Bridging the leadership development gap: recommendations for medical education

On the road to becoming a responsible leader: A simulation-based training approach for final year medical students

Background and objective: There is a need for young physicians to take a responsible role in clinical teams, comparable to a leadership role. However, today's medical curricula barely consider the development of leadership competencies. Acquisition of leadership skills are currently a by-product of medical education, even though it seems to be a competency relevant for physicians' success. Therefore, an innovative leadership training program for young physicians was developed and validated. Training conceptualisation were based upon findings of critical incidents interviews (N=19) with relevant personnel (e.g. experienced doctors/nurses, residents) and upon evidence-based leadership contents focusing on ethical leadership behaviors. Method: The training consists of four sessions (3-4 hours each) and provided evidence-based lectures of leadership theory and effective leader behaviors, interactive training elements and a simulation-based approach with professional role players focusing on interprofessional collaboration with care staff. Training evaluation was assessed twice after completion of the program (N=37). Assessments included items from validated and approved evaluation instruments regarding diverse learning outcomes (satisfaction/reaction, learning, self-efficacy, and application/transfer) and transfer indicators. Furthermore, training success predictors were assessed based on stepwise regression analysis. In addition, long-term trainings effects and behavioral changes were analysed. Results: Various learning outcomes are achieved (self-reported training satisfaction, usefulness of the content and learning effects) and results show substantial transfer effects of the training contents and a strengthened awareness for the leadership role (e.g. self-confidence, ideas dealing with work-related problems in a role as responsible physician). We identified competence of trainer, training of applied tools, awareness of job expectations, and the opportunity to learn from experiences of other participants as predictors of training success. Additionally, we found long-term training effects and participants reported an increase in specific competencies, relevant for effective interprofessional collaboration (active perspective-taking, communication, conflict management, personal competencies). Conclusion: The training of leadership competencies for young physicians seems feasible to develop constructive influence strategies for a successful interprofessional collaboration in early career stages. The simulation-based approach is beneficial for residents to practice leadership behaviour in realistic job situations.

Measurement properties and implementation of a checklist to assess leadership skills during interdisciplinary rounds in the intensive care unit

The implementation of interdisciplinary teams in the intensive care unit (ICU) has focused attention on leadership behavior. A daily recurrent situation in ICUs in which both leadership behavior and interdisciplinary teamwork are integrated concerns the interdisciplinary rounds (IDRs). Although IDRs are recommended to provide optimal interdisciplinary and patient-centered care, there are no checklists available for leading physicians. We tested the measurement properties and implementation of a checklist to assess the quality of leadership skills in interdisciplinary rounds. The measurement properties of the checklist, which included 10 essential quality indicators, were tested for interrater reliability and internal consistency and by factor analysis. The interrater reliability among 3 raters was good (κ, 0.85) and the internal consistency was acceptable (α, 0.74). Factor analysis showed all factor loadings on 1 domain (>0.65). The checklist was further implemented during videotaped IDRs which were led by senior physicians and in which 99 patients were discussed. Implementation of the checklist showed a wide range of "no" and "yes" scores among the senior physicians. These results may underline the need for such a checklist to ensure tasks are synchronized within the team.

The role of MD and MBA training in the professional development of a physician: a survey of 30 years of graduates from the Wharton Health Care Management Program

PURPOSE

The number of medical schools offering MD and MBA training has increased fivefold in the last two decades. The authors evaluated graduates' perceptions of the role of such training on their career and professional development.

METHOD

In 2011, the authors surveyed physician graduates from the Wharton School MBA Program in Heath Care Management at the University of Pennsylvania from 1981 to 2010. Survey responses were analyzed and evaluated using grounded theory.

RESULTS

Among 247 eligible graduates, 59.9% (148/247) completed the questionnaire and 89.9% (133/148) of them provided free-text responses. Approximately 85.1% (126/148) of respondents were male and 79.7% (118/148) entered residency training; however, both rates declined slightly over time. Among respondents within their first decade after graduation, 46.2% (24/52) reported clinical practice as their primary work sector compared with 39.5% (15/38) among respondents 11 to 20 years after graduation and 19.2% (5/26) of respondents 21 to 30 years after graduation. Overall, graduates reported mostly positive attitudes and often noted the benefits of career acceleration, professional flexibility, and credibility in multidisciplinary domains. The few negative remarks were focused on the opportunity cost of time and how peers in one discipline may negatively perceive the role of the other discipline's degree.

CONCLUSIONS

Graduates with an MD and MBA report mostly positive attitudes towards their training, and many are pursuing leadership and primarily nonclinical roles later in their careers. These findings reveal new insights for policies affecting physician workforce. Further study is necessary to evaluate whether similar trends exist more broadly.