Physician Leadership Research Articles

Cultivating Agents of Change in Medical Students: Addressing the Overdose Epidemic in the United States Through Enhancing Knowledge of Multimodal Pain Medicine and Increasing Accessibility via Open-Access, Web-Based Medical Education and Technology.

Medical students of today will soon be physician leaders and teachers of tomorrow about important relevant topics including the overdose epidemic and its devastating impact on our society. In the United States, the overdose crisis, including drug opioid-related overdoses, the increasing prevalence of opioid use disorder along with the increasing number of patients with chronic pain are intensifying and call attention for nationwide action. A strong medical educational foundation of the understanding of the relationship between pain and substance use disorder, their treatment including opioid analgesic therapy, multimodal and interdisciplinary care, and long-term management is needed to help cultivate comprehensive knowledge and training to prepare the next generation's frontline practitioners to meet these needs. Yet, traditional educational curricula covering these topics are not standardized in medical schools across the nation in the United States. The advent of web-based medical education and the integration of this technology may offer potential solutions to these challenges. Often found equally effective as in-person learning, web-based medical education through open-access modules and other technologies can help increase accessibility, enhance knowledge of multimodal pain management, safe and effective use of opioid analgesics, and other related topics, and provide flexible and powerful teaching initiatives. Our viewpoint is thus that open-access modules and other technology-integrated teaching initiatives can help deliver excellence in pain education, preparing and empowering medical students-our future agents of change-who will be at the forefront of the overdose epidemic.

Physicians as leaders: a systematic review through the lens of expert leadership

PurposeThe purpose of this paper is to provide a systematic review of the current state of physician leadership. Theory of expert leadership (TEL) was applied to explore the effects of physician inherent knowledge, industry experience and leadership capabilities on leader behaviors and outcomes.Design/methodology/approachThis review (August 2011–February 2022) applied the preferred reporting items for systematic review and meta-analysis strategy. Our search began with 3,537 studies and a final sample of 12 articles.FindingsThe findings offer a number of studies that note the relationship between physician leadership and the three dimensions of TEL. How influential these are on leadership behaviors and health-related outcomes varies. We also found a number of studies that described general physician leadership behaviors that were not directly linked to factors of TEL, as well as two additional themes: leader identity and trust.Originality/valueTo the best of the authors’ knowledge, this is the first systematic review that has applied a highly cited theory (i.e. TEL) to the data and the first that has focused solely on a U.S. population. These findings offer healthcare organizations insight into the potential strengths and challenges of physician leadership.

Linking leadership development programs for physicians with organization-level outcomes: a realist review

BackgroundHospitals invest in Leadership Development Programs (LDPs) for physicians, assuming they benefit the organization’s performance. Researchers have listed the advantages of LDPs, but knowledge of how and why organization-level outcomes are achieved is missing.ObjectiveTo investigate how, why and under which circumstances LDPs for physicians can impact organization-level outcomes.MethodsWe conducted a realist review, following the RAMESES guidelines. Scientific articles and grey literature published between January 2010 and March 2021 evaluating a leadership intervention for physicians in the hospital setting were considered for inclusion. The following databases were searched: Medline, PsycInfo, ERIC, Web of Science, and Academic Search Premier. Based on the included documents, we developed a LDP middle-range program theory (MRPT) consisting of Context-Mechanism-Outcome configurations (CMOs) describing how specific contexts (C) trigger certain mechanisms (M) to generate organization-level outcomes (O).ResultsIn total, 3904 titles and abstracts and, subsequently, 100 full-text documents were inspected; 38 documents with LDPs from multiple countries informed our MRPT. The MRPT includes five CMOs that describe how LDPs can impact the organization-level outcomes categories ‘culture’, ‘quality improvement’, and ‘the leadership pipeline’: 'Acquiring self-insight and people skills (CMO1)', 'Intentionally building professional networks (CMO2)', 'Supporting quality improvement projects (CMO3)', 'Tailored LDP content prepares physicians (CMO4)', and 'Valuing physician leaders and organizational commitment (CMO5)'. Culture was the outcome of CMO1 and CMO2, quality improvement of CMO2 and CMO3, and the leadership pipeline of CMO2, CMO4, and CMO5. These CMOs operated within an overarching context, the leadership ecosystem, that determined realizing and sustaining organization-level outcomes.ConclusionsLDPs benefit organization-level outcomes through multiple mechanisms. Creating the contexts to trigger these mechanisms depends on the resources invested in LDPs and adequately supporting physicians. LDP providers can use the presented MRPT to guide the development of LDPs when aiming for specific organization-level outcomes.

Striding into Your Future with Confidence: Leading from Within

Our personal and professional satisfaction and fulfillment hinge on our being ourselves, which requires knowing how we as individuals function optimally. As physicians, we are highly skilled, highly educated, and trained to think for ourselves. Are we acting as authentic autonomous individuals in dealing with patients and other relationships at work and at home? Are we honoring and respecting others who are being themselves? Physician leaders should examine whether they are following their own inner authority in their professional and personal lives, or simply doing what they are told to do.

How Physician Leaders Are Tackling Medicine’s Mental Health Crisis

Physician leaders are being more proactive about addressing the challenges and stigmas associated with mental health within the profession, including reducing the stigma of mental health issues among physicians and promoting treatment.

Grief, Grieving, and Grievance — Growth to Move Forward

Overwhelming grief during the pandemic’s peak was prevalent for many. Grieving the capabilities of one’s past practice settings in a new world order is still common, and for some, this manifests in holding a grievance toward unknown or unidentified forces. The physician workforce and physician leaders have an opportunity to reshape healthcare’s future by helping lead and care for those individuals and organizations caught up in a cycle of persistent grief.

Building Emotional Intelligence Through the DiSC Assessment

The most effective leaders understand their own styles and recognize the styles of others. They also know when to flex to another style to get the results they desire for their colleagues, patients, teams, and organizations. The DiSC assessment identifies four leadership preferences — dominance, influence, steadiness, and conscientiousness — and can be a practical tool for physician leaders to build emotional intelligence and relationship skills.

Physician Perceptions of Administrative Leadership Development Post-COVID-19

Effective physician leadership has become more critical as our healthcare system grapples with the worsening workforce attrition associated with the COVID-19 pandemic. A study explored physician leaders’ perspectives of their preparation for administrative leadership. Overall, this study revealed that physicians need training beyond traditional undergraduate and postgraduate medical education to prepare for administrative leadership as they and healthcare institutions navigate the post-COVID-19 landscape. It is essential to understand their specific needs so that leadership development opportunities can be developed and tailored to positively impact burnout and support today’s healthcare workforce.

Learning to lead: Supporting future emergency physician leaders.

Learning to lead: Supporting future emergency physician leaders.

The impact of physician leadership development on behaviour and work-related changes.

In this article, we present findings from a retrospective survey of 117 physician leadership development program graduates at the Sauder School of Business at the University of British Columbia in Vancouver. The survey was designed to assess how the program contributed to graduates' leadership development, specifically in terms of behaviour change and work-related changes. The themes resulting from the analysis of the open-ended questions reflected that the program led to changes in graduates' leadership behaviour and their ability to lead change in their respective organizations. The study highlighted the benefits of investment in training for physician leaders to advance transformation and improvement initiatives in a changing world.

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.

Pediatric antibiotic stewardship programs in Europe: a pilot survey among delegates of The European Academy of Pediatrics.

Antimicrobial resistance (AMR) is one of the leading causes of morbidity and mortality worldwide. Efforts to promote the judicious use of antibiotics and contain AMR are a priority of several medical organizations, including the WHO. One effective way to achieve this goal is the deployment of antibiotic stewardship programs (ASPs). This study aimed to survey the current situation of pediatric ASPs in European countries and establish a baseline for future attempts to harmonize pediatric ASPs and antibiotic use in Europe. A web-based survey was conducted among national delegates of the European Academy of Paediatrics (EAP). The survey assessed the presence of pediatric ASPs in the representatives' countries in the inpatient and outpatient settings, the staff included in the programs, and their detailed activities regarding antibiotic use. Of the 41 EAP delegates surveyed, 27 (66%) responded. Inpatient pediatric ASPs were reported in 74% (20/27) countries, and outpatient programs in 48% (13/27), with considerable variability in their composition and activities. Guidelines for managing pediatric infectious diseases were available in nearly all countries (96%), with those for neonatal infections (96%), pneumonia (93%), urinary tract (89%), peri-operative (82%), and soft tissue (70%) infections being the most common. Pediatric ASPs were reported at the national (63%), institutional (41%), and regional/local (<15%) levels. Pediatricians with infectious disease training (62%) and microbiologists (58%) were the most common members of the program personnel, followed by physician leaders (46%), infectious disease/infection control physicians (39%), pharmacists (31%), and medical director representatives (15%). Activities of the pediatric ASPs included educational programs (85%), monitoring and reporting of antibiotic use (70%) and resistance (67%), periodic audits with feedback (44%), prior approval (44%), and post-prescription review of selected antibiotic agents (33%). Although pediatric ASPs exist in most European countries, their composition and activities vary considerably across countries. Initiatives to harmonize comprehensive pediatric ASPs across Europe are needed.

Real-world impact of oncology education on clinical practices at five community cancer care centers.

e23003 Background: Broad based molecular testing is an underutilized but essential factor in determining patient candidacy for frontline immunotherapy (IO) for advanced NSCLC. Findings from previous educational initiatives and real-world studies such as Nadler et al. and Velcheti, et al. indicate that understanding the importance of molecular testing to optimize therapy in NSCLC, remains an educational gap among oncology clinicians. Based on this real-world data, an educational initiative was developed to impart demonstrable change in clinician’s molecular testing practices and IO treatment selection. Methods: Grand round modules held at 5 community cancer centers facilitated learners’ ability to incorporate molecular testing and treatment strategies into clinical practice, which may improve patient outcomes. Physician leaders were leveraged at each center in order to increase learner engagement, encourage peer-to-peer learning and foster a learning community and potentially encourage institutional changes. Educational impact was assessed via a matched Pre/Post Test methodology which incorporated fact based and procedural information as well as asking learners to rate their confidence and intent to perform. To evaluate educational impact, pre and post educational intervention, 100 tumor board patient cases collected by OncoLens from the five centers were analyzed to assess any change in molecular testing practices, and therapeutic selection. Results: 174 learners participated in the grand round modules, results from matched Pre- and Post-Test showed significant improvements in overall proficiency, +51% in module 1 and +89% in module 2, alongside self-reported increased intent to utilize broad-based molecular testing +93% and IO +236% in advanced NSCLC. Post-intervention tumor board cases demonstrated that effective education can lead to real-world practice changes; there was an increase (+207%) in molecular testing of NSCLC, 75% increased use of liquid biopsy, the shift towards more comprehensive testing was accompanied by more judicious determination of IO candidacy, and a 52% increase in IO implementation. Additionally, feedback from the physician leaders reported that institutional changes were implemented following the educational initiative; 3 centers now actively consider liquid biopsy if tissue quantity is not sufficient (QNS), one institution has implemented reflex testing to improve time to treatment. Conclusions: Findings suggest that onsite CME/CE targeting understanding and proficiency in molecular testing for advanced NSCLC, can translate into real-world change to clinical practice that optimizes therapeutic decision-making in patient care; community cancer center case data supports the efficacy of the education on real-world clinical practices. Nadler E, et al.doi: 10.1016/j.ctarc.2022.100522. Velcheti V, et al.doi: 10.1371/journal.pone.0206370.

In-depth assessment of critical access hospital stewardship program adherence to the CDC Core elements in Iowa and Nebraska

Background: Critical-access hospitals (CAHs) are required to meet the CDC 7 Core Elements of antimicrobial stewardship programs (ASPs). CAHs have lower adherence to the core elements than larger acute-care hospitals, and literature defining which core-element deficiencies exist within CAHs as well as barriers to adherence is lacking. Methods: We evaluated 21 CAH ASPs (5 in Nebraska and 15 in Iowa) that self-identified as potentially deficient in the Core Elements, via self-assessment followed by in-depth interviews with local ASP team members to assess adherence to the CDC Core Elements for ASPs. Core-element compliance was rated as either full (1 point), partial (0.5), or deficient (0), with a maximum score of 7 per ASP. High-priority recommendations to ensure core-element compliance were provided to facilities as written feedback. Self-reported barriers to implementation were thematically categorized. Results: Among the 21 CAH ASPs, none fully met all 7 core elements (range, 2.5–6.5), with a median of 5 full core elements met (Fig. 1). Only 6 ASPs (28.6%) had at least partial adherence to each of the 7 core elements. Action (21 of 21, 100%) and leadership commitment (16 of 21, 76.2%) were the core elements with the highest adherence, and accountability (4 of 21, 19%) and education (9 of 21, 42.9%) were the lowest. The most frequent high-priority recommendations were to provide physician and pharmacist leader ASP training (19 of 21, 90.5%), to track antimicrobial stewardship interventions (12 of 21, 57.1%), and to provide or track educational activities (12 of 21, 57.1%) (Fig. 2). One-third of programs were recommended to establish a physician leader. The most commonly self-identified barriers to establishing and maintaining an ASP were a lack of dedicated resources such as time of personnel (15 of 20, 75%), lack of infectious diseases expertise and training (8 of 20, 40%), and electronic medical record limitations (5 of 20, 25%) (Fig. 3). Conclusions: CAH ASPs demonstrate several critical gaps in achieving adherence to the CDC Core Elements, primarily in training for physician and pharmacist leaders and providing stewardship-focused education. Further resources and training customized to the issues present in CAH ASPs should be developed.Disclosures: None

Investigating physician leadership competencies in rural and remote areas of the province of Aceh, Indonesia

BackgroundsGlobally, the most rural healthcare systems are lagging behind those of urban healthcare systems. Especially in rural and remote areas, the essential resources to provide principal health services are inadequate....

Pain Medicine Education in the United States: Success, Threats, and Opportunities.

The year 2022 marked the 30th anniversary of the first Accreditation Council for Graduate Medical Education (ACGME) accreditation of pain medicine training programs. Before this, the education of pain medicine practitioners was through primarily an apprenticeship model. Since accreditation, pain medicine education has grown under the national leadership of pain medicine physicians and educational experts from the ACGME, exemplified by the release of Pain Milestones 2.0 in 2022. The rapid growth of knowledge in pain medicine, along with its multidisciplinary nature, poses challenges of fragmentation, standardization of curriculum, and adaptation to societal needs. However, these same challenges present opportunities for pain medicine educators to shape the future of the specialty.

Factors of a physician quality improvement leadership coalition that influence physician behaviour: a mixed methods study

BackgroundA coalition (Strategic Clinical Improvement Committee), with a mandate to promote physician quality improvement (QI) involvement, identified hospital laboratory test overuse as a priority. The coalition developed and supported the...

AOA Critical Issues Symposium: Leadership and Education During and After COVID-19: Back to the Future or a New Normal.

The devastating impact of COVID-19 has reshaped how we lead and train our future surgeons in the field of orthopaedics. Overnight, leaders in our field had to dramatically shift their mindset to continue to lead a hospital, department, journal, or residency or fellowship program in the face of an unprecedented level of adversity in the history of the United States. This symposium discusses the role of physician leadership during and after a pandemic, as well as the adoption of technology for training surgeons in the field of orthopaedics.

70. Environmental Sustainability of Internal Fixation Hardware

PURPOSE: Environmental sustainability has become a critical initiative among several industries, but it is rarely mentioned in healthcare. The environmental footprint of surgical procedures is not only based on the resource utilization of operating rooms, but rather on the entire value chain of intraoperative products utilized. The purpose of this investigation was to assess the corporate environmental responsibility of two leading manufacturers of internal fixation hardware. METHODS: The sustainability practices of two leading internal fixation hardware manufacturers were investigated based on self-reported corporate environmental data. Data were standardized per $1 million USD in revenue. Recent corporate initiatives and their resulting sustainability impact were analyzed over the last six years, specifically within the categories of greenhouse emissions (in metric tons of carbon dioxide equivalent, MTCO2e), water withdrawal (in cubic meters, m3), solid waste (in metric tons), and energy utilization (in gigajoules, GJ). RESULTS: Regarding greenhouse emissions, Company S most recently reported 10.0 MTCO2e per $1M in revenue, while their competitor Company D reported 12.0 MTCO2e per $1M in revenue. Company S recently reduced its carbon footprint at a rate of 1.9 MTCO2e per $1M per year, which has been nearly twice as fast as Company D at 1.0 MTCO2e per $1M per year. Regarding water withdrawal, Company S utilized 5.6 m3 per $1M in revenue, whereas Company D utilized only 1.43 m3 per $1M in revenue. Neither company has made substantial changes to their water withdrawal rates. Regarding solid waste, Company S only produced 0.34 tons of solid waste per $1M in revenue, whereas Company D produced 1.22 tons of solid waste per $1M in revenue. Company D currently recycles an impressive 86.9% of its nonhazardous solid waste. Over the past five years, Company S has diverted 25 million pounds of waste from landfills by reprocessing end of lifecycle products. Regarding energy utilization, Company S utilized 123.2 GJ per $1M in revenue, whereas Company D utilized 155 GJ per $1M in revenue. Both companies have made large strides in their energy reductions, such that Company S has reduced their energy utilization by 2.5 GJ per $1M per year, and Company D has reduced their energy utilization by 7.0 GJ per $1M per year. Company S more than doubled its renewable electric power utilization from 102.7 GJ per year to 241.7 GJ per year. While this is impressive, it still only represents 13.6% of its total purchased energy utilization. CONCLUSION: There are substantial differences in the business practices between internal fixation hardware suppliers. Physician leaders need to begin discussing responsible resource procurement. Future research over the coming months will investigate various other suppliers to analyze the supply chain footprint of each of our procedures, as well as the supply chain footprint of our plastic surgery department overall.

Oncology pharmacy practice in the United States: Results of a comprehensive, nationwide survey.

Introduction: This study was designed to describe the landscape of oncology pharmacy practice at patient facing institutional healthcare organizations throughout the United States. Methods: The Hematology/Oncology Pharmacy Association (HOPA) Practice Outcomes and Professional Benchmarking Committee conducted a multi-organization, voluntary survey of HOPA members between March 2021 and January 2022. Four overarching domains were targeted: institutional description, job function, staffing, and training/certification. Data were evaluated using descriptive statistics. Results: A total of 68 responses were analyzed including 59% and 41% who self-identified their organization as academic and community centers, respectively. The median number of infusion chairs and annual infusion visits were 49 (interquartile range (IQR): 32-92) and 23,500 (IQR: 8300-300,000), respectively. Pharmacy departments reported to a business leader, physician leader, and nursing leader 57%, 24%, and 10% of the time, respectively. The median oncology pharmacy full-time equivalents was 16 (IQR: 5-60). At academic centers, 50% (IQR: 26-60) of inpatient and 30% (IQR: 21-38) of ambulatory pharmacist FTEs were dedicated to clinical activities. At community centers, 45% (IQR: 26-65) of inpatient and 50% (IQR: 42-58) of ambulatory pharmacist FTEs were dedicated to clinical activities. As many as 18% and 65% of organizations required or encouraged certification for oncology pharmacists, respectively. The median number of Board-Certified Oncology Pharmacists was 4 (IQR: 2-15). Conclusion: As the number of patients with cancer rises, the oncology workforce must grow to support this expanding population. These results describe the practice landscape of oncology pharmacy at US healthcare institutions to serve as a foundation for future research evaluating metrics and benchmarks.