Postgraduate leadership development: a cross specialty trainees’ perspective

Psychiatric leadership development in postgraduate medical education and training

The value of strong, compassionate medical leadership in the delivery of high-quality care to patients within mental health services is clear. Leadership development, however, is far less well explored. This article is for psychiatric trainees, trainers and mental health organisations. It provides an introduction to the importance of leadership development within postgraduate medical training, the theory that should underpin its delivery, and the opportunities for both informal and formal leadership development within psychiatric training.

Integrating leadership development into radiation oncology training: A qualitative analysis of resident interviews

PURPOSE

Radiation oncologists need to have more than sound clinical and technical competencies. To optimize care for patients and advance all aspects of radiation oncology (RO), radiation oncologists must also be effective leaders. Embedding systematic leadership education into RO training programs is challenging. This study examined RO residents' perspectives and preferences relating to leadership education. Such data informs the integration of universal leadership learning into RO training in Australian and New Zealand, and identifies priority areas to facilitate successful leadership development initiatives in RO training programs worldwide.

METHODS AND MATERIALS

Semi-structured telephone interviews were conducted with 13 RO residents across eight Australian training departments and all stages of training. Data from transcriptions of taped interviews were coded by ≥ 2 researchers and collected to saturation. Qualitative thematic analysis was conducted employing an iterative inductive process to develop codes into themes and subthemes. Representative quotes were collated to illustrate subthemes.

RESULTS

Four key themes related to leadership education were identified and labelled: (1) Recognition, credibility and value of education, (2) Logistics of formal learning, (3) Real-world opportunities: 'seeing and doing', and (4) One size does not fit all. Residents unanimously felt formal leadership education was important and that aspects of becoming a good leader could be learned. Organisational and cultural factors emerged as either barriers or facilitators to learning. There was strong support for interactive methods of learning, and role-modelling by senior colleagues was identified as having a major impact on junior learners.

CONCLUSIONS

This study offers insight into RO residents' perspectives and preferences around their own leadership development. Findings have practical implications for the design of effective RO leadership programs and bring us one step closer to the ultimate goal of enhancing leadership capability for all RO professionals.

The Importance of Leadership Development in Medical Curricula: A UK Perspective (Stars are Aligning)

"Medical leadership and management" describes the engagement of doctors in the leadership and management of both individual patient care and of the departments, organizations and systems within which they work. Around the world, doctors are generally accepted as the leaders of clinical teams, holding ultimate accountability for individual patient care. However, the role of doctors as organizational and system leaders within healthcare, despite evidence of benefit, shows considerable variation. In this article, we briefly explore the history of leadership development for doctors, and then, taking a UK perspective on recent developments in undergraduate education and postgraduate training, consider the opportunities and challenges for medical schools, educators and doctors in implementing these. The future of medical leadership and management development is promising although there is still a lack of evidence on the longer-term outcomes and impact on patients of current interventions. It is clear, however, that faculty need to be skilled in holding effective developmental conversations and structuring formative experiences for those they educate, and that leadership development must be integrated longitudinally throughout a doctor's career, with undergraduate development being a critical stage for helping medical students recognize and understand their wider responsibility to the system, as well as the patient in front of them.

Pathogenesis of central and complex sleep apnoea

Central sleep apnoea (CSA) - the temporary absence or diminution of ventilatory effort during sleep - is seen in a variety of forms including periodic breathing in infancy and healthy adults at altitude and Cheyne-Stokes respiration in heart failure. In most circumstances, the cyclic absence of effort is paradoxically a consequence of hypersensitive ventilatory chemoreflex responses to oppose changes in airflow, that is elevated loop gain, leading to overshoot/undershoot ventilatory oscillations. Considerable evidence illustrates overlap between CSA and obstructive sleep apnoea (OSA), including elevated loop gain in patients with OSA and the presence of pharyngeal narrowing during central apnoeas. Indeed, treatment of OSA, whether via continuous positive airway pressure (CPAP), tracheostomy or oral appliances, can reveal CSA, an occurrence referred to as complex sleep apnoea. Factors influencing loop gain include increased chemosensitivity (increased controller gain), reduced damping of blood gas levels (increased plant gain) and increased lung to chemoreceptor circulatory delay. Sleep-wake transitions and pharyngeal dilator muscle responses effectively raise the controller gain and therefore also contribute to total loop gain and overall instability. In some circumstances, for example apnoea of infancy and central congenital hypoventilation syndrome, central apnoeas are the consequence of ventilatory depression and defective ventilatory responses, that is low loop gain. The efficacy of available treatments for CSA can be explained in terms of their effects on loop gain, for example CPAP improves lung volume (plant gain), stimulants reduce the alveolar-inspired PCO₂ difference and supplemental oxygen lowers chemosensitivity. Understanding the magnitude of loop gain and the mechanisms contributing to instability may facilitate personalized interventions for CSA.