Meeting the needs of clinician-educators: An innovative faculty development community of practice.

BACKGROUND: Requirements for faculty development for clinician-educators continue to increase. The number of faculty with experience delivering faculty development, however, remains limited. To overcome our deficit of faculty developers, we created a train-the-trainer programme. We recognised, however, that our plan would not meet the ultimate goal for our programme: Creating faculty developers to meet the faculty development needs of a large, dispersed system. We report on the creation and nurturing of faculty development community of practice (CoP), which we believe could be a solution for many academic systems struggling to engage busy clinicians, mature the teaching abilities of clinician educators, and meet the needs of their accrediting institutions. APPROACH: We developed a faculty development CoP with a mission of promoting educational expertise and excellence and ensuring continuous growth of the members of our COP and broader faculty. EVALUATION: A programme evaluation was performed consisting of two elements: The impact on the organisation (workshop and learner related metrics) and the impact on the CoP members (survey). We observed notable outcomes: Delivery of high quality workshops to faculty, attainment of leadership positions, and increases in motivation, networking, skills, confidence, and opportunities available to members. IMPLICATIONS: Innovations to create and sustain structured faculty development programmes for clinician-educators are needed. The development and nurturing of a CoP of faculty developers resulted in benefits both for the organisation and CoP members and may be a solution for large academic systems struggling to meet their faculty development demands.

Harnessing Followership to Empower Graduate Medical Education Trainees.

Followership is the leadership practiced by individuals who are in positions of responsibility without authority, whereby they exert their influence to help execute the vision of their leaders. The central principle of followership is a commitment to actively support leaders and organizations. Without effective followers, organizations flounder, decision-making lies only at the top echelons, and plans are either incompletely executed or not executed at all. In this perspective, we introduce the concept of followership as an important part of leadership development. We explore pedagogical methods for teaching graduate medical education (GME) trainees the followership tenets of service, assuming responsibility, and challenging leadership as necessary skills to achieve partnership with their leaders. We argue that developing followership skills, specifically partnering skills, can help trainees excel as leaders and attendings. GME trainees who practice effective followership take initiative by co-managing their patients with their attendings. By displaying both willingness to serve and challenge their leaders, they add to the success of the whole unit. Followership is a skill that can be learned. Learners should reflect on their own followership style and identify areas for flexibility and growth. Those seeking to become partners should solicit explicit feedback, observe their role models, and seek opportunities to role play situations that highlight the difficulties of followership. Partnership allows for development of a space between leaders and followers to experience empathy, reward ownership, and grow leaders.

Ten Leadership Principles from the Military Applied to Critical Care.

Core military leadership principles associated with success during wartime have previously translated to success in the civilian business and healthcare sectors. A review of these principles may be particularly valuable during times of increased and sustained stress in the intensive care unit. In this perspective paper, we provide an overview of 10 of these principles categorized under the following three essential truths: 1) planning is crucial, but adaptability wins the day; 2) take care of your people, and your people will take care of everything else; and 3) communication is the key to success. We reflect on these three truths and the 10 key principles that fall under them. As critical care physicians who have served in the military health system across two decades of war, we believe that internalizing these key leadership principles will result in optimized performance at multiple levels when crisis condition are encountered.

Could application of leader-member exchange theory have saved a residency mentorship program?

Mentorship may offer protégés numerous benefits including improved self-esteem, increased interest in research, and/or enhanced productivity. Without proper planning, reflection, and evaluation, however, mentorship programs may result in undesirable consequences. In this paper we describe a mentorship program designed to improve psychosocial support and professional development for residents, that while initially successful, was terminated due to perceptions of inequity that led to strife among residents and ultimately created a toxic learning climate. Leader-member exchange theory provides a lens through which to view our program's failure and to offer some potential solutions to mitigate such challenges for other programs. Leader-member exchange theory focuses on the importance of relationships, communication, and awareness of biases to optimize interactions between dyads such as a mentor and a protégé. We highlight opportunities during the stranger, acquaintance, and mature partnership phases that could have helped to save a residency mentorship program.

Real time application of whole genome sequencing for outbreak investigation - What is an achievable turnaround time?

Whole genome sequencing (WGS) is increasingly employed in clinical settings, though few assessments of turnaround times (TAT) have been performed in real-time. In this study, WGS was used to investigate an unfolding outbreak of vancomycin resistant Enterococcus faecium (VRE) among 3 patients in the ICU of a tertiary care hospital. Including overnight culturing, a TAT of just 48.5 h for a comprehensive report was achievable using an Illumina Miseq benchtop sequencer. WGS revealed that isolates from patient 2 and 3 differed from that of patient 1 by a single nucleotide polymorphism (SNP), indicating nosocomial transmission. However, the unparalleled resolution provided by WGS suggested that nosocomial transmission involved two separate events from patient 1 to patient 2 and 3, and not a linear transmission suspected by the time line. Rapid TAT's are achievable using WGS in the clinical setting and can provide an unprecedented level of resolution for outbreak investigations.

Case management study Walter Reed Army Medical Center. A 37-year-old soldier with right flank pain.

The objective of this study was to discuss the appropriate diagnostic and treatment approach to an active duty patient presenting with recurrent kidney stones. A 37-year-old active duty infantryman, stationed in Iraq, was evacuated by air to Waiter Reed Army Medical Center for workup of recurrent kidney stones and hypercalcemia. A diagnosis was made and the definitive treatment was performed. During this report, we will illustrate the various aspects of diagnosis that are involved with the workup of kidney stones and hypercalcemia as well as discuss the available treatment options. Relevant military issues include proceeding with the initial management regimen and recognition of appropriate reasons for initiation of referral consultation.