Training the next generation of physician-executives: an innovative residency pathway in management and leadership

The interplay between mentalization, personality traits and burnout in psychiatry training: Results from a large multicenter controlled study

BACKGROUND

A better characterization of educational processes during psychiatry training is needed, both to foster personal resilience and occupational proficiency.

METHODS

An adequate coverage of medical residents at the national level was reached (41.86% of the total reference population, 29 out of 36 training centers-80.55%). Controls were recruited among residents in other medical specialties. All participants were assessed by questionnaires to evaluate early life experiences, attachment style, personality traits, coping strategies, emotional competencies. A Structural Equation Model (SEM) framework was employed to investigate the interplay between individual factors.

RESULTS

A total sample of 936 people was recruited (87.9% response-rate; 645 residents in psychiatry, 291 other medical residents). Psychiatry trainees reported a higher prevalence of adverse childhood experiences (emotional abuse, emotional neglect, physical neglect), greater attachment insecurity (anxious or avoidant) in comparison to other medical trainees. Psychiatry residents also reported higher social support-seeking as a coping strategy, lower problem-orientation, and lower transcendence. Lower neuroticism, higher openness to experience, and higher emotional awareness were also observed in psychiatry trainees. Psychiatry training was associated with a redefinition of conflict management skills as a function of seniority. The SEM model provided support for an interplay between early traumatic experiences, mentalization skills (coping strategies, emotion regulation), interpersonal competencies and occupational distress.

CONCLUSIONS

The findings of the present study supported a theoretical model based on mentalization theory for the interactions between personal and relational competencies in psychiatry training, thus providing potential target of remodulation and redefinition of this specific process of education.

Interprofessional clinical decision-making process in health: A scoping review

AIMS

To describe the key elements of the interprofessional decision-making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications.

DESIGN

Scoping review of the literature.

DATA SOURCES

MEDLINE, APA Psycinfo OpenGrey, Lissa and Cochrane databases were searched in December 2019 and January 2023.

REVIEW METHODS

References were considered eligible if they (i) were written in French or English, (ii) concerned health, (iii) studied a clinical decision-making process, (iv) were performed in an interprofessional context. 'PRISMA-scoping review' guidelines were respected. The eligible studies were analysed and classified by an inductive approach RESULTS: We identified 1429 sources of information, 145 of which were retained for the analysis. Based on these studies, we identified five key elements of interprofessional decision-making in health. The process was found to be influenced by group dynamics, the available information and consideration of the unique characteristics of the patient. An organizational framework and specific training favoured improvements in the process.

CONCLUSION

Decision-making can be based on a willingness of the healthcare organization to promote models based on more shared leadership and to work on professional roles and values. It also requires healthcare professionals trained in the entire continuum of collaborative practices, to meet the unique needs of each patient. Finally, it appears essential to favour the sharing of multiple sources of accessible and structured information. Tools for knowledge formalization should help to optimize interprofessional decision-making in health.

IMPACT

The quality of a team decision-making is critical to the quality of care. Interprofessional decision-making can be structured and improved through different levels of action. These improvements could benefit to patients and healthcare professionals in every settings of care involving care collaboration.

IMPACT STATEMENT

Interprofessional decision-making in health is an essential lever of quality of care, especially for the most complex patients which are a contemporary challenge. This scoping review article offers a synthesis of a large corpus of data published to date about the interprofessional clinical decision-making process in healthcare. It has the potential to provide a global vision, practical data and a list of references to facilitate the work of healthcare teams, organizations and teachers ready to initiate a change.

A Good Practice Guide for Organizing the Scientific Program of International Conferences

This paper provides a step-by-step guide for organizing the scientific program (OSP) of international conferences. Through informal discussions, a panel of experts organizing international conferences came up with this guide, which includes a flowchart, checklist, and detailed discussions of each step. Subsequently, additional specialists were invited to evaluate this synopsis and provide their input. All of the participants approved the final version after the outline was improved. This guide proposes the following six steps: 1) preparation, 2) recruitment, 3) building the agenda, 4) cross-checking the program, 5) reviewing and finalizing, and 6) in-conference refining. Thirteen items are specified across the six main steps in a detailed checklist. This OSP guide includes a flowchart and a checklist for providing a comprehensive manual for establishing, conducting, and organizing international scientific conferences. Understanding the procedures that are expected to be followed when holding a scientific conference enables the involved parties to organize and assign tasks to one another as well as create a schedule that allows them to finish their work on time. This guide can be used at any kind of scientific conference to describe an organized process, resulting in a professional and distinguished scientific program.

French-speaking Swiss physician's perceptions and perspectives regarding their competencies and training need in leadership and management: a mixed-methods study

INTRODUCTION

Effective leadership and management (L&M) are essential to the success of health care organizations. Young medical leaders often find themselves ill-prepared to take on these new responsibilities, but rarely attend training in L&M skills. The aims of this study were to evaluate physician's self-perceived competencies and training needs for L&M, to identify available regional L&M training, and to highlight opportunities, challenges and threats regarding physicians' training in medical L&M in the French-speaking part of Switzerland.

METHODS

We conducted a mixed methods study in three steps: (1) a survey on perceived L&M competencies and training needs (5 dimensions) to all physicians of a Swiss University Hospital (N = 2247); (2) a mapping of the Swiss French speaking L&M training programs through analysis of hospital websites and interviews; and (3) semi-structured interviews with L&M program coordinators about the programs' strengths and weaknesses as well as the opportunities and challenges to include physicians in such training. We used analysis of variance to compare differences in perceived competences between physicians of different hierarchical status and used Cramer's V to measure the association's degree between physicians' training needs and prior training in L&M and hierarchical status. We analysed semi-structured interviews using thematic analysis.

RESULTS

Five-hundred thirty-two physicians responded (24%). Physicians perceived themselves as rather competent in most leadership dimensions. More experienced physicians reported a higher sense of competence in all dimensions of leadership (e.g. Working with others: F = 15.55, p < .001; Managing services: F = 46.89, p < .001). Three competencies did not vary according to the hierarchical status: emotional intelligence (F = 1.56, p = .20), time management (F = 0.47, p = .70) and communicating (F = 1.97, p = .12). There was a weak to moderate association between the responders' self-perceived needs for training and their hierarchal status for all competencies (Cramer's V ∈ [0.16;0.35]). Physicians expressed a strong desire to seek out training for all competencies, especially for knowing one's leadership style (82%), managing teams (83%), and managing conflict (85%). Although existing local L&M training programs covered most relevant topics, only a forth of responders had attended any type of training. L&M program coordinators identified several facilitators and barriers to physician attendance on institutional (matching reality and training), relational (managing collective intelligence), and individual levels (beliefs and self-perceived identity).

CONCLUSIONS

French-speaking Swiss hospital physicians clearly express training needs for L&M skills although they only rarely attend such training programs. Reasons for non-attendance to such programs should be explored in order to understand physicians' low participation rates in these trainings.

Curriculum satisfaction of graduates of medical residency in ophthalmology

BACKGROUND

The number of ophthalmologists trained in Brazil has increased, but their satisfaction with the medical residency curriculum is unclear. The purpose of this study is to evaluate the satisfaction and self-confidence of graduates of a reference ophthalmology residency program in Brazil and to analyze whether there is a difference in these parameters among those who graduated in different decades.

METHODS

This is a cross-sectional web-based study conducted in 2022 with 379 ophthalmologists who graduated from the Faculty of Medical Sciences of the State University of Campinas (UNICAMP), Brazil. We aim to obtain data on satisfaction and self-confidence in clinical and surgical practices.

RESULTS

In total, 158 questionnaires were completed (41.68% response rate); 104 respondents completed their medical residency between 2010 and 2022, 34 between 2000 and 2009, and only 20 before 2000. Most respondents were satisfied or very satisfied with their programs (98.7%). Respondents reported insufficient exposure to low vision rehabilitation (62.7%), toric intraocular implants (60.8%), refractive surgery (55.7%), and orbital trauma surgery (84.8%), particularly among graduates before 2010. They also reported insufficient training in certain non-clinical areas, such as office management (61.4%), health insurance management (88.6%), and personnel and administration skills (74.1%). We found that respondents who graduated a long time ago had higher confidence in clinical and surgical practices.

CONCLUSIONS

Brazilian ophthalmology residents and UNICAMP graduates expressed high levels of satisfaction with their residency training programs. Those who completed the program a long time ago appear to have more confidence in clinical and surgical practices. There were clinical and non-clinical areas with insufficient training identified for improvement.

Patient Safety/Quality Improvement Primer, Part IV: Psychological Safety-Drivers to Outcomes and Well-being

Psychological safety is the concept that an individual feels comfortable asking questions, voicing ideas or concerns, and taking risks without undue fear of humiliation or criticism. In health care, psychological safety is associated with improved patient safety outcomes, increased clinician engagement, and greater creativity. A culture of psychological safety is imperative for physician well-being and satisfaction, which in turn directly affect delivery of care. For health care professionals, psychological safety creates an environment conducive to trust and openness, enabling the team to focus on high-quality care. In contrast, unprofessional behavior reduces psychological safety and threatens the culture of the organization. This patient safety/quality improvement primer considers the barriers and facilitators to psychological safety in health care; outlines principles for creating a psychologically safe environment; and presents strategies for managing conflict, microaggressions, and lapses in professionalism. Individuals and organizations share the responsibility of promoting psychological safety through proactive policies, conflict management, interventions for microaggressions, and cultivation of emotional intelligence.

A Resident-as-Leader Curriculum for Managing Inpatient Teams

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.

A Systematic Approach in Developing Management Workforce Readiness for Digital Health Transformation in Healthcare

BACKGROUND

The COVID-19 pandemic has sped up digital health transformation across the health sectors to enable innovative health service delivery. Such transformation relies on competent managers with the capacity to lead and manage. However, the health system has not adopted a holistic approach in addressing the health management workforce development needs, with many hurdles to overcome. The objectives of this paper are to present the findings of a three-step approach in understanding the current hurdles in developing a health management workforce that can enable and maximize the benefits of digital health transformation, and to explore ways of overcoming such hurdles.

METHODS

A three-step, systematic approach was undertaken, including an Australian digital health policy documentary analysis, an Australian health service management postgraduate program analysis, and a scoping review of international literatures.

RESULTS

The main findings of the three-step approach confirmed the strategies required in developing a digitally enabled health management workforce and efforts in enabling managers in leading and managing in the digital health space.

CONCLUSIONS

With the ever-changing landscape of digital health, leading and managing in times of system transformation requires a holistic approach to develop the necessary health management workforce capabilities and system-wide capacity. The proposed framework, for overall health management workforce development in the digital health era, suggests that national collaboration is necessary to articulate a more coordinated, consistent, and coherent set of policy guidelines and the system, policy, educational, and professional organizational enablers that drive a digital health focused approach across all the healthcare sectors, in a coordinated and contextual manner.

The Role of Advanced Academic Degrees in Orthopaedic Sports Medicine Faculty

Background:

Limited knowledge exists on the role of advanced academic degrees within faculty positions in orthopaedic sports medicine.

Purpose:

To 1) provide an assessment of the baseline demographics of advanced degrees among orthopaedic sports medicine faculty and 2) examine the impact of advanced degrees on research productivity and career attainment of orthopaedic sports medicine faculty.

Study Design:

Cross-sectional study; Level of evidence, 4.

Methods:

Orthopaedic sports medicine academics were identified using faculty listings on websites of the 200 orthopaedic surgery residency programs during the 2020-2021 academic year. Advanced degrees were defined as those additional to the primary medical degree (Doctor of Medicine [MD] or Doctor of Osteopathic Medicine [DO]). Outcome measures included timing of advanced degree obtainment, residency program rankings, research productivity, and current academic rank and leadership roles. Statistical analysis was performed using chi-square and Mann-Whitney U tests to determine the association of advanced degrees on outcome measures.

Results:

In total, 911 orthopaedic sports medicine faculty members were identified, of whom 100 had an advanced degree. The most common advanced degrees were Master of Science (MS/MSc; 38%), Doctor of Philosophy (PhD; 23%), and Master of Business Administration (MBA; 13%). The presence of an advanced degree was associated with greater research productivity, including higher h-index and number of publications, as well as more editorial board positions on orthopaedics journals ( P < .001). Advanced degrees were not significantly associated with attending a higher ranked orthopaedic surgery residency program, current academic rank, or leadership roles. At the institutional level, orthopaedic sports medicine programs that employed faculty with an advanced degree had a higher residency program ranking and the presence of a sports medicine fellowship was more likely ( P < .05).

Conclusion:

Advanced degrees in orthopaedic sports medicine were associated with greater faculty research engagement and employment at a higher ranked institution; they were not associated with matching to a highly ranked orthopaedic surgery residency program, higher faculty rank, or academic leadership roles.

Establishing Competencies for Leadership Development for Postgraduate Internal Medicine Residents

BACKGROUND

Although graduate medical education accrediting bodies recognize the importance of leadership for residents and encourage curricular development, it remains unclear which competencies are most important for early career physicians to possess.

OBJECTIVE

To generate a prioritized list of essential postgraduate leadership competencies to inform best practices for future curricular development.

METHODS

In 2019, we used a Delphi approach, which allows for generation of consensus, to survey internal medicine (IM) physicians in leadership roles with expertise in medical education and/or leadership programming within national professional societies. Panelists ranked a comprehensive list of established leadership competencies for health care professionals, across 3 established domains (character, emotional intelligence, and cognitive skills), on importance for categorical IM residents to perform by the end of residency. Respondents also identified number of content hours and pedagogical format best suited to teach each skill.

RESULTS

Sixteen and 14 panelists participated in Delphi rounds 1 and 2, respectively (88% response rate). Most were female (71%) and senior (64% in practice > 15 years, 57% full professor). All practiced in academic environments and all US regions were represented. The final consensus list included 12 "essential" and 9 "very important" leadership skills across all 3 leadership domains. Emotional intelligence and character domains were equally represented in the consensus list despite being disproportionately underweighted initially. Panelists most frequently recommended content delivery via mentorship/coaching, work-based reflection, and interactive discussion.

CONCLUSIONS

This study's results suggest that postgraduate curricular interventions should emphasize emotional intelligence and character domains of leadership and prioritize coaching, discussion, and reflection for delivery.

The need for management education of healthcare management employees

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.

Effect of a novel healthcare leadership program on leadership and emotional intelligence

The purpose of this study was to assess the effectiveness of the Feagin Leadership Program (FLP) in teaching leadership domains and emotional intelligence. An anonymous survey of 178 graduates of FLP (2011-2019) including the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) was used to assess emotional intelligence and program views. ANOVA was used to compare the difference in emotional intelligence domains between groups. Respondents reported the FLP most improved skills in communication, emotional intelligence, and team building. Medical students (18, 38.3%) and faculty/staff (5/14, 35.7%) reported the most relevant domain was emotional intelligence; residents/fellows reported the most relevant domain was teamwork (8/37, 21.6%). Respondents in residency/fellowship had the highest score in emotionality (P = .01). These results suggest that a healthcare leadership program tailored to medical trainees was effective in improving their competency in various leadership domains, and that emotional intelligence and teamwork were the most relevant components of the program.

Preliminary results of a clinical research and innovation scholarship to prepare medical students to lead innovations in health care

There is consensus amongst national organizations to integrate health innovation and augmented intelligence (AI) into medical education. However, there is scant evidence to guide policymakers and medical educators working to revise curricula. This study presents academic, operational, and domain understanding outcomes for the first three cohorts of participants in a clinical research and innovation scholarship program.

How Can We Raise Awareness of Physician's Needs in Order to Increase Adherence to Management and Leadership Training?

Due to the increasing complexity of medical education and practice, the training of healthcare professionals for leadership and management roles and responsibilities has become increasingly important. But gaps in physician leadership and management skills have been identified across a broad range of organizational and geographic settings. Many clinicians are inadequately prepared to meet their day-to-day clinical leadership responsibilities. Simultaneously, physicians' leadership and management skills play a central role and yield superior outcomes for patients and health care delivery organizations. Currently, there is a tremendous variability in the amount of time, structure and resources dedicated to leadership/management training for physicians. Physicians who have completed such trainings seem to be pleased with the outcome. However, only a limited number of physicians enroll in these types of trainings. Several reasons can explain this fact, but it seems crucial to investigate what could increase the involvement of medical leaders and managers in these training programs. This paper offers a framework for addressing the barriers to training commitment and for designing initial training interventions for physicians. This framework is rooted in two well-known theoretical models used in social sciences. It aims to promote self-assessed knowledge and expertise amongst physicians about to embrace leader/manager careers. By developing the ability to explore and be curious about one's own experience and actions, physicians may suddenly open up the possibilities of purposeful learning. The process we describe in this paper may be an essential step in fostering the involvement of physicians in leadership and management training processes. And this is essential to contribute to the advancement of medical discipline.

Leadership and surgical training part 1: preparing to lead the way?

Every day surgeons lead teams on the wards, in clinics and operating theatres, but most trainees and some surgeons do not consider themselves as leaders. Leadership skills are increasingly important for surgeons, who need knowledge of organizational structure and policy, management strategy and team dynamics to deliver and improve health care in resource-constrained environments. The Royal Australasian College of Surgeons recognizes leadership as one of 10 core surgical competencies but leadership curricula within surgical training programmes are not well defined. There is limited opportunity for formal leadership training and development prior to becoming a consultant.

Avoiding Death by Meeting: An Interactive Workshop for Academic Faculty Highlighting Strategies to Facilitate Effective Team Meetings

Introduction

Effective meetings are a key marker of team function and are critical for task management. While important, the skill set for running an effective meeting is poorly understood.

Methods

We developed an interactive curriculum that provided physician leaders in academic medicine with generalizable knowledge and skills to effectively plan and lead various types of team meetings, leverage engagement, and troubleshoot challenging personalities. This workshop (either 60 or 90 minutes) included a video-based demonstration, interactive and facilitated small- and large-group discussion, and a brief didactic to teach best practices in leading meetings. Participants included academic physicians across a spectrum of rank, specialty, and leadership experience. Knowledge, attitudes, and anticipated behavior changes were evaluated using postsurveys including 5-point Likert-type scale questions (1 = poor, 5 = outstanding) and free-text responses.

Results

Fifty-seven participants rated the workshop highly with regard to content (M = 4.8), audiovisual materials (M = 4.7), and overall (M = 4.8). Most participants (82%) indicated a plan to change future design or utilization of an agenda as a result of this workshop. Feedback highlighted the need to incorporate practice opportunities in future iterations of the workshop.

Discussion

Our results demonstrated that this standalone, interactive workshop focused on skills to effectively lead team meetings was well received and improved knowledge and attitudes of participants across a spectrum of rank, specialty, and leadership experience. The curriculum was time-efficient, widely generalizable, and can be easily adapted for use within academic medical centers to improve meeting effectiveness.

Cognitive Diversity as the Quality of Leadership in Crisis: Team Performance in Health Service during the COVID-19 Pandemic

The level of leadership skills of healthcare team leaders has long been the subject of interest and many discussions. Several studies have pointed to their inadequacy, which is becoming a serious problem during the global crisis due to the Covid-19 pandemic. There is a direct link between the leadership in the healthcare system and its performance, conditioned by the level of decisions of leaders of medical teams. It is they who determine the performance of healthcare delivery. The study published in this article contains the results from the examination of the dependence between crisis leadership and team performance in healthcare providers. The subject of the research is the impact of cognitive diversity and the quality of crisis-leadership decision-making on the performance of medical teams in the acute crisis phase. The study was conducted on a research sample of 216 healthcare providers after the outbreak of the COVID-19 pandemic in Slovakia (April 2020). The respondents to the research sample involved team leaders in healthcare providers, who have been involved in managing the crisis. The study has justified the positive association between crisis leadership and team performance, which is mediated by cognitive diversity, supporting the quality of decision-making in crisis leadership. The results of the research have proven that the performance of the medical team in the acute crisis phase can be positively influenced through qualified decision-making in crisis leadership amplified by the usage of cognitive diversity.

The Key Role of Strategically and People-Oriented HRM in Hospitals in Slovakia in the Context of Their Organizational Performance

The main objective and purpose of our paper is to verify the positive congruence between the synergistic effect of the mixed roles of human resources management departments in healthcare facilities and their organizational performance. Such congruence is mediated by means of a transformational leadership style and information sharing. The research was carried out on a sample of 44 hospitals in the Slovak Republic, which are included in the ranking according to a comprehensive indicator of their performance (medical and non-medical). Data were obtained using a questionnaire for 44 top managers from these hospitals. Mediation was used as a tool to examine the relevant variables relationship mechanism. All data was analyzed using the SPSS 24.0 software package with the help of selected analytical tools. A series of regression analysis were used to identify the proposed hypotheses. ANOVA was used to analyze the multiple dependence. We worked at a significance level of 5%. The main conclusion of our study is the significant impact of the implementation of the new-mixed role of human resources management departments on organizational performance. Another finding is that the direct effect between the two variables examined is more significant than the mediated effect. This means that if management unambiguously declares and implements the policy of mixed roles of human resources management departments, less influence from the mediator-transformational leadership is sufficient to transmit the effect of this variable onto organizational performance. Completed specialization studies in the field of management play a significant role in the studied relationships.

Leading Employees Through the Crises: Key Competences of Crises Management in Healthcare Facilities in Coronavirus Pandemic

Purpose

The fast and shocking onset of the crisis caused by the COVID-19 virus created the need for a complete crisis management of healthcare facilities to manage the current stage of the crisis. The purpose of our research is to examine the relations between the competences of crisis management in healthcare facilities and the performance of employees, measured during the acute stage of the crisis by their feeling of satisfaction, safety and creation of conditions for work, whereby we assume that these variables are mutually interlinked by the sharing of information, teamwork and cognitive diversity of the work teams.

Materials and Methods

A questionnaire survey was created and used based on a sample of 216 mid-level managers of health care facilities in Slovakia, which took place during the first month after the outbreak of the crisis (during the month of March/April 2020). The Baron and Kenny mediator model has been used for research purposes and the Freedman–Schatzkin test has been used to test the mediator effect. Regression analysis has been used to verify the hypotheses. The control variables were the size of the healthcare facility based on the number of employees, gender and age of the manager, his position in the management hierarchy and the duration of practice in a management position. The ANOVA analysis of variance was used to analyze multiple dependencies. The level of significance was 5%. The research sample consisted of 216 managers at different types of healthcare facilities.

Results

The hypothesis for the dependency between the crisis competences of management and performance of teams during the acute stage of the crisis, facilitated by sharing information, teamwork and cognitive diversity of crisis management was confirmed. It is a multilateral incomplete mediation, where almost two thirds of the total effect are facilitated by mediators, of which the sharing of information has the greatest effect (35%).

Conclusion

Based on our mediation model, healthcare facilities, which strive to implement crisis management during the acute stage of the crisis, should place emphasis especially on reliable background information and the fast sharing of information, supporting the performance of healthcare teams. The strategies for achieving these goals should also include education focused on the development of managerial competences.

Significance of research in a surgeon-scientist's career - A view from Japan

Reflections of academic pediatric surgery in Japan are shared by the authors. As in most areas of surgical practice committement and life long dedication are emphasized as the key(s) to success. An enquiring mind is always an advantage.

The MBA in Medical Education: Current MD/MBA Student Aspirations, Perceptions, and Motivations

BACKGROUND

As combined Doctor of Medicine and Master of Business Administration (MD/MBA) programs gain popularity, it is critical to understand the motives, perceptions, and interests of MD/MBA students. The purpose of this study was to investigate career aspirations of MD/MBA students, skills they perceive to gain from the dual degree, and reasons why students enroll in MD/MBA programs.

MATERIALS AND METHODS

All 73 MD/MBA programs in the United States were invited to participate in a twelve-question, online survey. Responses were collected between August 2019 and February 2020 from students enrolled during the 2019-2020 academic year. The questions were designed to examine career aspirations, program perceptions, and personal motivations. Data were aggregated into descriptive summary statistics and rank orders.

RESULTS

A total of 18 MD/MBA programs agreed to participate in this study, of which 14 met criteria for final analysis. From these programs, 67 of 175 students responded (38%). Among respondents, 100% planned to pursue residency. The most common career interests included the following: clinical practice at an academic hospital (85%), executive leadership in a hospital network (76%), and clinical practice in a community hospital (65%). Students ranked "making a broader impact on health care" and "pursuing leadership in clinical practice" highest among reasons to pursue an MD/MBA. Students reported high rates of acquiring MBA-oriented skills.

CONCLUSIONS

MD/MBA students in this study focused on pursuing clinical careers. Students appear satisfied with their education, reporting high rates of skill acquisition. Residency programs interested in MD/MBA students can incorporate leadership and entrepreneurial opportunities to foster students' broad interests.

An Unmet Need in Healthcare Leadership: A Survey of Practicing Physicians' Perspectives on Healthcare Delivery Science Education

Background

Healthcare delivery science education (HDSE) is increasingly needed by physicians balancing clinical care, practice management, and leadership responsibilities in their daily lives. However, most practicing physicians have received little HDSE in undergraduate through residency training. The purpose of this study is to 1) quantify the perception of the need for HDSE and interest in HDSE among a diverse sample of physicians, and 2) determine if perspectives on HDSE vary by specialty, rurality, and years in practice.

Methods

Using a cross-sectional, single state, mailed questionnaire, we surveyed 170 physicians about their perspectives on HDSE and interest in an HDSE program. Descriptive statistics and a multivariable logistic regression are presented.

Results

Among the 70.5% of responding eligible physicians, 75% of physicians had less HDSE than they would like and 90% were interested in obtaining more HDSE. Thirty-five percent of physicians were interested in joining the described HDSE program. The most prevalent barriers to obtaining HDSE were a lack of time and existing programs. Physician perspectives were similar across specialties, years in practice, and rurality.

Conclusion

There is a high unmet need for HDSE among physicians. Diverse and innovative HDSE programming needs to be developed to meet this need. Programming should be developed not only for physicians but also for undergraduate through residency training programs.

Leadership and Management Competencies for Hospital Managers: A Systematic Review and Best-Fit Framework Synthesis

OBJECTIVE

Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system. To improve their management competence, understanding of management competency requirements is important. The purpose of this study was to synthesize the evidence related to the leadership and management competencies in healthcare organizations through the best-fit method.

METHODS

A systematic review of literature published between 2000 and 2020 was performed to identify studies focusing on confirming and/or identifying the competency requirements of hospital managers. The best-fit framework synthesis method was used to map the identified competencies and associated behavioral items against the validated management competency assessment program (MCAP) management competency framework.

RESULTS

Twelve studies were identified for inclusion in the review. The mapping of the identified competencies and behavioral items generated a competency model for hospital managers that can apply for different healthcare context. The new competency model includes the following seven core leadership and management competencies: evidence-informed decision-making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism.

CONCLUSION

This review and the mapping of the competencies identified in previous studies against the validated MCAP framework has resulted in the recommendation for an extended leadership and management competency framework for health service managers. It provides guidance for the formulation of training and development directions for the health service management workforce in a different healthcare context.

Diversity Management as a Tool for Sustainable Development of Health Care Facilities

Organizations providing health services are often criticized because of inadequate and unsuitable management processes or procedures. Today’s challenge is focused on effective management and leadership skills in the area of health care. The aim of the research is to describe, analyze, and evaluate the current state of diversity management in details in the context of human resources management in the selected healthcare facilities. The source of the information was a questionnaire survey. The sample consists of 181 managers from various health care and health service organizations. The method of analysis of variance (ANOVA) was used for data processing. The results were processed in SPSS and Excel programs. Pearson’s coefficient was used to evaluate the cross-correlation of the variables. The level of significance was 5% on both sides. Basic awareness of diversity management in the healthcare facilities is low. Some tools of diversity management are used, but only in isolation, non-conceptually, and unsystematically. The acknowledgment of diversity concept is poor and chaotic. The basic models of this concept defining its goals, activities, programs, responsibilities, and measurements are not known. One of the strong areas of the diversity management in the healthcare facilities is the diversity of working teams. On other hand, the weak side is the diversity as part of the organization culture and diversity as a part of human resource management. The summarizing index Attitudes towards Diversity received a higher average value than the Diversity Management Implementation index. Significant variables influencing the level of aggregate indices were identified: Ownership, size of the organization in terms of number of employees, patients’ satisfaction, and employees’ satisfaction.

Practice Management Knowledge Amongst Plastic Surgery Residents in Canada: A National Survey

Business and practice management principles are critical components of healthcare provision. Business and practice management is currently undertaught in plastic surgery training programs. The objective was to assess the status of business and practice management teaching amongst plastic surgery programs in Canada. An online survey of all enrolled plastic surgery residents was conducted in 2019 to 2020. Participants were invited to rate their knowledge and confidence about core principles in business and practice management. Sixty-five out of 126 residents responded to this survey (response rate, 51.6%). Only 7.8% of participants had previous business and practice management training; 23.1% reported receiving training in business and practice management during their residency. Participants reported a low level of knowledge and confidence in business and practice management (average Likert score between 3 and 4). Participants reported a high desire for future training in business and practice management particularly in billing and coding (91.2%) and business operations (91.2%). Plastic surgery residents in Canada reported a low level of knowledge and confidence about business and practice management. They desire the inclusion of business and practice management training in future curriculum.

Leadership training programs in graduate medical education: a systematic review

BACKGROUND

With the increasing recognition that leadership skills can be acquired, there is a heightened focus on incorporating leadership training as a part of graduate medical education. However, there is considerable lack of agreement regarding how to facilitate acquisition of these skills to resident, chief resident, and fellow physicians.

METHODS

Articles were identified through a search of Ovid MEDLINE, EMBASE, CINAHL, ERIC, PsycNet, Cochrane Systemic Reviews, and Cochrane Central Register of Controlled Trials from 1948 to 2019. Additional sources were identified through contacting authors and scanning references. We included articles that described and evaluated leadership training programs in the United States and Canada. Methodological quality was assessed via the MERSQI (Medical Education Research Study Quality Instrument).

RESULTS

Fifteen studies, which collectively included 639 residents, chief residents, and fellows, met the eligibility criteria. The format, content, and duration of these programs varied considerably. The majority focused on conflict management, interpersonal skills, and stress management. Twelve were prospective case series and three were retrospective. Seven used pre- and post-test surveys, while seven used course evaluations. Only three had follow-up evaluations after 6 months to 1 year. MERSQI scores ranged from 6 to 9.

CONCLUSIONS

Despite interest in incorporating structured leadership training into graduate medical education curricula, there is a lack of methodologically rigorous studies evaluating its effectiveness. High-quality well-designed studies, focusing particularly on the validity of content, internal structure, and relationship to other variables, are required in order to determine if these programs have a lasting effect on the acquisition of leadership skills.

Effectiveness of a Leadership Development Course for Chief Residents: A Longitudinal Evaluation

BACKGROUND

Nonclinical skills (eg, self-regulation, team leadership, conflict resolution) are essential for success as a chief resident (CR). The literature on programs teaching these skills reports few if any effectiveness outcomes.

OBJECTIVE

We reported the outcomes of a leadership course for CRs using participants' self-reported outcomes and assessments from their program directors (PDs).

METHODS

A 2-day curriculum focused on emotional intelligence competencies, including self-awareness, self-management, social awareness, and relationship management. We used a logic model to align 2017-2018 curriculum with targeted outcomes. Questionnaires before and after the course assessed short-term and intermediate outcomes for the participants and PD interviews evaluated observed changes in CRs' performance attributable to the course.

RESULTS

A total of 74 residents participated in the course, and 65% and 59% responded to the post-course and follow-up questionnaires, respectively. Over 95% of respondents indicated developing leadership knowledge and skills and connecting with new CRs in the post-course questionnaire. During follow-up, CRs reported applying concepts learned during chief residency, using tools to address conflict, engaging in quality and patient safety projects, and continuing to interact with other participants. The relationships between reported outcomes and participants' gender/prior leadership training were not significant (P > .05), with small to medium effect sizes (0.01-0.32). All 14 PDs offered positive appraisal of the CRs, but we could not specifically attribute this growth to the course.

CONCLUSIONS

Participation in this CR leadership development course was associated with enhancement and application of leadership competencies in immediate and intermediate time frames.

"You are in Some Sort of Occupational Adolescence": An Exploratory Study to Understand Knowledge, Skills, and Experiences of CanMEDS Leader Role in Psychiatry

OBJECTIVE

The study explored knowledge, attitude, and practices of Canadian Medical Education Directions for Specialists (CanMEDS) "'Leader" role in faculty psychiatrists in a university setting.

METHODS

This is a qualitative study using a thematic analysis approach. Participants were identified by purposive, convenience, and snowball sampling. Telephone interviews were conducted to explore participants' perceptions of leadership. Qualitative analysis was carried out using a constant comparative analysis approach to identify themes across the interview data. Data was transcribed and coded into themes and categories to form an analysis of physicians' knowledge, attitude, and practices of the CanMEDS "Leader" role.

RESULTS

Twenty-eight faculty psychiatrists participated in the study. The following themes and subthemes emerged from analysis: (a) characteristics of leadership and lack of clarity regarding CanMEDS "Leader" role (subthemes: differences between manager and leader, lack of specificity and practicality, relevance to practice) and (b) the meaning of leadership (subthemes: "positional leadership" and "everyday leadership," physician as team leader, developing leadership skills, getting beyond "occupational adolescence").

CONCLUSION

Participants perceived CanMEDS "Leader" role description as a high-level vision, which needs practice-oriented guidance. Participants conceptualized the dual nature of physician leadership at an individual level and at an organizational level. Leadership training is important both in residency as well as lifelong learning.

Are hospital managers ready for value-based healthcare?

Purpose

Hospital organisations are currently experiencing significant challenges that have encouraged a move towards a value-based approach to health care. However, such a transition requires understanding the underlying competencies required to enable such a focus. This paper aims to undertake a systematic review of the available literature on managerial competencies in hospitals and considers these in a value-based health-care context.

Design/methodology/approach

A systematic literature review was conducted to identify research studies that describe the characteristics of management competence in hospital environments.

Findings

Categories and sub-categories of management competence in hospitals were identified and considered in a value-based health-care context.

Research limitations/implications

The systematic literature review identifies a need for further research regarding managerial competencies of managers of hospitals. Competencies for managing in a value-based health-care model also require deeper investigation.

Practical implications

The categories of management competence provide guidance to organisations transitioning towards value-based health care in terms of identifying and developing management competencies. Hospitals should consider the development of a competency model that includes broader categories of competencies than purely clinical or professional competencies.

Originality/value

This study builds upon and advances previous reviews of management competence in hospitals, and the competency categories presented can be used as a basis to identify management competency requirements in hospitals.

Formal leadership training for orthopedic surgeons: Limited opportunities amongst growing demand

Leadership skills are important to all orthopedic surgeons, regardless of practice or location, as interactions with patients, staff, and other physicians necessitate professionalism and leadership. Leadership skills are best developed through formal training and experiential opportunities. Several programs emphasizing leadership skills for orthopedic surgeons exist; however, the number of programs is not adequate to meet the demand. It is difficult for orthopedic surgeons to take advantage of these opportunities, given clinical and professional responsibilities. To appropriately adapt to the changing healthcare environment and ensure advancement of the orthopedic field, formal leadership skills development should be widely integrated into orthopedic training.

Critical Care Organizations: Building and Integrating Academic Programs

OBJECTIVE

Academic medical centers in North America are expanding their missions from the traditional triad of patient care, research, and education to include the broader issue of healthcare delivery improvement. In recent years, integrated Critical Care Organizations have developed within academic centers to better meet the challenges of this broadening mission. The goal of this article was to provide interested administrators and intensivists with the proper resources, lines of communication, and organizational approach to accomplish integration and Critical Care Organization formation effectively.

DESIGN

The Academic Critical Care Organization Building section workgroup of the taskforce established regular monthly conference calls to reach consensus on the development of a toolkit utilizing methods proven to advance the development of their own academic Critical Care Organizations. Relevant medical literature was reviewed by literature search. Materials from federal agencies and other national organizations were accessed through the Internet.

SETTING

The Society of Critical Care Medicine convened a taskforce entitled "Academic Leaders in Critical Care Medicine" on February 22, 2016 at the 45th Critical Care Congress using the expertise of successful leaders of advanced governance Critical Care Organizations in North America to develop a toolkit for advancing Critical Care Organizations.

MEASUREMENTS AND MAIN RESULTS

Key elements of an academic Critical Care Organization are outlined. The vital missions of multidisciplinary patient care, safety, and quality are linked to the research, education, and professional development missions that enhance the value of such organizations. Core features, benefits, barriers, and recommendations for integration of academic programs within Critical Care Organizations are described. Selected readings and resources to successfully implement the recommendations are provided. Communication with medical school and hospital leadership is discussed.

CONCLUSIONS

We present the rationale for critical care programs to transition to integrated Critical Care Organizations within academic medical centers and provide recommendations and resources to facilitate this transition and foster Critical Care Organization effectiveness and future success.

Leadership Development in Postgraduate Medical Education: A Systematic Review of the Literature

PURPOSE

To evaluate and interpret evidence relevant to leadership curricula in postgraduate medical education (PGME) to better understand leadership development in residency training.

METHOD

The authors conducted a systematic review of peer-reviewed, English-language articles from four databases published between 1980 and May 2, 2017 that describe specific interventions aimed at leadership development. They characterized the educational setting, curricular format, learner level, instructor type, pedagogical methods, conceptual leadership framework (including intervention domain), and evaluation outcomes. They used Kirkpatrick effectiveness scores and Best Evidence in Medical Education (BEME) Quality of Evidence scores to assess the quality of the interventions.

RESULTS

Twenty-one articles met inclusion criteria. The classroom setting was the most common educational setting (described in 17 articles). Most curricula (described in 13 articles) were isolated, with all curricula ranging from three hours to five years. The most common instructor type was clinical faculty (13 articles). The most commonly used pedagogical method was small group/discussion, followed by didactic teaching (described in, respectively, 15 and 14 articles). Study authors evaluated both pre/post surveys of participant perceptions (n = 7) and just postintervention surveys (n = 10). The average Kirkpatrick Effectiveness score was 1.0. The average BEME Quality of Evidence score was 2.

CONCLUSIONS

The results revealed that interventions for developing leadership during PGME lack grounding conceptual leadership frameworks, provide poor evaluation outcomes, and focus primarily on cognitive leadership domains. Medical educators should design future leadership interventions grounded in established conceptual frameworks and pursue a comprehensive approach that includes character development and emotional intelligence.

Organizational factors affecting physician well-being

Purpose of review

Symptoms of burnout affect approximately half of pediatricians and pediatric subspecialists at any given time, with similarly concerning prevalence of other aspects of physician distress, including fatigue, depressive symptoms, and suicidal ideation. Physician well-being affects quality of care, patient satisfaction, and physician turnover. Organizational factors influence well-being, stressing the need for organizations to address this epidemic.

Recent findings

Organizational characteristics, policies, and culture influence physician well-being, and specific strategies may support an environment where physicians thrive. We highlight four organizational opportunities to improve physician well-being: developing leaders, cultivating community and organizational culture, improving practice efficiency, and optimizing administrative policies. Leaders play a key role in aligning organizational and individual values, promoting professional fulfillment, and fostering a culture of collegiality and social support among physicians. Reducing documentation burden and improving practice efficiency may help balance job demands and resources. Finally, reforming administrative policies may reduce work-home conflict, support physician's efforts to attend to their own well-being, and normalize use of supportive resources.

Summary

Physician well-being is critical to organizational success, sustainment of an adequate workforce, and optimal patient outcomes. Because burnout is primarily influenced by organizational factors, organizational interventions are key to promoting well-being. Developing supportive leadership, fostering a culture of wellness, optimizing practice efficiency, and improving administrative policies are worthy of organizational action and further research.

The Significance of an MBA Degree for a Podiatric Physician-Is It Worth It? A Survey Study

BACKGROUND:

The Kent State University College of Podiatric Medicine is negotiating with the College of Business Administration at Kent State University to establish a dual Doctor of Podiatric Medicine (DPM)/Master of Business Administration (MBA) degree. Of the nine colleges of podiatric medicine in the nation, there are two schools that have a joint DPM/MBA program listed in their catalogue, but no joint program was operational at the time this survey was conducted. A telephone survey of the other eight podiatric medical colleges was conducted to obtain that information. This survey was used to assess further data for the exploration of a dual DPM/MBA program at Kent State University College of Podiatric Medicine.

METHODS:

A survey was sent out to 38 individuals who possessed both a DPM and an MBA degree. They responded to questions about why they obtained the business degree, how they are using their business degree, what courses in the MBA program are most relevant, and whether they would recommend that DPM students pursue a dual degree.

RESULTS:

The majority of respondents indicated that they obtained an MBA degrees to gain a better understanding of the marketplace, to increase their income, and to better manage a podiatric medical practice. The respondents were generally very happy to have obtained their MBA degree and would encourage a dual-degree option. They admitted that a minor or series of courses with a business focus may be helpful to a DPM student who did not opt for an MBA degree.

CONCLUSIONS:

The positive survey results from respondents encourage continued research into a dual-degree DPM/MBA program. During research for a DPM/MBA degree, we feel a DPM with an MBA degree will allow our students to be better prepared for leadership roles within their community and administrative positions and to have a deeper understanding of the business of health care.

Leading the Dialysis Unit: Role of the Medical Director

The responsibilities of a dialysis unit medical director are specified in the ESRD Conditions for Coverage and encompass multiple quality, safety, and educational domains. Many of these responsibilities require leadership skills that are neither intuitive nor acquired as part of the medical director's training. An effective medical director is able to shape the culture of the dialysis facility such that patients and staff feel free to communicate their concerns regarding suboptimal processes without fear of retribution, and there is a continuous iterative process of quality improvement and safety, which values input from all stakeholders. This ultimately decreases the use of shortcuts and work-arounds that may compromise patient safety and quality because policies and procedures make it easiest to do the right thing. Fundamental to this leadership by the medical director are communications skills, staff empowerment, allocation of resources, mentoring, team building, and strategic vision. The medical director leads by example and must be present in the dialysis unit for extended periods to send a message of accessibility and commitment. Many dialysis medical directors would benefit from leadership training inside or outside their dialysis corporation.

Competitive Advantage of MBA for Physician Executives: A Systematic Literature Review

In response to systemic challenges facing the US healthcare system, many medical students, residents and practicing physicians are pursuing a Master in Business Administration (MBA) degree. The value of such proposition remains poorly defined. The aim of this review is to analyze current literature pertaining to the added value of MBA training for physician executives (PEs). We hypothesized that physicians who supplement their clinical expertise with business education gain a significant competitive advantage. A detailed literature search of four electronic databases (PubMed, SCOPUS, Embase and ERIC) was performed. Included were studies published between Jan 2000 and June 2017, focusing specifically on PEs. Among 1580 non-duplicative titles, we identified 23 relevant articles. Attributes which were found to add value to one's competitiveness as PE were recorded. A quality index score was assigned to each article in order to minimize bias. Results were tabulated by attributes and by publication. We found that competitive domains deemed to be most important for PEs in the context of MBA training were leadership (n = 17), career advancement opportunities (n = 12), understanding of financial aspects of medicine (n = 9) and team-building skills (n = 10). Among other prominent factors associated with the desire to engage in an MBA were higher compensation, awareness of public health issues/strategy, increased negotiation skills and enhanced work-life balance. Of interest, the learning of strategies for reducing malpractice litigation was less important than the other drivers. This comprehensive systemic review supports our hypothesis that a business degree confers a competitive advantage for PEs. Physician executives equipped with an MBA degree appear to be better equipped to face the challenge of the dynamically evolving healthcare landscape. This information may be beneficial to medical schools designing or implementing combined dual-degree curricula.

Perceptions of Health Care Executives on Leadership Development Skills for Residents After Participating in a Longitudinal Mentorship Program

Despite the fact that physicians are being asked to lead and enact change to improve a myriad of quality of care measures, there is little focus on leadership skills development during their training. One strategy to address this gap is to focus on trainees during graduate medical education, specifically those residents aspiring to careers as physician leaders in quality. The authors designed a leadership curriculum for self-selected residents who are pursuing a certificate in health care leadership in quality. Residents were surveyed and focus groups were conducted with health system executives who participated in the curriculum as part of an evaluation designed to inform improvements in the program and to provide guidance to others who direct physician leadership training programs. The findings support the need to invest in young physician leaders who are focused on quality with the ultimate goal of improving population health in the ever-changing health care environment.

The Affordable Care Act and Its Effects on Physician Leadership: A Qualitative Systematic Review

OBJECTIVES

The Affordable Care Act (ACA) shifted the focus in medical care from quantity to quality. This qualitative systematic review aimed to determine the key skills necessary for effective physician leaders after the implementation of the ACA, and to compare them with key skills identified prior to its implementation.

METHODS

A qualitative systematic review was conducted. A systematic literature search on leadership skills for physicians returned 26 articles published between 2009 and 2016. Thematic analysis was used to categorize the data presented in each article. The results from the thematic analysis were then compared with a similar article published before the implementation of the ACA.

RESULTS

Teamwork and team-building, communication, and self-awareness skills were mentioned most often. The percentage of articles mentioning teamwork and team-building skills (61.5%) was significantly greater than the percentage (25%) reported before the implementation of the ACA (P ≤ .04).

CONCLUSION

With the shift toward quality of patient care, health care workers at all levels should strive to work as a team to provide the best quality of care at all stages of patient care.

Psychiatric Management, Administration, and Leadership: a Continuum or Distinct Concepts?

To clarify the relationship between the concepts of management, administration, and leadership in psychiatry. The authors provide a review of the conceptual evolution of administrative psychiatry and develop operational definitions of these three domains. Based upon their experiences, they discuss relevant core competencies and personal attributes. The authors found that the terms psychiatric management, psychiatric administration, and psychiatric leadership are often used interchangeably, yet they each have a different and distinct focus. Additionally, some in the field consider the concepts overlapping, existing on a continuum, while others draw distinct conceptual boundaries between these terms. Psychiatrists in leadership positions function in all three domains. While these are distinct concepts, the authors recommend that administrative psychiatrists integrate all three in their everyday work. The authors suggest the distinctions among these concepts should inform training and identify core competencies related to these distinctions. Mentoring should focus on the practical integration of the concepts of management, administration, and leadership in administrative psychiatry. The authors present a cohesive framework for future development of a curriculum for education and research.

Leadership Training in Graduate Medical Education: A Systematic Review

BACKGROUND

Leadership is a critical component of physician competence, yet the best approaches for developing leadership skills for physicians in training remain undefined.

OBJECTIVE

We systematically reviewed the literature on existing leadership curricula in graduate medical education (GME) to inform leadership program development.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we searched MEDLINE, ERIC, EMBASE, and MedEdPORTAL through October 2015 using search terms to capture GME leadership curricula. Abstracts were reviewed for relevance, and included studies were retrieved for full-text analysis. Article quality was assessed using the Best Evidence in Medical Education (BEME) index.

RESULTS

A total of 3413 articles met the search criteria, and 52 were included in the analysis. Article quality was low, with 21% (11 of 52) having a BEME score of 4 or 5. Primary care specialties were the most represented (58%, 30 of 52). The majority of programs were open to all residents (81%, 42 of 52). Projects and use of mentors or coaches were components of 46% and 48% of curricula, respectively. Only 40% (21 of 52) were longitudinal throughout training. The most frequent pedagogic methods were lectures, small group activities, and cases. Common topics included teamwork, leadership models, and change management. Evaluation focused on learner satisfaction and self-assessed knowledge. Longitudinal programs were more likely to be successful.

CONCLUSIONS

GME leadership curricula are heterogeneous and limited in effectiveness. Small group teaching, project-based learning, mentoring, and coaching were more frequently used in higher-quality studies.

Barriers and enablers to academic health leadership

Purpose This study sought to identify the barriers and enablers to leadership enactment in academic health-care settings. Design/methodology/approach Semi-structured interviews ( n = 77) with programme stakeholders (medical school trainees, university leaders, clinical leaders, medical scientists and directors external to the medical school) were conducted, and the responses content-analysed. Findings Both contextual and individual factors were identified as playing a role in affecting academic health leadership enactment that has an impact on programme development, success and maintenance. Contextual factors included sufficient resources allocated to the programme, opportunities for learners to practise leadership skills, a competent team around the leader once that person is in place, clear expectations for the leader and a culture that fosters open communication. Contextual barriers included highly bureaucratic structures, fear-of-failure and non-trusting cultures and inappropriate performance systems. Programmes were advised to select participants based on self-awareness, strong communication skills and an innovative thinking style. Filling specific knowledge and skill gaps, particularly for those not trained in medical school, was viewed as essential. Ineffective decision-making styles and tendencies to get involved in day-to-day activities were barriers to the development of academic health leaders. Originality/value Programmes designed to develop academic health-care leaders will be most effective if they develop leadership at all levels; ensure that the organisation's culture, structure and processes reinforce positive leadership practices; and recognise the critical role of teams in supporting its leaders.

Medical student healthcare consulting groups: A novel way to train the next generation of physician-executives

Meeting the challenges of the evolving healthcare environment requires leadership of physicians well-trained in clinical medicine and healthcare management. However, many physicians lack training in business and leadership. While some residency programs have management tracks, training at the medical school level is currently lacking. We developed the Hopkins Health Management Advisory Group, an extracurricular program at Johns Hopkins University School of Medicine that exposes medical students to healthcare management and fosters development of leadership skills. Teams of students work directly with health system executives on 3-6 month-long projects using management consulting principles to address problems spanning health system domains, including strategy, operations, and quality improvement. Since the program's inception, 23 students have completed seven projects, with 13 additional students currently working on three more projects. Sponsors leading six out of seven completed projects have implemented recommendations. Qualitative survey respondents have found the program beneficial, with students frequently describing how the program has helped to develop professional skills and foster knowledge about healthcare management. These early assessments show positive impact for both students and the institution, and suggest that such programs can train students in management early and concurrently in their medication education by immersing them in team-based health system projects.

Physician leadership development: Evidence-informed design tempered with real-life experience

This article describes key considerations for creation of evidence-informed in-house physician leadership development. Ten elements extracted from a scan of the peer-reviewed and grey literature are presented, and key learnings at the Queen Elizabeth II Health Sciences Centre, a quaternary academic health sciences centre in Halifax, Nova Scotia, are highlighted. Each element is briefly described with practical considerations and challenges to implementation outlined in the context of the former Capital District Health Authority, where the authors collaborated to create in-house physician leadership development prior to the consolidation of health districts in that province. The purpose of this article is to share how the authors used evidence to plan physician leadership development and to explore the additional situational and contextual factors and considerations needed for implementation.

Business Education for Plastic Surgeons: A Systematic Review, Development, and Implementation of a Business Principles Curriculum in a Residency Program

BACKGROUND

Rising health care costs, decreasing reimbursement rates, and changes in American health care are forcing physicians to become increasingly business-minded. Both academic and private plastic surgeons can benefit from being educated in business principles. The authors conducted a systematic review to identify existing business curricula and integrated a business principles curriculum into residency training.

METHODS

The authors anonymously surveyed their department regarding perceived importance of business principles and performed a systematic literature review from 1993 to 2013 using PubMed and Embase to identify residency training programs that had designed/implemented business curricula. Subsequently, the authors implemented a formal, quarterly business curriculum.

RESULTS

Thirty-two of 36 physicians (88.9 percent; 76.6 percent response rate) stated business principles are either "pretty important" or "very important" to being a doctor. Only 36 percent of faculty and 41 percent of trainees had previous business instruction. The authors identified 434 articles in the systematic review: 29 documented formal business curricula. Twelve topics were addressed, with practice management/administration (n = 22) and systems-based practice (n = 6) being the most common. Four articles were from surgical specialties: otolaryngology (n = 1), general surgery (n = 2), and combined general surgery/plastic surgery (n = 1). Teaching formats included lectures and self-directed learning modules; outcomes and participant satisfaction were reported inconsistently. From August of 2013 to June of 2015, the authors held eight business principles sessions. Postsession surveys demonstrated moderately to extremely satisfied responses in 75 percent or more of resident/fellow respondents (n = 13; response rate, 48.1 percent) and faculty (n = 9; response rate, 45.0 percent).

CONCLUSIONS

Business principles can be integrated into residency training programs. Having speakers familiar with the physician audience and a session coordinator is vital to program success.

Filling the Pipeline: AOA Critical Issues

This is the Presidential Address, "Filling the Pipeline," that was given by Sanford E. Emery, MD, MBA, at the Annual Meeting of the American Orthopaedic Association in June 2016.

Defining leadership competencies for pediatric critical care fellows: Results of a national needs assessment

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.