leaders to embrace ideas that are "proudly developed elsewhere" and work with colleagues in outside disciplines to conduct collaborative research and develop integrated training interventions to best develop physician leaders who are prepared for the complex, dynamic challenges of modern health care.
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Affiliation(s)
- Christopher G Myers
- C.G. Myers is assistant professor, Carey Business School and School of Medicine, and core faculty, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland; ORCID: 0000-0001-7788-8595. K.M. Sutcliffe is Bloomberg Distinguished Professor, Carey Business School and School of Medicine, and core faculty, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland. B.T. Ferrari is dean emeritus, Carey Business School, Johns Hopkins University, Baltimore, Maryland
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Nelson DE, Faupel-Badger JM, Izmirlian G. Leadership Roles and Activities Among Alumni Receiving Postdoctoral Fellowship Training in Cancer Prevention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:526-534. [PMID: 29492801 DOI: 10.1007/s13187-018-1335-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study was conducted in 2016-2017 to better understand formal and informal leadership roles and activities of alumni from postdoctoral research training programs in cancer prevention. Data were obtained from surveys of 254 employed scientists who completed cancer prevention postdoctoral training within the National Cancer Institute (NCI) Cancer Prevention Fellowship Program, or at US research institutions through NCI-sponsored National Research Service Award (NRSA) individual postdoctoral fellowship (F32) grants, from 1987 to 2011. Fifteen questions categorized under Organizational Leadership, Research Leadership, Professional Society/Conference Leadership, and Broader Scientific/Health Community Leadership domains were analyzed. About 75% of respondents had at least one organizational leadership role or activity during their careers, and 13-34% reported some type of research, professional society/conference, or broader scientific/health community leadership within the past 5 years. Characteristics independently associated with leadership from regression models were being in earlier postdoctoral cohorts (8 items, range for statistically significant ORs = 2.8 to 10.8) and employment sector (8 items, range for statistically significant ORs = 0.4 to 11.7). Scientists whose race/ethnicity was other than white were less likely to report organizational leadership or management responsibilities (OR = 0.4, 95% CI 0.2-0.9). Here, many alumni from NCI-supported cancer prevention postdoctoral programs were involved in leadership, with postdoctoral cohort and employment sector being the factors most often associated with leadership roles and activities. Currently, there is relatively little research on leadership roles of biomedical scientists in general, or in cancer prevention specifically. This study begins to address this gap and provide a basis for more extensive studies of leadership roles and training of scientists.
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Affiliation(s)
- David E Nelson
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jessica M Faupel-Badger
- Postdoctoral Research Associate Program, National Institute of General Medical Sciences, National Institutes of Health, 45 Center Drive, Bethesda, MD, 20892-6200, USA.
| | - Grant Izmirlian
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Hartzell JD, Gilbert L. Recognizing the Importance of Leadership: A Recent Graduate Develops a Corpsman. Mil Med 2019; 183:3-4. [PMID: 29401333 DOI: 10.1093/milmed/usx028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/23/2017] [Indexed: 11/12/2022] Open
Abstract
There is a growing interest in leadership development within the field of medicine both within the military and the larger medical community. Recognition of the importance of leadership training during graduate medical education has grown, but many residents and faculty still argue that residency training should focus on clinical skills and medical knowledge. Most graduates of training programs in the military quickly find themselves in formal leadership positions or they must informally lead in their clinical practice. As these new graduates enter practice, they quickly realize the need to be able to effectively lead. In order to highlight some of the leadership challenges that junior military physicians face, Military Medicine is starting a new column called "Leadership Lessons from the Field." This article is the first in the series and discusses a recent graduate's experience in dealing with an underperforming corpsman. The article reviews the importance of emotional intelligence, feedback, and goal setting.
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Affiliation(s)
- Joshua D Hartzell
- Department of Internal Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda MD 20814. E-mail:
| | - Laura Gilbert
- Department of Internal Medicine, U.S. Naval Hospital Guam, Bldg 50, Farenholt Ave, Tutuhan, GU 96910
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Gordon L, Rees C, Ker J, Cleland J. Using video-reflexive ethnography to capture the complexity of leadership enactment in the healthcare workplace. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1101-1121. [PMID: 28039588 PMCID: PMC5663839 DOI: 10.1007/s10459-016-9744-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/20/2016] [Indexed: 06/01/2023]
Abstract
Current theoretical thinking asserts that leadership should be distributed across many levels of healthcare organisations to improve the patient experience and staff morale. However, much healthcare leadership education focusses on the training and competence of individuals and little attention is paid to the interprofessional workplace and how its inherent complexities might contribute to the emergence of leadership. Underpinned by complexity theory, this research aimed to explore how interprofessional healthcare teams enact leadership at a micro-level through influential acts of organising. A whole (interprofessional) team workplace-based study utilising video-reflexive ethnography occurred in two UK clinical sites. Thematic framework analyses of the video data (video-observation and video-reflexivity sessions) were undertaken, followed by in-depth analyses of human-human and human-material interactions. Data analysis revealed a complex interprofessional environment where leadership is a dynamic process, negotiated and renegotiated in various ways throughout interactions (both formal and informal). Being able to "see" themselves at work gave participants the opportunity to discuss and analyse their everyday leadership practices and challenge some of their sometimes deeply entrenched values, beliefs, practices and assumptions about healthcare leadership. These study findings therefore indicate a need to redefine the way that medical and healthcare educators facilitate leadership development and argue for new approaches to research which shifts the focus from leaders to leadership.
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Affiliation(s)
- Lisi Gordon
- School of Management, University of St Andrews, The Gateway, North Haugh, St Andrews, KY16 9RJ, Scotland, UK.
| | - Charlotte Rees
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jean Ker
- NHS Education for Scotland, East Region Ninewells Hospital, Dundee, Scotland, UK
| | - Jennifer Cleland
- Institute of Education in Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
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Saravo B, Netzel J, Kiesewetter J. The need for strong clinical leaders - Transformational and transactional leadership as a framework for resident leadership training. PLoS One 2017; 12:e0183019. [PMID: 28841662 PMCID: PMC5571931 DOI: 10.1371/journal.pone.0183019] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 07/28/2017] [Indexed: 12/05/2022] Open
Abstract
Background For the purpose of providing excellent patient care, residents need to be strong, effective leaders. The lack of clinical leadership is alarming given the detrimental effects on patient safety. The objective of the study was to assess whether a leadership training addressing transactional and transformational leadership enhances leadership skills in residents. Methods A volunteer sample of 57 residents from postgraduate year one to four was recruited across a range of medical specialties. The residents took part in an interventional controlled trial. The four-week IMPACT leadership training provided specific strategies for leadership in the clinical environment, addressing transactional (e.g. active control, contingent reward) and transformational leadership skills (e.g. appreciation, inspirational motivation). Transactional and transformational leadership skill performance was rated (1) on the Performance Scale by an external evaluator blinded to the study design and (2) self-assessed transformational and transactional leadership skills. Both measures contained items of the Multifactor Leadership Questionnaire, with higher scores indicating greater leadership skills. Results Both scores were significantly different between the IMPACT group and the control group. In the IMPACT group, the Performance Scale increased 15% in transactional leadership skill performance (2.10 to 2.86) (intervention effect, 0.76; 95% CI, 0.40 to 1.13; p < .001, eta2 = 0.31) and 14% in transformational leadership skill performance (2.26 to 2.94) (intervention effect, 0.68; 95% CI, 0.27 to 1.09; p < .001, eta2 = 0.22). The self-assessed transactional skills revealed a 4% increase (3.83 to 4.03) (intervention effect, 0.20; 95% CI, 0.08 to 0.33; p < .001, eta2 = 0.18) and a 6% increase in transformational leadership skills (3.54 to 3.86) (intervention effect, 0.31; 95% CI, 0.02 to 0.40; p< .001, eta2 = 0.53). Discussion and conclusions These findings support the use of the transactional and transformational leadership framework for graduate leadership training. Future studies should incorporate time-latent post-tests, evaluating the stability of the behavioral performance increase.
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Affiliation(s)
- Barbara Saravo
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Janine Netzel
- Center for Leadership and People Management, Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
| | - Jan Kiesewetter
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Ludwig-Maximilians-Universität München, Munich, Bavaria, Germany
- * E-mail:
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Green ML, Winkler M, Mink R, Brannen ML, Bone M, Maa T, Arteaga GM, McCabe ME, Marcdante K, Schneider J, Turner DA. Defining leadership competencies for pediatric critical care fellows: Results of a national needs assessment. MEDICAL TEACHER 2017; 39:486-493. [PMID: 28281362 DOI: 10.1080/0142159x.2017.1297527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Physicians in training, including those in Pediatric Critical Care Medicine, must develop clinical leadership skills in preparation to lead multidisciplinary teams during their careers. This study seeks to identify multidisciplinary perceptions of leadership skills important for Pediatric Critical Care Medicine fellows to attain prior to fellowship completion. METHODS We performed a multi-institutional survey of Pediatric Critical Care Medicine attendings, fellows, and nurses. Subjects were asked to rate importance of 59 leadership skills, behaviors, and attitudes for Pediatric Critical Care practitioners and to identify whether these skills should be achieved before completing fellowship. Skills with the highest ratings by respondents were deemed essential. RESULTS Five hundred and eighteen subjects completed the survey. Of 59 items, only one item ("displays honesty and integrity") was considered essential by all respondents. When analyzed by discipline, nurses identified 21 behaviors essential, fellows 3, and attendings 1 (p < 0.05). Nurses differed (p < 0.05) from attendings in their opinion of importance in 64% (38/59) of skills. CONCLUSIONS Despite significant variability among Pediatric Critical Care attendings, fellows, and nurses in identifying which clinical leadership competencies are important for graduating Pediatric Critical Care fellows, they place the highest importance on skills in self-management and self-awareness. Leadership skills identified as most important may guide the development of interventions to improve trainee education and interprofessional care.
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Affiliation(s)
- Michael L Green
- a Department of Pediatrics, Division of Critical Care Medicine , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Margaret Winkler
- b Department of Pediatrics, Division of Critical Care Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Richard Mink
- c Division of Pediatric Critical Care Medicine , Harbor-UCLA Medical Center , Torrance , CA , USA
- d David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
| | | | - Meredith Bone
- f Division of Pediatric Critical Care , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Tensing Maa
- g Division of Critical Care Medicine at Nationwide Children's Hospital , The Ohio State University College of Medicine , Columbus , OH , USA
| | - Grace M Arteaga
- h Division of Pediatric Critical Care Medicine , Mayo Clinic , Rochester , MN , USA
| | - Megan E McCabe
- i Department of Pediatrics Division of Critical Care Medicine , Albert Einstein School of Medicine/Children's Hospital at Montefiore , Bronx , NY , USA
| | - Karen Marcdante
- j Department of Pediatrics , Medical College of Wisconsin , Milwaukee , WI , USA
| | - James Schneider
- k Department of Pediatrics Division of Critical Care Medicine, Hofstra-Northwell School of Medicine , Cohen Children's Medical Center , New Hyde Park , NY , USA
| | - David A Turner
- l Duke University Hospital and Health System , Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital , Durham , NC , USA
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Cadieux DC, Lingard L, Kwiatkowski D, Van Deven T, Bryant M, Tithecott G. Challenges in Translation: Lessons from Using Business Pedagogy to Teach Leadership in Undergraduate Medicine. TEACHING AND LEARNING IN MEDICINE 2017; 29:207-215. [PMID: 27813682 DOI: 10.1080/10401334.2016.1237361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PROBLEM Leadership is increasingly recognized as a core physician competency required for quality patient care, continual system improvement, and optimal healthcare team performance. Consequently, integration of leadership into medical school curriculum is becoming a priority. This raises the question of the appropriate context, timing, and pedagogy for conveying this competency to medical students. INTERVENTION Our program introduced a 1-week leadership course grounded in business pedagogy to Year 1 medical students. The curriculum centred on four themes: (a) Understanding Change, (b) Effective Teamwork, (c) Leading in Patient Safety, and (d) Leadership in Action. Post-curriculum qualitative student feedback was analyzed for insight into student satisfaction and attitude towards the leadership course content. CONTEXT The Undergraduate Medical Education program of the Schulich School of Medicine & Dentistry, Western University, is delivered over 4 years across 2 campuses in London and Windsor, Ontario, Canada. Course structure moved from traditional passive lectures to established business pedagogy, which involves active engagement in modules, case-based discussions, insights from guest speakers, and personal reflection. OUTCOME A student-led survey evaluated student opinion regarding the leadership course content. Students valued career development reading materials and insights from guest speakers working in healthcare teams. Students did not relate to messages from speakers in senior healthcare leadership positions. Course scheduling late in the second semester was viewed negatively. Overall student opinion suggested that the 1-week course was suboptimal for establishing leadership principles and translated business pedagogy was ineffective in this context. LESSONS LEARNED Leadership curriculum in Undergraduate Medical Education should be grounded in a healthcare context relevant to the student's stage of training. Student engagement may be better supported if leadership is framed as a competency throughout their career. Schools considering such innovations could draw lessons from other professional schools and utilize material and faculty that resonate with students.
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Affiliation(s)
- Dani C Cadieux
- a Schulich School of Medicine & Dentistry, Western University , London , Ontario , Canada
| | - Lorelei Lingard
- b Centre for Education Research & Innovation, Western University , London , Ontario , Canada
| | - Daniela Kwiatkowski
- a Schulich School of Medicine & Dentistry, Western University , London , Ontario , Canada
| | - Teresa Van Deven
- a Schulich School of Medicine & Dentistry, Western University , London , Ontario , Canada
| | - Murray Bryant
- c Ivey Business School, Western University , London , Ontario , Canada
| | - Gary Tithecott
- a Schulich School of Medicine & Dentistry, Western University , London , Ontario , Canada
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Murphy KR, McManigle JE, Wildman-Tobriner BM, Little Jones A, Dekker TJ, Little BA, Doty JP, Taylor DC. Design, implementation, and demographic differences of HEAL: a self-report health care leadership instrument. J Healthc Leadersh 2016; 8:51-59. [PMID: 29355186 PMCID: PMC5741008 DOI: 10.2147/jhl.s114360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The medical community has recognized the importance of leadership skills among its members. While numerous leadership assessment tools exist at present, few are specifically tailored to the unique health care environment. The study team designed a 24-item survey (Healthcare Evaluation & Assessment of Leadership [HEAL]) to measure leadership competency based on the core competencies and core principles of the Duke Healthcare Leadership Model. A novel digital platform was created for use on handheld devices to facilitate its distribution and completion. This pilot phase involved 126 health care professionals self-assessing their leadership abilities. The study aimed to determine both the content validity of the survey and the feasibility of its implementation and use. The digital platform for survey implementation was easy to complete, and there were no technical problems with survey use or data collection. With regard to reliability, initial survey results revealed that each core leadership tenet met or exceeded the reliability cutoff of 0.7. In self-assessment of leadership, women scored themselves higher than men in questions related to patient centeredness (P=0.016). When stratified by age, younger providers rated themselves lower with regard to emotional intelligence and integrity. There were no differences in self-assessment when stratified by medical specialty. While only a pilot study, initial data suggest that HEAL is a reliable and easy-to-administer survey for health care leadership assessment. Differences in responses by sex and age with respect to patient centeredness, integrity, and emotional intelligence raise questions about how providers view themselves amid complex medical teams. As the survey is refined and further administered, HEAL will be used not only as a self-assessment tool but also in “360” evaluation formats.
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Affiliation(s)
- Kelly R Murphy
- Duke Healthcare Leadership Program, Duke University School of Medicine, Durham, NC, USA
| | - John E McManigle
- Duke Healthcare Leadership Program, Duke University School of Medicine, Durham, NC, USA
| | | | - Amy Little Jones
- Duke Healthcare Leadership Program, Duke University School of Medicine, Durham, NC, USA
| | - Travis J Dekker
- Duke Healthcare Leadership Program, Duke University School of Medicine, Durham, NC, USA
| | - Barrett A Little
- Duke Healthcare Leadership Program, Duke University School of Medicine, Durham, NC, USA
| | - Joseph P Doty
- Duke Healthcare Leadership Program, Duke University School of Medicine, Durham, NC, USA
| | - Dean C Taylor
- Duke Healthcare Leadership Program, Duke University School of Medicine, Durham, NC, USA
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Monroe-Wise A, Mashalla Y, O’Malley G, Nathanson N, Seloilwe E, Gachuno O, Odero T, Nakanjako D, Sewankambo N, Tarimo E, Urassa D, Manabe YC, Chapman S, Voss JG, Wasserheit J, Farquhar C. Training tomorrow's leaders in global health: impact of the Afya Bora Consortium Fellowship on the careers of its alumni. BMC MEDICAL EDUCATION 2016; 16:241. [PMID: 27643589 PMCID: PMC5028919 DOI: 10.1186/s12909-016-0750-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/19/2016] [Indexed: 05/30/2023]
Abstract
BACKGROUND Effective leadership is a cornerstone of successful healthcare delivery in resource limited settings throughout the world. However, few programs in Africa prepare healthcare professionals with the leadership skills vital to the success of the healthcare systems in which they work. One such program, the Afya Bora Consortium Fellowship in Global Health Leadership, has been training health professionals since 2011. The purpose of this study was to assess what career changes, if any, the Afya Bora Fellowship's alumni have experienced since completing the fellowship, and to describe those changes. METHODS The Afya Bora Fellowship is a multidisciplinary, one-year training program that teaches health professionals leadership skills through didactic and experiential learning in four African countries. Between January 2011 and June 2013 the consortium trained 42 nurses and doctors. In November 2013, an electronic survey was sent to all alumni to assess their performance in the workplace post-fellowship. RESULTS Thirty-one (74 %) of 42 alumni completed surveys. Twenty-one (68 %) reported changes to their position at work; of those, sixteen (76 %) believed the change was due to participation in the fellowship. All alumni reported improved performance at work, and cited the application of a wide range of fellowship skills, including leadership, research, communication, and mentoring. Twenty-six (84 %) alumni spearheaded improvements in their workplaces and almost all (97 %) remained in contact with colleagues from the fellowship. Among the respondents there were five publications, nine manuscripts in preparation, and three international conference presentations. CONCLUSIONS Afya Bora alumni overwhelmingly reported that the one year fellowship positively influenced both their work and career trajectory. Training health professionals in leadership skills through didactic modules with the opportunity to apply learned skills at attachment sites in the Afya Bora Fellowship has an impact on performance in the workplace and the potential to improve long-term institutional capacity.
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Affiliation(s)
- Aliza Monroe-Wise
- Departments of Medicine and Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104-2499 USA
| | - Yohana Mashalla
- Department of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Neal Nathanson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Esther Seloilwe
- School of Nursing, University of Botswana, Gaborone, Botswana
| | - Onesmus Gachuno
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Theresa Odero
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Damalie Nakanjako
- Department of Internal Medicine, Makerere University, Kampala, Uganda
| | | | - Edith Tarimo
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - David Urassa
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yukari C. Manabe
- Department of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Susan Chapman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA USA
| | - Joachim G. Voss
- School of Nursing, University of Washington, Seattle, WA USA
| | - Judith Wasserheit
- Departments of Medicine and Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104-2499 USA
| | - Carey Farquhar
- Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA USA
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Brewer ML, Flavell HL, Trede F, Smith M. A scoping review to understand "leadership" in interprofessional education and practice. J Interprof Care 2016; 30:408-15. [PMID: 27191254 DOI: 10.3109/13561820.2016.1150260] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This scoping study examined how "leadership" is referred to and used in interprofessional education and practice. A total of 114 refereed articles were reviewed to determine how leadership is defined, conceptualised, and theorised. The review also examined what capabilities were identified for effective interprofessional leadership. The majority of papers were empirical studies undertaken by researchers based in North America. The majority of articles did not refer to a specific leadership approach, nor did they define, describe, or theorise leadership. Moreover, "leadership" capabilities were rarely identified. Articles generally focused on health practitioners and educators or students as leaders with little exploration of leadership at higher levels (e.g. executive, accrediting bodies, government). This review indicates the need for a more critical examination of interprofessional leadership and the capabilities required to lead the changes required in both education and practice settings. The goal of this article is to stimulate discussion and more sophisticated, shared understandings of interprofessional leadership for the professions. Recommendations for future research are required in both education and practice settings.
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Affiliation(s)
- Margo L Brewer
- a Faculty of Health Sciences, Curtin University , Perth , Western Australia , Australia
| | - Helen Louise Flavell
- a Faculty of Health Sciences, Curtin University , Perth , Western Australia , Australia
| | - Franziska Trede
- b Education for Practice Institute , Charles Sturt University , Sydney , New South Wales , Australia
| | - Megan Smith
- c School of Community Health , Charles Sturt University , Albury Wodonga , New South Wales , Australia
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Pradarelli JC, Jaffe GA, Lemak CH, Mulholland MW, Dimick JB. A leadership development program for surgeons: First-year participant evaluation. Surgery 2016; 160:255-63. [PMID: 27138180 DOI: 10.1016/j.surg.2016.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/16/2016] [Accepted: 03/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND In a dynamic health care system, strong leadership has never been more important for surgeons. Little is known about how to design and conduct effectively a leadership program specifically for surgeons. We sought to evaluate critically a Leadership Development Program for practicing surgeons by exploring how the program's strengths and weaknesses affected the surgeons' development as physician-leaders. METHODS At a large academic institution, we conducted semistructured interviews with 21 surgical faculty members who applied voluntarily, were selected, and completed a newly created Leadership Development Program in December 2012. Interview transcripts underwent qualitative descriptive analysis with thematic coding based on grounded theory. Themes were extracted regarding surgeons' evaluations of the program on their development as physician-leaders. RESULTS After completing the program, surgeons reported personal improvements in the following 4 areas: self-empowerment to lead, self-awareness, team-building skills, and knowledge in business and leadership. Surgeons felt "more confident about stepping up as a leader" and more aware of "how others view me and my interactions." They described a stronger grasp on "giving feedback" as well as a better understanding of "business/organizational issues." Overall, surgeon-participants reported positive impacts of the program on their day-to-day work activities and general career perspective as well as on their long-term career development plans. Surgeons also recommended areas where the program could potentially be improved. CONCLUSION These interviews detailed self-reported improvements in leadership knowledge and capabilities for practicing surgeons who completed a Leadership Development Program. A curriculum designed specifically for surgeons may enable future programs to equip surgeons better for important leadership roles in a complex health care environment.
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Affiliation(s)
- Jason C Pradarelli
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, University of Michigan, Ann Arbor, MI.
| | - Gregory A Jaffe
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Christy Harris Lemak
- Department of Health Services Administration, School of Health Professions at the University of Alabama, Birmingham, AL
| | | | - Justin B Dimick
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI
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Abstract
Formal training in the multifaceted components of leadership is now accepted as highly desirable for health care leaders. Despite natural leadership instincts, some core leadership competencies ("differentiating competencies") must be formally taught or refined. Leadership development may begin at an early career stage. Despite the recognized need, the number of comprehensive leadership development opportunities is still limited. Leadership training programs in health care were started primarily as internal institutional curricula, with a limited scope, for the development of faculty or practitioners. More comprehensive national leadership programs were developed in response to the needs of specific cohorts of individuals, such as programs for women, which are designed to increase the ranks of senior women leaders in the health sciences. As some programs reach their 20th year of existence, outcomes research has shown that health care leadership training is most effective when it takes place over time, is comprehensive and interdisciplinary, and incorporates individual/institutional projects allowing participants immediate practical application of their newly acquired skills. The training should envelop all the traditional health care domains of clinical practice, education, and research, so the leader may understand all the activities taking place under his/her leadership. Early career leadership training helps to develop a pipeline of leaders for the future, setting the foundation for further development of those who may chose to pursue significant leadership opportunities later in their career. A combination of early and mid-to-late career development may represent the optimal training for effective leaders. More training programs are needed to make comprehensive leadership development widely accessible to a greater number of potential health care leaders. This paper addresses the skills that health care leaders should develop, the optimal leadership development concepts that must be acquired to succeed as a health care leader today, some resources for where such training may be obtained, and what gaps are still present in today's system.
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Affiliation(s)
- Roberta E Sonnino
- Department of Surgery, Division of Pediatric Surgery, Wayne State University School of Medicine, Detroit, MI, USA
- RES Coaching LLC, Locust Hill, VA, USA
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Gordon LJ, Rees CE, Ker JS, Cleland J. Dimensions, discourses and differences: trainees conceptualising health care leadership and followership. MEDICAL EDUCATION 2015; 49:1248-1262. [PMID: 26611190 DOI: 10.1111/medu.12832] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/11/2015] [Accepted: 07/23/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT As doctors in all specialties are expected to undertake leadership within health care organisations, leadership development has become an inherent part of medical education. Whereas the leadership literature within medical education remains mostly focused on individual, hierarchical leadership, contemporary theory posits leadership as a group process, which should be distributed across all levels of health care organisation. This gap between theory and practice indicates that there is a need to understand what leadership and followership mean to medical trainees working in today's interprofessional health care workplace. METHODS Epistemologically grounded in social constructionism, this research involved 19 individual and 11 group interviews with 65 UK medical trainees across all stages of training and a range of specialties. Semi-structured interviewing techniques were employed to capture medical trainees' conceptualisations of leadership and followership. Interviews were audiotaped, transcribed verbatim and analysed using thematic framework analysis to identify leadership and followership dimensions which were subsequently mapped onto leadership discourses found in the literature. RESULTS Although diversity existed in terms of medical trainees' understandings of leadership and followership, unsophisticated conceptualisations focusing on individual behaviours, hierarchy and personality were commonplace in trainees' understandings. This indicated the dominance of an individualist discourse. Patterns in understandings across all stages of training and specialties, and whether definitions were solicited or unsolicited, illustrated that context heavily influenced trainees' conceptualisations of leadership and followership. CONCLUSIONS Our findings suggest that UK trainees typically hold traditional understandings of leadership and followership, which are clearly influenced by the organisational structures in which they work. Although education may change these understandings to some extent, changes in leadership practices to reflect contemporary theory are unlikely to be sustained if leadership experiences in the workplace continue to be based on individualist models.
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Affiliation(s)
- Lisi J Gordon
- Medical Education Institute, School of Medicine, University of Dundee, Dundee, UK
| | - Charlotte E Rees
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Jean S Ker
- Medical Education Institute, School of Medicine, University of Dundee, Dundee, UK
| | - Jennifer Cleland
- Division of Medical and Dental Education, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
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Sklar DP. A knock on the door. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:831-832. [PMID: 24865824 DOI: 10.1097/acm.0000000000000258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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