Medical Leadership Research Articles

S22: Social Connectedness, Ageing and Mental Health in Doctors

Being a doctor is tough, especially in a post-pandemic world. Never has the field of doctors’ health been so stretched by need. Senior doctors, and medical leaders in particular, have been particularly taxed, as have their families. Unpacking some of the insights gleaned about medical leadership and wisdom in medicine, and conversely when this is lacking, is important for the sake of patients and doctors alike. In this symposium we will address new perspectives in doctors’ health tailored to this new healthcare world. Topics include: (i) Systemic interventions to support senior medical leadership; (ii) Wisdom in medicine; (iii) The dysfunctional or disruptive physician in healthcare; (iv) Senior doctors and their families; (v) Medical retirement in a post-pandemic world. Strong audience participation will be encouraged in this symposium.

The Financial Relationship Between the Medical Industry and Residency Leadership in OB/GYN and Urology.

Background Industry payments to physicians exceed millions of dollars. Payments can influence physicians' practices and potentially impact trainees. Objective To examine the magnitude of industry payments to obstetrics and gynecology (OB/GYN) and urology residency directors and department chairs in the United States. Methods For this retrospective cross-sectional study, program directors and department chairs of OB/GYN and urology residency programs were identified in December 2021. Nonresearch payments between August 1, 2013, and December 31, 2020, from drug or device manufacturers to program directors and department chairs of OB/GYN and urology residency programs were compiled from the Centers for Medicare & Medicaid Services Open Payments Database. Statistical analysis was conducted using the Kruskal-Wallis test and a linear mixed-effects model. Results A total of 19 903 payments, totaling $6,041,585, were provided to 396 physicians, with a median of $232.62 per physician over the 6 years analyzed. Urologists received more payments and higher amounts per payment than OB/GYNs (7820 vs 12 083, P<.01; $1,689,519.48 vs $4,352,066.40, P<.01). Department chairs received more payments per year than program directors (8 vs 4, P<.01). There were also geographic differences, with higher payments in the Northeast US region ($131.10 more, P<.01). Based on the linear mixed-effects model, 3 variables predicted the magnitude of industry payments received: physician age, number of years in leadership position, and geographic location. Conclusions Urologists and OB/GYN US residency program directors and department chairs received considerable nonresearch industry payments from 2013 to 2020.

Analysis of Ventricular Arrhythmias and Sudden Death with Acalabrutinib from 5 Prospective Clinical Trials

Background: The approval of ibrutinib, the first covalent Bruton tyrosine kinase inhibitor (BTKi), provided an effective non-chemotherapy option for the treatment of B-cell malignancies, such as chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). While generally well tolerated, ibrutinib demonstrated significant toxicities in clinical studies, particularly cardiovascular adverse events such as hypertension, atrial fibrillation, and ventricular arrhythmias (VAs). Post hoc analysis of the phase 3 FLAIR trial in patients with previously untreated CLL reported an unexplained sudden or cardiac death rate of 0.5 patients per 100 patient-years with ibrutinib plus rituximab (Hillmen et al. Lancet Oncol. 2023). Acalabrutinib is a next-generation, more selective, irreversible BTKi approved to treat CLL/SLL and relapsed/refractory mantle cell lymphoma. Herein, the rates of nonfatal and fatal VAs and sudden deaths (SDs) from 5 acalabrutinib clinical trials of patients with CLL were analyzed. Methods: Incidence and relative risk of nonfatal and fatal VAs and SDs were analyzed using pooled data from 5 prospective acalabrutinib clinical trials (nonrandomized trials: CL-001 [acalabrutinib monotherapy], CL-003 [acalabrutinib + obinutuzumab]; randomized trials: CL-006 [acalabrutinib vs ibrutinib], CL-007 [acalabrutinib ± obinutuzumab vs chlorambucil + obinutuzumab], CL-309 [acalabrutinib vs idelalisib + rituximab OR bendamustine + rituximab]). Acalabrutinib-containing arms were pooled as a single group; comparators, which were standard-of-care therapies, were pooled as a separate group. Events were identified by comprehensive data extraction of terms capturing nonfatal and fatal VAs and SDs (terms are defined in Table 1 footnote). Nonfatal events were analyzed with and without the inclusion of premature ventricular contractions (PVCs). A subset of fatal events also was analyzed after adjudication through manual clinical review by the sponsor's medical, clinical, and safety leadership. Results: In total, 1299 patients received acalabrutinib (cumulative exposure, 4568.4 patient-years) and 585 received standard-of-care therapies (comparator group) (941.3 patient-years). Considering only fatal VAs and SDs, 5 (0.4%) and 3 (0.5%) patients had an event in the acalabrutinib and comparator groups, respectively, via comprehensive data extraction ( Table 1). Based on exposure-adjusted event rates per 100 patient-years, fatal VAs and SDs were numerically less frequent for acalabrutinib versus comparators; however, relative risks did not statistically favor either group. This trend persisted when events were adjudicated through manual clinical review. After adjudication, 2 of 5 patients in the acalabrutinib group and 2 of 3 patients in the comparator group were determined to have fatal VA or cardiac-related SD. Nonfatal VAs were reported in 11 (0.8%) patients in the acalabrutinib group and 3 (0.5%) patients in the comparator group. When PVCs were excluded, 2 patients in each group (acalabrutinib, 0.2%; comparator, 0.3%) had nonfatal VAs. These nonfatal VAs consisted of ventricular fibrillation (acalabrutinib, n=2 [grades 2 and 4]; comparator, n=1 [grade 4]) and unspecified VA (comparator, n=1 [grade 1]). Although the acalabrutinib group had a lower exposure-adjusted event rate per 100 patient-years than the comparator group, relative risk did not favor either group. With both fatal and nonfatal VAs (with or without PVCs), time to event was notably longer with acalabrutinib than with comparators ( Table 1). A sensitivity analysis excluding the ibrutinib-treated patients from the comparator cohort yielded overall similar results (data not shown). Conclusions: This pooled analysis of prospective acalabrutinib clinical trials demonstrates that the risk of VA and SD with acalabrutinib is low and similar to that of standard-of-care therapies when adjusted for exposure. The current analysis with more than 1200 patients treated with acalabrutinib points to favorable safety outcomes and no specific trend with SDs and VAs. Additional analyses with larger cohorts from the clinical development program and all postmarketing sources will continue to further characterize the safety profile of acalabrutinib.

Impact of a Wellness Leadership Intervention on the Empathy, Burnout, and Resting Heart Rate of Medical Faculty

ObjectiveTo evaluate the efficacy of a wellness leadership intervention for improving the empathy, burnout, and physiological stress of medical faculty leaders. Participants and MethodsParticipants were 49 medical faculty leaders (80% physicians, 20% basic scientists; 67% female). The 6-week course was evaluated with a 15-week longitudinal waitlist-control quasi-experiment from September 1, 2021, through December 20, 2021 (during the COVID-19 pandemic). We analyzed 3 pretest-posttest-posttest and 6 weekly survey measurements of affective empathy and burnout, and mean=85 (SD=31) aggregated daily resting heart rates per participant, using 2-level hierarchical linear modeling. ResultsThe course found a preventive effect for leaders’ burnout escalation. As the control group awaited the course, their empathy decreased (coefficientTime=−1.27; P=.02) and their resting heart rates increased an average of 1.4 beats/min (coefficientTime=0.18; P<.001), reflecting the toll of the pandemic. Intervention group leaders reported no empathy decrements (coefficientTime=.33; P=.59) or escalated resting heart rate (coefficientTime=−0.05; P=.27) during the same period. Dose-response analysis revealed that both groups reduced their self-rated burnout over the 6 weeks of the course (coefficientTime=−0.28; P=.007), and those who attended more of the course showed less heart rate increase (coefficientTime∗Dosage=−0.05; P<.001). In addition, 12.73% of the within-person fluctuation in empathy was associated with burnout and resting heart rate. ConclusionA wellness leadership intervention helped prevent burnout escalation and empathy decrement in medical faculty leaders during the COVID-19 pandemic, showing potential to improve the supportiveness and psychological safety of the medical training environment.

Effective Humanitarian Work: Teaching Medical Skill Sets in Ukraine.

The senior authors traveled to Ukraine to teach specific skills to Ukrainian physicians and other medical professionals, utilizing a 2-day ATLS course, workshops in point-of-care ultrasonography (POCUS), lectures and webinars on damage control resuscitation, damage control surgery, and transfusion of whole blood. The authors have focused on providing skill sets that Ukrainian doctors can utilize within their existing system to improve immediate patient care for casualties resulting from the unanticipated Russian invasion and improve outcomes. Given the resource limitations and differences of the Ukrainian healthcare systems, the authors believe Western-based professionals who come to Ukraine to help for short periods should resist the temptation to offer western solutions that may not work in Ukraine. Major improvements in Ukrainian health care will require long-term efforts in teaching but also need to include increased efforts to improve hospitals, clinics, staffing, education, supplies, and equipment. Those who travel to help in Ukraine can still teach short courses that provide skills that Ukrainian doctors and nurses can use within their existing healthcare system to improve the quality of patient care in the immediate period of crisis and hopefully improve outcomes in the near term. It is not a reasonable expectation to think that the delivery of 2-day courses such as ATLS or POCUS will significantly change the country-wide delivery of healthcare. This sort of practice change requires the engagement of medical and political leaders and a sustained reform effort over years, not days or weeks. Supportive countries and non-governmental organizations need to prepare for a long and extensive investment in improving Ukrainian healthcare.

Applying Customer Discovery Method to a Chronic Disease Self-Management Mobile App: Qualitative Study.

A significant health challenge is evident in the United States, with 6 in 10 adults having a chronic disease and 4 in 10 adults having 2 or more. Chronic disease self-management aims to prevent or delay disease progression and disability and reduce mortality risk. The evidence to support the use of information technology tools, including mobile apps, web-based portals, and web-based educational interventions, that support disease self-management and improve clinical outcomes is growing. Customer discovery and value proposition design methodology is a form of stakeholder engagement and is based on marketing and lean start-up business methods. As applied in health care, customer discovery and value proposition methodology can be used to understand the clinical problem and articulate the product's hypothesized unique value proposition relative to alternative options that are available to end users. This study aims to describe the experience and findings of academic researchers applying the customer discovery and value proposition methodology to identify stakeholders, needs, adaptability, and sustainability of a chronic disease self-management mobile app (CDapp). The motivation of the work is to make mobile health app interventions accessible and acceptable for all segments of patients' chronic diseases. Data were obtained through key informant interviews and analyzed using rapid qualitative analysis techniques. The value proposition framework was used to build the interview guide. The aim was to identify the needs, challenges (pains), and potential benefits (gains) of the CDapp for our stakeholders. Our results showed that the primary consumers (end users) of a CDapp were the patients. The app adopters (decision makers) can be medical center leaders including population health department managers or insurance providers, while the consumer adoption influencers (influencers or saboteurs) are clinicians and patient caregivers. We developed an ecosystem map to visualize the clinical practice workflow and how an app for chronic disease management might integrate within an academic health care center or system. A value proposition for the identified customer segments was generated. Each stakeholder segment was working within a different framework to improve patient self-management. Patients needed help to adhere to self-care activities and they needed tailored health education. Health care leaders aim to improve the quality of care while reducing costs and workload. Clinicians wanted to improve patient education and care while reducing the time burden. Our results also showed that within academic medical centers, there were variations regarding patients' self-reported abilities to manage their diseases. Customer discovery is a useful form of stakeholder engagement when designing studies that seek to implement, adapt, and sustain an intervention. The customer discovery and value proposition methodology can be used as an alternative or complementary approach to formative research to generate valuable information in a brief period.

Reproductive psychiatric advance directives: promoting autonomy for perinatal people with serious mental illness diagnoses.

People with serious mental illness (SMI) diagnoses who become pregnant are particularly vulnerable to symptom recurrence and resulting potential lack of decision-making capacity (Taylor et al. J Psychiatr Res 104:100-107, 2018; Bagadia et al. Int J Soc Psychiatry 66:792-798, 2020). In these situations, prenataland behavioral health providers have little legally viable guidance on what medical and/or psychiatric care the patient desires (Aneja and Arora Indian J Med Ethics V:133-139, 2020). We created a "Reproductive Psychiatric Advance Directive (PAD)," grounded in Reproductive Justice principles, that promotes patient autonomy by proactively articulating perinatal medical and psychiatric care preferences. We conducted a medical and legal literature review using two sets of terms related to (1) PADs and (2) reproductive health. We convened an expert working group of legal, medical, psychiatric, peer, and advocacy leaders and community-based organizations to develop a Reproductive PAD. Our literature review yielded no results about Reproductive PADs. We created de novo a Reproductive PAD template with sections on medical and psychiatric history, informed consent for critical medical and psychiatric care, family planning and custody preferences, and optional sections on abortion and on electroconvulsive therapy. The Reproductive PAD provides a possible legal mechanism for people of childbearing age with SMI diagnoses to articulate their medical and psychiatric care choices around reproduction and pregnancy. Future research should evaluate the Reproductive PAD as an effective tool for protecting patient autonomy during pregnancy and postpartum and guiding medical and psychiatric providers.

Undue Burden the Medical School Application Process Places on Low-Income Latinos

Undue Burden the Medical School Application Process Places on Low-Income Latinos

“We just don’t have the resources”: Supervisor perspectives on introducing workplace-based assessments into medical specialist training in South Africa

BackgroundSouth Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. Despite the fact that competency-based medical education (CBME) has been in place for about two decades, WBA offers new and interesting challenges. The literature indicates that WBA has resource, regulatory, educational and social complexities. Implementing WBA would therefore require a careful approach to this complex challenge. To date, insufficient exploration of WBA practices, experiences, perceptions, and aspirations in healthcare have been undertaken in South Africa or Africa. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical specialist educators. The outcomes being reported are themes derived from reported potential barriers and enablers to WBA implementation in the SA context.MethodsThis paper reports on the qualitative data generated from a mixed methods study that employed a parallel convergent design, utilising a self-administered online questionnaire to collect data from participants. Data was analysed thematically and inductively.ResultsThe themes that emerged were: Structural readiness for WBA; staff capacity to implement WBA; quality assurance; and the social dynamics of WBA.ConclusionsParticipants demonstrated impressive levels of insight into their respective working environments, producing an extensive list of barriers and enablers. Despite significant structural and social barriers, this cohort perceives the impending implementation of WBA to be a positive development in registrar training in South Africa. We make recommendations for future research, and to the medical specialist educational leaders in SA.

Pathways to interoperable electronic patient records in health and social care, Part 2: introduction for commissioners, chief clinical information officers and senior medical and social care leaders involved in health IT commissioning and strategy

Since the start of the 2020 Coronavirus 2019 (COVID-19) pandemic, new models of care have rapidly emerged in both health and social care in the UK. The sharing of structured and unstructured data across care organisations has become increasingly important, especially in transfer of care situations and other services, such as hospital at home. At the same time synchronous and asynchronous communication between professionals, patients and their carers, which integrates with patients' records, is optimising care pathways, improving access to care and enhancing self-management of care, particularly for people with long-term conditions. Interoperability and integration of healthcare records is a complex undertaking with various technical, regulatory and organisational challenges. It requires a long-term commitment, collaboration, and investment for all stakeholders to create a comprehensive, interoperable health and social care information ecosystem across the UK. Engaged understanding of these building blocks by clinical and social care leaders will help ensure today's solutions do not become tomorrow's problems.

The Case for Community-Based Global Oral Health Immersive Experiences

Abstract: We designed and implemented a collaborative immersion in Ethiopia as a service learning experience for a team of interprofessional (IP) learners. The IP team of four dental students, one dental faculty, nine medical students, two medical student leaders, and one global health faculty fully experienced this immersion. The setting was in rural Ethiopia, and the immersive experience included ecological accommodations by the Common River Non-Governmental Organization (CR-NGO).

Comparison of Online to In-Person Administration of a Medical Student Leadership Curriculum.

Comparison of Online to In-Person Administration of a Medical Student Leadership Curriculum.

Development and Validation of a Measure of Medical Student Leadership in Team-Based Simulations.

Development and Validation of a Measure of Medical Student Leadership in Team-Based Simulations.

Preventive Cardiovascular Care for Hypercholesterolemia in US Emergency Departments: A National Missed Opportunity.

Hypercholesterolemia (HCL) affects nearly half of Emergency Department (ED) patients who present with possible acute coronary syndrome (ACS). However, it is unknown whether US ED providers obtain lipid panels, calculate 10-year atherosclerotic cardiovascular disease (ASCVD) risk, and prescribe cholesterol-lowering medications for these patients. We conducted a nationwide cross-sectional ED survey from April 18, 2023, to May 12, 2023. An electronic survey assessing current preventive HCL care practices for patients being evaluated for ACS. A convenience sample was obtained by sharing the survey with ED medical directors, chairs, and senior leaders using emergency medicine professional organization listservs and snowball sampling. Responding EDs were categorized as being associated with an academic medical center (AMC) or not (non-AMC). During the 4-week study period, 110 EDs (50 AMC and 60 non-AMC EDs) across 39 states responded. Just 1.8% (2/110) stated that their providers obtain a lipid panel on at least half of patients with possible ACS and only one ED (0.9%) responded that its providers calculate 10-year ASCVD risk and prescribe cholesterol medication for the majority of eligible patients. Most reported never obtaining lipid panels (60.9%, 67/110), calculating 10-year ASCVD risk (55.5%, 61/110), or prescribing cholesterol-lowering medications (52.7%, 58/110). The vast majority of US ED providers do not provide preventive cardiovascular care for patients presenting with possible ACS. Most ED providers do not evaluate for HCL, calculate ASCVD risk, or prescribe cholesterol-lowering medications for these patients.

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

IntroductionEffective 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.MethodsWe 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.ResultsFive-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).ConclusionsFrench-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.

Medical Physics Leadership Academy Journal Club (Leadership Club) program: Two-year review in building a community of leaders.

The American Association of Physicists in Medicine began the Medical Physics Leadership Academy Journal Club in the fall of 2020. The initiative was launched to provide a forum for medical physicists to learn about leadership topics using published material, discuss and reflect on the material, and consider incorporating the discussed skills into their professional practice. This report presents the framework for the MPLA Journal Club program, describes the lessons learned over the last 2years, summarizes the data collected from attendees, and highlights the roadmap for the program moving forward.

Hospitalists Improving Transitions of Care Through Virtual Collaborative Rounding with Skilled Nursing Facilities-the HiToC SNF Study.

Over one in five Medicare patients discharged to skilled nursing facilities (SNFs) are re-hospitalized within 30days of discharge. Poor communication between the hospital and SNF upon hospital discharge is frequently cited as the most common cause of readmission. The goal of this program was to assess the ability of a weekly post-discharge hospitalist led virtual rounding program to augment the written discharge summary sent to SNFs. Two academic hospitals and six SNFs in Baltimore, MD. Hospitalists and medical directors or directors of nursing from the partner SNF. During weekly encounters, the hospitalist and SNF providers discussed the clinical status, discharge medications, treatment plan, and follow-up care of all discharged patients. The intervention took place from July 2021 to December 2021. During the study, 544 patients were discussed in a post-discharge virtual encounter. After the discussions, hospitalists identified clinically significant errors in 124 discharge summaries. A survey of participating hospitalists and SNF medical and nursing leadership indicated the intervention was thought to improve care transitions. Our innovation was successful in identifying errors in discharge summaries and was thought to improve the transition of care by participating SNF and hospitalist providers.

The Eighth Annual Academic International Medicine Congress and Scientific Forum, July 14–16, 2023: Thinking Globally, Acting Locally

The first in-person Academic International Medicine Congress (AIM 2023) since the beginning of the COVID-19 Pandemic took place at Rutgers University in New Brunswick, NJ, almost exactly 4 years after a meeting at the same location had to be canceled due to the global calamity. Featuring 3 days packed with high quality continuing medical education content and leadership development sessions, AIM 2023 set several important records for our organization. Among the most important sessions was the half-day strategic leadership retreat, with a goal of charting ACAIM’s path for the next 3-5 years. The main program featured more than 35 speakers and panelists, and offered more than 20 hours of continuing medical education credits. The scientific program included more than 30 abstracts and interesting case presentations. The AIM 2023 Gala and Awards Ceremonies were among the most attended attractions. This report includes a summary of key events and sessions from the AIM 2023 Congress, inclusive of published abstracts from the meeting. The following core competencies are addressed in this article: Interpersonal and communication skills, Professionalism, Practice-based learning and improvement, Systems based practice.

Scoping review protocol: exploration of the barriers and facilitators to the uptake of early postnatal contraception

IntroductionIt is well documented that many women do not desire a short interpregnancy interval. Medical societies, government agencies and leaders in the field recommend that contraception should be part of...

Leadership in Undergraduate Medical Education: A Study of Pakistani Medical Students’ Perceptions, Attitudes, and Interest

Background: Despite calls for the much-needed involvement of physicians in leadership, very few medical colleges in Pakistan provide explicit training on the knowledge, skills, and attitudes necessary to be an effective physician leader. &#x0D; Objective: To explored Pakistani medical students’ perceptions, attitudes, and interests regarding Leadership training in medical education.&#x0D; Methods:&#x0D; Participants were asked about their perceptions and attitudes towards medical leadership on a 5-point Likert scale. Students also self-rated their leadership competencies noted as per Medical Leadership Competency Framework. Survey also assessed the perceived need and topics for a leadership curriculum for physician leaders, the teaching format, and barriers to leadership training in medical schools. Data were analyzed using SPSS 26.&#x0D; Results:&#x0D; 60.6% of the total 1204 respondents rated their leadership training in medical college as “very poor” or “poor” and 80.3% of them endorsed their interest and need for it. 77.4% of the participants agreed that clinicians should influence leadership decisions in a clinical setting. Only 25% of respondents were aware of the demands of a leadership rank in medicine. Leadership competencies endorsed for training included problem-solving, leading a team, confronting problematic employees, and communication skills with a multimodal teaching approach, including teaching methods like small group discussions. The main barriers to leadership training were identified as time constraints (66.1%), lack of available curriculum (69.0%), and disinterest by faculty (67.0%).&#x0D; Conclusion:&#x0D; Our study suggests that medical students in Pakistan appreciate the importance of leadership training in undergraduate education. There is a need for dedicated leadership teaching and study data to specify the possible content and delivery methods to serve as goals for an undergraduate leadership curriculum in Pakistan.&#x0D;