The Effects of Leadership Curricula With and Without Implicit Bias Training on Graduate Medical Education: A Multicenter Randomized Trial

Mapping the Void: Understanding Diversity, Equity, and Inclusion Training in Medicine

OBJECTIVE

To delineate how identity-based bias exposure evolves with rank and/or context among health care workers, and assess their attitudes toward existing diversity, equity, and inclusion (DEI) education.

BACKGROUND

Although DEI training is widely mandated for health care workers, few studies examine how clinicians' needs evolve across a career, how context impacts recipients' ability to respond, or how well existing programs adapt to individual contexts.

METHODS

A 54-question electronic survey was distributed during Morbidity and Mortality conferences beginning in December 2020. Descriptive statistics were performed regarding respondents' bias exposure across rank, perceptions regarding existing training's fidelity to recipients' lived experience, and ability to confer useful response strategies.

RESULTS

This study included 648 individuals (65.6% White; 50.2% women) practicing in mostly academic medical centers (70.6%). Respondents affirmed that discrimination was common, with half (320, 49.4%) reporting that they experienced bias at least monthly. Among people of color, the proportion reporting monthly exposure decreased with rank. Women of color experienced the biggest drop (74% as residents/fellows down to 11% in late career). Broadly, participants reported the greatest discomfort in addressing subtle bias from patients or high-ranked individuals, and this did not uniformly improve with seniority. Finally, although 478 (73.8%) individuals reported receiving DEI training, 51.3% of respondents reported online DEI modules had little utility. Shortcomings included that training focused on individual rather than structural solutions and that it did not confer response strategies users could reliably employ.

CONCLUSIONS

Identity and context strongly influence both clinicians' exposure and ability to respond to bias in the hospital environment, independent of seniority. Existing DEI training fails to account for this nuance, ultimately diminishing its utility to clinicians.

Needs, rationale, and outcomes of leadership education in neurosurgery

BACKGROUND

Surgeons are expected to lead teams/organizations to achieve optimal patient outcomes; however, few receive formal education in leadership. The goals of the study were to: 1) assess the unmet needs and gaps in leadership education for neurosurgeons and residents/fellows; 2) identify factors associated with availability of leadership education, access to leadership positions and the similarities/differences across geographic regions and institutional type; 3) describe the associations between gender and leadership; 4) determine the impact of leadership education.

METHODS

International survey of 657 neurosurgeons, residents/fellows. A series of univariate analysis and multivariate were conducted to assess the association between specific variables and leadership outcomes.

RESULTS

Almost half (48%) indicated that leadership education did not exist in their organization. This lack was more notable in non-academic centers (p < 0.001), among neurosurgeons with less than 5 years of work experience (p = 0.03), and respondents from South America (p = 0.02). Nearly two-thirds (61.1%) reported never having leadership training. Significantly fewer respondents in the age range 35-44 years old (p = 0.02), those working in the Middle East (p = 0.02), neurosurgeons with work experience less than 5 years (p = 0.004), working in non-academic center (p = 0.02) attended leadership training. In contrast to the differences seen across geographic regions and types of institutions, overall, the proportions of males and females having access to leadership training and being offered leadership positions were similar. Among participants, 87.1% of those with leadership training were offered leadership roles, compared to 65.5% of those without leadership training (p <  0.001). Additionally, participants with leadership training experienced a burnout rate of 29.2%, whereas those without leadership training had a higher rate of burnout of 40.5% (p =  0.02).

CONCLUSIONS

There is a pressing need to develop educational opportunities for leadership in neurosurgery, especially for younger neurosurgeons, neurosurgeons working in non-academic centers, in countries and non-academic institutions where leadership education is less accessible. Leadership education is associated with increased numbers of neurosurgical leaders at all levels as well as reduced levels of burnout.

Determining the Effectiveness of a Clinical Nursing Teaching Intervention in Improving Teamwork Ability: A Quasi-Experimental Study

Objective

This study aimed to explore the effectiveness of applying TeamSTEPPS ((Team Strategies & Tools to Enhance Performance & Patient Safety, TeamSTEPPS)) in clinical nursing education and evaluate its impact on improving teamwork skills among nursing trainees. TeamSTEPPS is a systematic framework developed to improve healthcare team performance and patient safety, focusing on core elements such as leadership, communication, situation monitoring, mutual support, and team structure.

Methods

A total of 120 nursing trainees, who interned at Affiliated Hospital of Jiangnan University from November 2020 to November 2022, participated in this study. The participants were randomly divided into two groups: an intervention group (n= 60) that received instruction based on the TeamSTEPPS framework, and a control group (n= 60) that followed the traditional nursing education model. The TeamSTEPPS curriculum consisted of five key modules: team structure, effective communication, leadership, situation monitoring, and mutual support. The intervention included weekly theoretical and practical training sessions over a six-month period, incorporating group discussions, simulation training, scenario-based teaching, and role-playing. The impact of the intervention was assessed through pre- and post-intervention evaluations using the Teamwork Attitudes Questionnaire (T-TAQ), which measured teamwork awareness, communication skills, leadership, and mutual support.

Results

Before the intervention, there were no significant differences between the two groups in terms of Team Structure, Leadership, Situation Monitoring, Mutual Support, and Communication skills (P > 0.05). After the intervention, the intervention group showed significant improvements in Team Structure, Leadership, Situation Monitoring, Mutual Support, and Communication skills, with scores significantly higher than those of the control group (P < 0.05).

Conclusion

The TeamSTEPPS-based teaching model significantly enhances nursing students' Team Structure, Leadership, Situation Monitoring, Mutual Support, and Communication skills, showing superior outcomes compared to the traditional education model. This evidence suggests that TeamSTEPPS is a valuable tool for nursing education and should be further promoted and applied in clinical training settings.

Leadership training in emergency medicine: A national survey

Background

Emergency medicine (EM) is a uniquely stressful environment in which leadership training could improve individual and team performance, patient outcomes, well-being, and EM career intentions. The primary aim was to evaluate EM-specific leadership training (EMLeaders) compared to no leadership training. A secondary comparison was with other forms of leadership training.

Methods

An online survey was distributed to Royal College of Emergency Medicine (RCEM) members in England. Three groups were recruited: those who reported receiving EMLeaders training, no training, and other training. Information was collected on group demographics, job roles, responses to 14 leadership knowledge and skills items, well-being at work, and EM career intentions.

Results

A total of 417 responders (177 EMLeaders, 148 no training, 92 other training) were largely representative of RCEM members, although the EMLeaders group were at less senior career grades. Although all groups provided generally positive responses, EMLeaders demonstrated more positive ratings for seven of 14 leadership items relative to no training (all p < 0.05): knowledge about clinical leadership, application of clinical leadership, empowerment to make decisions, managing the emergency department environment, ability to influence the EM environment, confidence in leadership, and confidence in facilitating teams. The other training group demonstrated superior ratings for five of seven of the same items, except empowerment to make decisions and ability to influence the EM environment. Direct comparison of EMLeaders with other training identified ability to influence the EM environment as a unique benefit of EMLeaders (p < 0.05), while knowledge about clinical leadership favored other training (p < 0.05).

Conclusions

EMLeaders improved many aspects of perceived leadership knowledge and skills, but there was little evidence of impact on well-being or EM career intentions. EMLeaders particularly appears to enhance perceived ability to influence the EM environment. Considering that the EMLeaders group were generally earlier in their career, the findings are promising and can inform the refinement of future EM-specific training.

Multi-Team Shared Expectations Tool (MT-SET): An Exercise to Improve Teamwork Across Health Care Teams

Care transitions among high-intensity units caring for patients with complex needs are a critical yet undeveloped area of patient safety research. In addition, effective communication and coordination across disciplines remain elusive. This study introduces and tests the Multi-Team Shared Expectations Tool (MT-SET), an exercise that aims to engage health care teams in eliciting needs and establishing agreed-upon expectations teams and individuals within a multi-team system have of one another. We piloted the exercise within hospital-based workflows for oncology inpatients and later adopted it to elicit data on mutual needs and expectations of teams across units involved in patient transitions in two patient safety projects. Our studies demonstrated that the exercise identified common cross-unit coordination problems of delays in care, unwanted variations in care, and lack of standardized communication among units. It also revealed mismatched prioritization of each of these problems between specific unit types. The participants reported that the MT-SET helped establish positive relationships for building better cross-unit and cross-disciplinary teamwork and coordination. There is a need for systematic approaches to understand and facilitate cross-unit communication and coordination in care delivery and transitions. Future studies should broaden the application of the exercise to additional types of multi-unit and multidisciplinary teams and observe intervention ideas generated from the exercise, as well as their implementation.

Closing the gender gap in medicine: the impact of a simulation-based confidence and negotiation course for women in graduate medical education

BACKGROUND

Currently, 75-80% of the medical workforce worldwide consists of women. Yet, women comprise 21% of full professors and less than 20% of department chairs and medical school deans. Identified causes of gender disparities are multifactorial including work-life responsibilities, gender discrimination, sexual harassment, bias, lack of confidence, gender differences in negotiation and leadership emergence, and lack of mentorship, networking, and/or sponsorship. A promising intervention for the advancement of women faculty is the implementation of Career Development Programs (CDPs). Women physician CDP participants were shown to be promoted in rank at the same rate as men by year five, and more likely to remain in academics after eight years compared to both men and women counterparts. The objective of this pilot study is to investigate the effectiveness of a novel, simulation-based, single-day CDP curriculum for upper-level women physician trainees to teach communication skills identified as contributing to medicine's gender advancement gap.

METHODS

This was a pilot, pre/post study performed in a simulation center implementing a curriculum developed to educate women physicians on 5 identified communication skills recognized to potentially reduce the gender gap. Pre- and post-intervention assessments included confidence surveys, cognitive questionnaires, and performance action checklists for five workplace scenarios. Assessment data were analyzed using scored medians and descriptive statistics, applying Wilcoxon test estimation to compare pre- versus post-curriculum intervention scores, with p < 0.05 considered statistically significant.

RESULTS

Eleven residents and fellows participated in the curriculum. Confidence, knowledge, and performance improved significantly after completion of the program. Pre-confidence: 28 (19.0-31.0); Post-confidence: 41 (35.0-47.0); p < 0.0001. Pre-knowledge: 9.0 (6.0-11.00); Post knowledge: 13.0 (11.0-15.0); p < 0.0001. Pre-performance: 35.0 (16.0-52.0); Post-performance: 46.0 (37-53.00); p < 0.0001.

CONCLUSION

Overall, this study demonstrated the successful creation of a novel, condensed CDP curriculum based on 5 identified communication skills needed for women physician trainees. The post-curriculum assessment demonstrated improved confidence, knowledge, and performance. Ideally, all women medical trainees would have access to convenient, accessible, and affordable courses teaching these crucial communication skills to prepare them for careers in medicine to strive to reduce the gender gap.

Leadership Experiences of Internal Medicine Residents: A Needs Assessment for Leadership Curricula

Purpose

Leadership development during medical training is critical. Accrediting bodies strongly recommend and residents desire leadership training. However, limited needs assessment data exist regarding trainee perceptions of and experiences with leadership training. Our objective is to describe residents' perceptions of leadership and desires for leadership training with the goal of informing effective curricular development.

Patients and Methods

In 2019 a trained qualitative interviewer conducted semi-structured interviews with volunteer second-year categorical internal medicine residents recruited via email across four institutions. Interviews were audio-recorded, transcribed, and inductively coded by two independent coders. After adjudicating discrepancies, coders synthesized codes into broader themes. Final thematic analysis was triangulated with the entire author group.

Results

Fourteen residents were interviewed (50% female). Few reported prior leadership training. Thematic analysis yielded six main themes. First, residents perceive "leadership" to be related to formal, assigned, hierarchical roles. Second, residents identify their own leadership primarily in the inpatient clinical setting. Third, residents identify clinical competence, emotional intelligence, and communication as important skills for effective leadership. Fourth, residents struggle to identify where leadership is currently being taught. Fifth, residents desire additional leadership development. Finally, residents prefer well-labeled, interactive methods for leadership development.

Conclusion

Although residents desire leadership development, these skills are not often explicitly taught, labeled, or assessed. Curriculum developers may consider explicitly contextualizing leadership training within an "everyday leadership" framework, dovetailing leadership coaching with daily teaching workflow and feedback structures, and implementing faculty development initiatives to allow for appropriate feedback and assessment of these skills.

Evidence-Based Medicine in Otolaryngology, Part XIII: Health Disparities Research and Advancing Health Equity

OBJECTIVE

To provide a contemporary resource for clinicians and researchers on health equity research and implementation strategies to mitigate or eliminate disparities in health care.

DATA SOURCES

Published studies and literature on health disparities, applicable research methodologies, and social determinants of health in otolaryngology.

REVIEW METHODS

Literature through October 2021 was reviewed, including consensus statements, guidelines, and scientific publications related to health care equity research. This research focus provides insights into existing disparities, why they occur, and the outcomes of interventions designed to resolve them. Progress toward equity requires intentionality in implementing quality improvement initiatives, tracking data, and fostering culturally competent care. Priority areas include improving access, removing barriers to care, and ensuring appropriate and effective treatment. Although research into health care disparities has advanced significantly in recent years, persistent knowledge gaps remain. Applying the lens of equity to data science can promote evidence-based practices and optimal strategies to reduce health inequities.

CONCLUSIONS

Health disparities research has a critical role in advancing equity in otolaryngology-head and neck surgery. The phases of disparities research include detection, understanding, and reduction of disparities. A multilevel approach is necessary for understanding disparities, and health equity extensions can improve the rigor of evidence-based data synthesis. Finally, applying an equity lens is essential when designing and evaluating health care interventions, to minimize bias.

IMPLICATIONS FOR PRACTICE

Understanding the data and practices related to disparities research may help promote an evidence-based approach to care of individual patients and populations, with the potential to eventually surmount the negative effects of health care disparities.