Medical Leadership Research Articles

Medical leadership and management: What's in it for FACEM trainees?

Medical leadership and management: What's in it for FACEM trainees?

Empowering the Invisible: Accelerating Leadership Development for Midcareer Women in Medicine.

Midcareer women physicians face numerous obstacles to career advancement and leadership roles resulting in their contributions and achievements becoming "invisible." This paper addresses the paradox of increasing professional experience coupled with decreased visibility for women in medicine at this stage in their careers. To address this disparity, the Women in Medicine Leadership Accelerator has developed a leadership skill development program specifically tailored for midcareer women physicians. The program incorporates key principles derived from effective leadership training models and aims to combat systemic barriers while equipping women with the necessary tools to navigate and transform the medical leadership landscape.

Communities of Practice: Redressal of Medical Education Leadership Challenges through a Workplace-Based Learning Approach

Background: There is a realization that learning leadership skills is beyond classroom teaching and requires leaders to participate in communities of practice (CoP) that enables them to learn from the wisdom of seasoned leader because such leaders don’t ask budding leaders to follow their instructions, they rather set examples of best practices in medical education. However, dearth of published evidence both locally and internationally suggests that there is a need to investigate how have communicates of practice impacted leadership skills of physicians as medical education leaders.
 Participants and Methods: A transcendental phenomenological study was conducted, involving seven physician leaders working as medical teachers from both basic and clinical sciences, heading the medical college and/or their departments as professors in a medical college on the basis of convenience sampling and their experiences as medical education leaders who had presumably experienced the phenomenon of ‘learning leadership skills’. The researcher conducted hour-long one-on-one interviews with participants at their workplace offices and one interview was conducted at the researcher’s home office. One of the participants was interviewed twice as additional gaps were identified from the initial analysis. Interviews conducted in the surgeon’s office were interrupted many a times by theatre assistants, but the continuity was resumed successfully. The qualitative data was analyzed manually by using the Stevick-Colaizzi-Keen method.
 Results: One major theme namely ‘communities of practice impacting leadership skills’ emerged from the transcripts whereas, two subthemes namely ‘gaining wisdom’ and ‘uplifting emotional wellbeing’ were identified as main aspects that had a major influence on leadership skills of physicians in the medical education milieu.
 Conclusion: CoP has a positive impact on leadership skills. It enables leaders in medical education to learn wisdom to solve difficult leadership problems. Evidence supports that CoP also uplifts emotional wellbeing of leaders by preventing their burn out.

Maintaining High Quality Dosimetry Education in Radiation Oncology Medical Residency Amid and Post-COVID-19 Pandemic: A Reimagined Training Rotation

Maintaining High Quality Dosimetry Education in Radiation Oncology Medical Residency Amid and Post-COVID-19 Pandemic: A Reimagined Training Rotation

Editorial introductions.

Editorial introductions.

Perceptions of Gender Stereotypes among Women Residents in Surgical and Nonsurgical Specialties.

The objective of this study was to determine whether and to what degree residents experience stereotype perception by gender and specialty type (surgical vs nonsurgical). A cross-sectional survey was sent to resident physicians across all specialties at a single academic institution in February 2021. The survey items asked whether participants believe residents, faculty, and the public expect men or women to be better physicians on a numerical scale from 1 to 7. A χ2 test compared the calculated mean and standard error for each survey item. This study took place at Washington University School of Medicine in St. Louis, Missouri, a large academic tertiary care center. A total of 411 (46% of total) residents participated; 13 were excluded because of nonbinary gender or missing demographic information, for a final sample of 398. Participants perceived all three groups to expect men to be better physicians than women. Regression analysis showed a significant effect of gender on stereotype perception, with women reporting stronger stereotype perceptions than men. There were no significant differences in stereotype perceptions by specialty type. Women resident physicians in both surgical and nonsurgical fields reported higher levels of gender stereotype perception compared with men, making it imperative that graduate medical education leadership support changes to the current learning environment.

A Health Equity Fellowship Based in Experiential Learning Through a Rural Academic-Community Partnership

While rural communities continue to experience significant health disparities, investment in graduate medical education (GME) focused on rural health remains uneven.1 Investing in rural GME could allow early-career physicians to address health disparities by providing leadership training and mentored experience generating systems change. Leadership skills and systems change are especially important when physicians work in communities they are not from. There is a steep learning curve to understanding a community's priorities, governance structures, and building their trust. Despite best intentions, unprepared physicians may fail to make lasting beneficial change for the community, and communities risk losing physicians to burnout and turnover.The Massachusetts General Hospital Fellowship Program in Rural Health Leadership teaches skills in leadership and health systems change to early-career primary care physicians through a rural-based experiential learning model based on Kolb's Learning Styles Inventory.2 Fellows develop attitudes, knowledge, and skills in leadership and health equity by moving through 4 stages of learning: (1) experiencing and reflecting on the rural experience; (2) acquiring new knowledge and concepts; (3) practicing new ideas through discussion; and (4) taking action and learning from the result.Fellows spend a quarter per year of the 2-year program at the rural community partner site in Rosebud, South Dakota, working clinically as independent attending-level physicians. Rosebud is the home of the Sicangu Lakota Oyate and Indian Health Service Rosebud Service Unit and has long experienced some of the worst health outcomes in the country due to sustained historical, systemic, and infrastructure challenges. As the Rosebud community experiences many of the same challenges facing rural communities across the United States, fellows learn skills in leadership and health equity that can be translated in their future careers to other sites with challenged infrastructure.Faculty support is provided by a network of academic teaching physicians experienced in rural health through a combination of asynchronous/synchronous and remote/on-site forums, including weekly meetings where difficult clinical cases and systems improvement work is discussed, a de-identified encrypted group chat, monthly discussion exchanges with other global and rural fellowships, weekly fellow seminars, and shared reading lists. These teaching interactions provide fellows with new concepts to apply to their experiences, as well as opportunities to articulate their reflections and test their new ideas through discussion.A key aspect of the fellowship is the completion of a mentored capstone project in any aspect of systems change—research, policy, advocacy, quality improvement, or education are a few examples. Focused mentorship and a program-funded Master of Public Health are pillars of the capstone project support. These capstone projects allow fellows to apply their lessons learned to new practice and to observe the results.The key values of the program are imbued in the structure of experiential learning and are seen in the fellows' activities during the program and beyond (Table).In a 2021 GME survey of fellows, the clinical breadth and intense experiential learning in clinical and leadership roles was consistently named as a major strength of the program.Successful graduates from the program should be prepared to move directly into a leadership position in rural and community health. Since the first fellowship class graduated in 2017, the fellowship has produced 7 graduates. Since graduation, fellows have gone on to positions in medical education leadership, policy, and leading innovative clinical programs with rural and underserved populations.

COVID-19 Restrictions In Jails And Prisons: Perspectives From Carceral Leaders.

COVID-19 has been an unprecedented challenge in carceral facilities. As COVID-19 outbreaks spread in the US in early 2020, many jails, prisons, juvenile detention centers, and other carceral facilities undertook infection control measures such as increased quarantine and reduced outside visitation. However, the implementation of these decisions varied widely across facilities and jurisdictions. We explored how carceral decision makers grappled with ethically fraught public health challenges during the pandemic. We conducted semistructured interviews during May-October 2021 with thirty-two medical and security leaders from a diverse array of US jails and prisons. Although some facilities had existing detailed outbreak plans, most plans were inadequate for a rapidly evolving pandemic such as COVID-19. Frequently, this caused facilities to enact improvised containment plans. Quarantine and isolation were rapidly adopted across facilities in response to COVID-19, but in an inconsistent manner. Decision makers generally approached quarantine and isolation protocols as a logistical challenge, rather than an ethical one. Although they recognized the hardships imposed on incarcerated people, they generally saw the measures as justified. Comprehensive outbreak control guidelines for pandemic diseases in carceral facilities are urgently needed to ensure that future responses are more equitable and effective.

Protocol for improving the costs and outcomes of assistive reproductive technology fertility care pathways: a study using cost measurement and process mining

IntroductionValue-based healthcare suggests that care outcomes should be evaluated in relation to the costs of delivering that care from the perspective of the provider. However, few providers achieve this because...

Committee on Surgical Combat Casualty Care position statement: Neurosurgical capability for the optimal management of traumatic brain injury during deployed operations.

Experiences over the last three decades of war have demonstrated a high incidence of traumatic brain injury (TBI) resulting in a persistent need for a neurosurgical capability within the deployed theater of operations. Despite this, no doctrinal requirement for a deployed neurosurgical capability exists. Through an iterative process, the Joint Trauma System Committee on Surgical Combat Casualty Care (CoSCCC) developed a position statement to inform medical and nonmedical military leaders about the risks of the lack of a specialized neurosurgical capability. The need for deployed neurosurgical capability position statement was identified during the spring 2021 CoSCCC meeting. A triservice working group of experienced forward-deployed caregivers developed a preliminary statement. An extensive iterative review process was then conducted to ensure that the intended messaging was clear to senior medical leaders and operational commanders. To provide additional context and a civilian perspective, statement commentaries were solicited from civilian clinical experts including a recently retired military trauma surgeon boarded in neurocritical care, a trauma surgeon instrumental in developing the Brain Injury Guidelines, a practicing neurosurgeon with world-renowned expertise in TBI, and the chair of the Committee on Trauma. After multiple revisions, the position statement was finalized, and approved by the CoSCCC membership in February 2023. Challenges identified include (1) military neurosurgeon attrition, (2) the lack of a doctrinal neurosurgical capabilities requirement during deployed combat operations, and (3) the need for neurosurgical telemedicine capability and in-theater computed tomography scans to triage TBI casualties requiring neurosurgical care. Challenges identified regarding neurosurgical capabilities within the deployed trauma system include military neurosurgeon attrition and the lack of a doctrinal requirement for neurosurgical capability during deployed combat operations. To mitigate risk to the force in a future peer-peer conflict, several evidence-based recommendations are made. The solicited civilian commentaries strengthen these recommendations by putting them into the context of civilian TBI management. This neurosurgical capabilities position statement is intended to be a forcing function and a communication tool to inform operational commanders and military medical leaders on the use of these teams on current and future battlefields. Prognostic and Epidemiological; Level V.

Students' Leadership Development During a High-fidelity Military Medical Field Practicum.

Leadership development is a cornerstone aspect of military medical education. Operation Bushmaster, a medical field practicum (MFP) conducted by the USU, tests fourth-year medical students' clinical skills and leadership acumen in an operational environment. No studies have examined students' perceptions of their own leadership development during this MFP. Therefore, this study explored leadership development from the students' perspectives. Using a qualitative phenomenological design, we analyzed the reflection papers of 166 military medical students who participated in Operation Bushmaster during the fall of 2021. Our research team coded and categorized the data. Once defined, these categories served as the themes in this study. Three central themes were expressed: (1) the importance of direct and decisive communication, (2) unit cohesion and interpersonal relationships enhance the team's ability to adapt, and (3) followership quality determines leadership outcomes. The students' leadership ability was maximized by established relationships within their unit and well-practiced communication, and a decreased propensity for followership negatively affected leadership. Overall, Operation Bushmaster increased students' appreciation of the importance of leadership development and overall enhanced their leadership outlook as a future military medical officer. This study provided an introspective vantage from military medical students pertaining to their own leadership development, as participants described how the challenging environment of a military MFP challenged them to hone and develop their leadership skills. As a result, the participants gained a greater appreciation of continued leadership development and realization of their future roles and responsibilities within the military health care system.

Undergraduate Medical Education Leader Performance Predicts Postgraduate Military Leader Performance.

Developing physicians as leaders has gained attention across the United States. Undergraduate medical education (UME) and graduate medical education (GME) leader development programs have increased. During postgraduate years (PGY), graduates bring their leadership education to the bedside; however, associations between leader performance in medical school and GME is largely unknown. It is important to find experiences that can assess leader performance that may be useful to predict future performance. The purpose of this study was to determine if (1) there is a correlation between leader performance during the fourth year of medical school versus leader performance in PGY1 and 3, and (2) leader performance during the fourth year of medical school is associated with military leadership performance in PGY1 and 3s while taking previous academic performance markers into account. This study examined overall leader performance of learners (classes of 2016-2018) during the fourth year of medical school and their graduate leader performance post-medical school. Leader performance was assessed by faculty during a medical field practicum (UME leader performance) and graduate leader performance was assessed by program directors at the end of PGY1 (N = 297; 58.3%) and 3 (N = 142; 28.1%). Pearson correlation analysis examined relationships among UME leader performance and between the PGY leader performance items. In addition, stepwise multiple linear regression analyses were conducted to examine the relationship between leader performance at the end of medical school with military leadership performance in PGY1 and 3, while taking into account the academic performance markers. Pearson correlation analyses revealed that the UME leader performance was correlated with 3 of 10 variables at PGY1, and was correlated at PGY3 with 10 out of 10 variables. Results of the stepwise multiple linear regression analysis indicated that leader performance during the fourth year of medical school explained an additional 3.5% of the variance of PGY1 leader performance after controlling for the previous academic performance markers (MCAT total score, USMLE Step 1 score and Step 2 CK score). In contrast, leader performance during the fourth year of medical school alone accounted for an additional 10.9% of the variance of PGY3 leader performance above and beyond the set of academic performance markers. Overall, UME leader performance has more predictive power in PGY leader performance than the MCAT or USMLE Step exams. The findings of this study indicate that a positive relationship exists between leader performance at the end of medical school and leader performance in PGY1 and 3 years of residency. These correlations were stronger in PGY3 compared to PGY1. During PGY1, learners may be more focused on being a physician and an effective team member compared to PGY3 where they have a deeper understanding of their roles and responsibilities and can take on more leadership roles. Additionally, this study also found that MCAT and USMLE Step exams performance was not predictive of PGY1 or PGY3 leader performance. These findings provide evidence of the power of continued leader development in UME and beyond.

Breaking Down Grit: Persistency and Flexibility in the Career Plans of Military Medical Students.

The field of medicine is experiencing a crisis as high levels of physician and trainee burnout threaten the pipeline of future physicians. Grit, or passion and perseverance for long-term goals, has been studied in high-performing and elite military units and found to be predictive of successful completion of training in adverse conditions. The Uniformed Services University of the Health Sciences (USU) graduates military medical leaders who make up a significant portion of the Military Health System physician workforce. Taken together, an improved understanding of the relationships between burnout, well-being, grit, and retention among USU graduates is critical to the success of the Military Health System. The current study was approved by the Institutional Review Board at USU and explored these relations among 519 medical students across three graduating classes. These students participated in two surveys approximately one year apart from October 2018 until November 2019. Participants completed measures on grit, burnout, and likelihood of leaving the military. These data were then merged with demographic and academic data (e.g., Medical College Admission Test scores) from the USU Long Term Career Outcome Study. These variables were then analyzed simultaneously using structural equation modeling to examine the relationships among variables in a single model. Results reaffirmed the 2-factor model of grit as both passion and perseverance (or interest consistency). No significant relationships emerged between burnout and other study variables. Sustained and focused interest was predictive of less likelihood of staying in the military. This study offers important insights into the relationship among well-being factors, grit, and long-term career planning in the military. The limitations of using a single-item measure of burnout and measuring behavioral intentions in a short time frame during undergraduate medical education highlight the importance of future longitudinal studies that can examine actual behaviors across a career lifespan. However, this study offers some key insights into potential impacts on the retention of military physicians. The findings suggest that military physicians who are most likely to stay in the military tend to embrace a more fluid and flexible medical specialty path. This is critical in expectation setting for the military to train and retain military physicians across a wide range of critical wartime specialties.

National Needs Assessment for Medical Resuscitation Leadership Education

National Needs Assessment for Medical Resuscitation Leadership Education

Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different contextof care.

To learn lessons for maternity care by scrutinizing postpartum hemorrhage management (PPH) in cases of PPH-related maternal deaths in France and the Netherlands. In this binational Confidential Enquiry into Maternal Deaths (CEMD), 14 PPH-related maternal deaths were reviewed by six experts from the French and Dutch national maternal death review committees regarding cause and preventability of death, clinical care and healthcare organization. Improvable care factors and lessons learned were identified. CEMD practices and PPH guidelines in France and the Netherlands were compared in the process. For France, new insights were primarily related to organization of healthcare, with lessons learned focusing on medical leadership and implementation of (surgical) checklists. For the Netherlands, insights were mainly related to clinical care, emphasizing hemostatic surgery earlier in the course of PPH and reducing the third stage of labor by prompter manual removal of the placenta. Experts recommended extending PPH guidelines with specific guidance for women refusing blood products and systematic evaluation of risk factors. The quality of CEMD was presumed to benefit from enhanced case finding, also through non-obstetric sources, and electronic reporting of maternal deaths to reduce the administrative burden. A binational CEMD revealed opportunities for improvement of care beyond lessons learned at the national level.

Implementing an Awake Proning Protocol for COVID-19 Patients with Moderate Hypoxia in the Emergency Department

Background: New York City emergency departments (EDs) faced a sudden influx of critically ill patients during the initial wave of COVID-19, leading to a shortage of resources to care for patients experiencing hypoxia. This study describes the development and implementation of an awake proning protocol in which conscious patients with suspected or confirmed COVID-19 moderate hypoxia were assisted to a prone position to improve oxygenation. Methods: This one-week project took place in a single New York City ED. An interdisciplinary team of nursing and medical leadership reviewed the literature on the safety and effectiveness of awake proning and developed a treatment protocol and seven-member interdisciplinary proning team. Oxygenation (SpO2), heart rate (HR), and respiration rate (RR) were recorded at baseline and 10-minutes post-proning. Results: Thirty patients were included. Mean age was 60.8 and a majority were male (n = 25; 83%). Significant differences between pre- and post-proning measures were found for SpO2 (p < 0.000), HR (p < 0.028), and RR (p < 0.025) after 10 minutes of awake proning. Conclusion: Awake proning is a promising technique for improving outcomes in patients with respiratory distress and can be implemented effectively in an ED setting.

Understanding the Context for Incorporating Equity into Quality Improvement Throughout a National Health Care System.

Although health care systems aspire to deliver equitable care, practical tools that empower the health care workforce to weave equity throughout quality improvement (QI) processes are lacking. In this article, we report findings from context of use interviews that informed the development of a user-centered tool to support equity-focused QI. Semistructured interviews were conducted from February to April of 2019. Participants included 14 medical center administrators, departmental or service line leaders, and clinical staff involved in direct patient care from three Veterans Affairs (VA) Medical Centers within a single region. Interviews covered existing practices for monitoring health care quality (i.e., priorities, tasks, workflow, and resources) and explored how equity data might fit into current processes. Themes extracted through rapid qualitative analysis were used to draft initial functional requirements for a tool to support equity-focused QI. Although the potential value of examining disparities in health care quality was clearly recognized, the data necessary for examining disparities were lacking for most quality measures. Interviewees also desired guidance on how inequities could be addressed through QI. The ways in which QI initiatives were selected, carried out, and supported also had important design implications for tools to support equity-focused QI. The themes identified in this work guided the development of a national VA Primary Care Equity Dashboard to support equity-focused QI within VA. Understanding the ways in which QI was carried out across multiple levels of the organization provided a successful foundation upon which to build functional tools to support thoughtful engagement around equity in clinical settings.

Sleep, Immune Function, and Vaccinations in Military Personnel: Challenges and Future Directions.

The U.S. military invests substantial resources to vaccinate all personnel, including recruits, against operationally important infectious disease threats. However, research suggests that vaccine immune response and, therefore, vaccine effectiveness may be inadvertently reduced because of chronic and/or acute sleep deficiency experienced by recipients around the time of vaccination. Because sleep deficiency is expected and even necessary in deployed and training contexts, research investigations of the impacts of sleep and related physiological systems such as circadian rhythms on vaccine effectiveness in military settings are needed. Specifically, research should be aimed at understanding the effects of sleep deficiency, as well as vaccine administration schedules, on response to vaccination and clinical protection. Furthermore, knowledge gaps among military medical leadership on sleep, vaccines, and immune health should be assessed. This area of research may benefit the health and readiness of service members while also decreasing health care utilization and associated costs from illness.

Importance of Leadership skills for International Medical Graduates

Academic Performance To assess the importance of leadership skills, especially participation in Research projects, attending conferences, collaborating with other faculty members and team-based learning.
 This study emphasizes the importance of leadership skills that tremendously impact the competitive residency matching process. Good medical leadership enable physicians to learn management and inspire others through effective communication and critical thinking. Therefore, medical graduates are expected to develop skills to deal with conflict resolution, Help others, take mutual responsibility and Improve their performance in clinical practice, research and developing team building skills.

Women as a Growing Force in Critical Care Medicine-the Journal, Profession, and Society.

Women as a Growing Force in Critical Care Medicine-the Journal, Profession, and Society.