Leading Change in Health Care.

Change leadership is essential for individuals, teams, and organizations. It focuses on leadership to initiate, support, and adapt to modifications, alterations, and new situations. Many perspectives, models, theories, and steps have been offered to optimize change. Some approaches emphasize organizational change, whereas others focus on responses of individuals to change. With regard to leading change in health care, it is important to enhance well-being among health-care professionals and patients and to improve organizational and system best practices. To achieve optimal health-care changes, this article draws from several business-focused approaches to change leadership, psychological models, and the authors' Leader-Follower Framework (LF2).

Y-Net for Chest X-Ray Preprocessing: Simultaneous Classification of Geometry and Segmentation of Annotations.

Over the last decade, convolutional neural networks (CNNs) have emerged as the leading algorithms in image classification and segmentation. Recent publication of large medical imaging databases have accelerated their use in the biomedical arena. While training data for photograph classification benefits from aggressive geometric augmentation, medical diagnosis - especially in chest radiographs - depends more strongly on feature location. Diagnosis classification results may be artificially enhanced by reliance on radiographic annotations. This work introduces a general pre-processing step for chest x-ray input into machine learning algorithms. A modified Y-Net architecture based on the VGG11 encoder is used to simultaneously learn geometric orientation (similarity transform parameters) of the chest and segmentation of radiographic annotations. Chest x-rays were obtained from published databases. The algorithm was trained with 1000 manually labeled images with augmentation. Results were evaluated by expert clinicians, with acceptable geometry in 95.8% and annotation mask in 96.2% (n = 500), compared to 27.0% and 34.9% respectively in control images (n = 241). We hypothesize that this pre-processing step will improve robustness in future diagnostic algorithms.Clinical relevance-This work demonstrates a universal pre-processing step for chest radiographs - both normalizing geometry and masking radiographic annotations - for use prior to further analysis.

Using Social Psychology Principles to Develop Emotionally Intelligent Healthcare Leaders.

Healthcare providers must acquire extensive knowledge and skills to help promote physical health, behavioral health, and wellness; prevent and treat illnesses and injuries; encourage and guide rehabilitation; counsel and assist with decisions relevant to health, life, and death. In addition, 21st Century healthcare providers must develop leadership knowledge and skills to optimize their interactions and effectiveness with healthcare teams, patients, and patients' significant others. Emotional intelligence is recognized as an essential component of leader education and development. It is important to optimally educate and develop healthcare providers with regard to components of emotional intelligence: self-awareness, self-regulation, social-awareness, and social regulation. Self-awareness focuses on understanding one's own behaviors, cognitions, motivations, and emotions. Self-regulation emphasizes self-control and adaptability to various situations and settings. Social awareness includes understanding others' behaviors, cognitions, motivations, and emotions. Social regulation draws upon the other components of emotional intelligence in order to optimize collaboration and cooperation and attainment of mutual goals with other people. The present paper presents four principles of Social Psychology that are relevant to developing emotionally intelligent healthcare leaders: Field Theory, Informal Social Communication, Social Comparison, and Cognitive Dissonance. Although these principles are well-established and have received extensive attention, analysis, and discussion in the academic social psychology literature, they are rarely mentioned in the emotional intelligence or leadership literatures. Therefore, each of these principles is briefly described in the present paper followed by an explanation of how each principle relates to the development of emotional intelligence in general and to emotionally intelligent healthcare leaders in particular.

Applying Classic Social Psychology Principles to Improve Healthcare Teams.

This article was migrated. The article was marked as recommended. Modern healthcare involves teams composed of educators, learners, healthcare providers, patients, patients' significant others and families, healthcare administrators, and information sources. Principles of social psychology are relevant to interactions among team members when learning and performing professional duties; communicating to build trust, commitment, and teamwork; and collaborating among members of the healthcare team. This paper briefly discusses several classic principles of social psychology and how they apply to healthcare teams and medical education. Understanding and applying these principles will help healthcare providers optimize performance and interactions with colleagues, learners, and patients. It is important to incorporate study and practice of these principles into medical education and professional development.

Charting a Course for Leader and Leadership Education and Development in American Medical Schools.

This article was migrated. The article was marked as recommended. Problem: Leadership has been identified as an essential component for success in medicine. Many medical schools have initiated Leader and Leadership Education and Development (LEAD) programs to develop physician leaders. Currently, there is no consensus whether teaching leadership is important, who to teach, what topics to teach, and where leadership fits into the curriculum during medical school. Approach: To address these issues, the Uniformed Services University of the Health Sciences (USU) LEAD team convened an inaugural Medical Student LEAD Summit and Working Group Meeting on April 4, 2017. Participants came from public and private U.S. medical schools engaged in LEAD programs, military service academies, the Veterans Administration, and the Association of American Medical Colleges. The purpose of this meeting was to share opinions, experiences, and current practices regarding medical student LEAD. Outcomes: Participants overwhelmingly agreed that: (1) providing LEAD is an essential component of undergraduate medical education; (2) there currently is no single best LEAD program for all medical schools; (3) a clear purpose, goal, philosophy, and conceptual framework consistent with the mission and vision of each institution is needed; (4) assessment of students, programs, faculty must be incorporated; and (5) research and scholarship are essential for LEAD programs. Next Steps: Based on the positive feedback and interest from participants, the USU LEAD team will host a second Summit in April 2018 to follow up with the inaugural participants and to include representatives from additional institutions who are currently conducting or interested in starting their own medical school LEAD programs.

Design, implementation, and demographic differences of HEAL: a self-report health care leadership instrument.

The medical community has recognized the importance of leadership skills among its members. While numerous leadership assessment tools exist at present, few are specifically tailored to the unique health care environment. The study team designed a 24-item survey (Healthcare Evaluation & Assessment of Leadership [HEAL]) to measure leadership competency based on the core competencies and core principles of the Duke Healthcare Leadership Model. A novel digital platform was created for use on handheld devices to facilitate its distribution and completion. This pilot phase involved 126 health care professionals self-assessing their leadership abilities. The study aimed to determine both the content validity of the survey and the feasibility of its implementation and use. The digital platform for survey implementation was easy to complete, and there were no technical problems with survey use or data collection. With regard to reliability, initial survey results revealed that each core leadership tenet met or exceeded the reliability cutoff of 0.7. In self-assessment of leadership, women scored themselves higher than men in questions related to patient centeredness (P=0.016). When stratified by age, younger providers rated themselves lower with regard to emotional intelligence and integrity. There were no differences in self-assessment when stratified by medical specialty. While only a pilot study, initial data suggest that HEAL is a reliable and easy-to-administer survey for health care leadership assessment. Differences in responses by sex and age with respect to patient centeredness, integrity, and emotional intelligence raise questions about how providers view themselves amid complex medical teams. As the survey is refined and further administered, HEAL will be used not only as a self-assessment tool but also in "360" evaluation formats.

Career accomplishments of Uniformed Services University of the Health Sciences medical graduates: classes 1980-2001.

PURPOSE: To report accomplishments of graduates of the F. Edward Hébert School of Medicine who have left, retired, or are near the end of their uniformed career in several professional domains: military career milestones, medical professional education, academic landmarks, and leadership. METHODS: This study utilized an earlier questionnaire that was modified to capture additional career landmarks and improve the clarity of several items. The modified survey was sent electronically to alumni who graduated from 1980-2001 in March, 2012. RESULTS: The questionnaire was sent to 2,825 alumni for whom we had e-mail addresses. We estimate that we reached 2,400 alumni. A total of 1,189 alumni returned the questionnaire, yielding an estimated response rate of 50%. For this cohort, the board certification was 95%, over 20% obtained additional degrees, 92.8% had worked as a full-time physician, nearly two-thirds had deployed for combat, 13.9% had received the Legion of Merit, and 68.6% had published at least one peer-reviewed manuscript. CONCLUSION: Many accomplishments including board certification rates, deployment experience, academic and military leadership positions, military awards, promotion rates, and academic medicine contributions are indicators that USU is continuing to meet its unique mission.

Assessing curriculum effectiveness: a survey of Uniformed Services University medical school graduates.

PURPOSE: This study assessed alumni perceptions of their preparedness for clinical practice using the Accreditation Council for Graduate Medical Education (ACGME) competencies. We hypothesized that our alumni's perception of preparedness would be highest for military-unique practice and professionalism and lowest for system-based practice and practice-based learning and improvement. METHOD: 1,189 alumni who graduated from the Uniformed Services University (USU) between 1980 and 2001 completed a survey modeled to assess the ACGME competencies on a 5-point, Likert-type scale. Specifically, self-reports of competencies related to patient care, communication and interpersonal skills, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, and military-unique practice were evaluated. RESULTS: Consistent with our expectations as the nation's military medical school, our graduates were most confident in their preparedness for military-unique practice, which included items assessing military leadership (M = 4.30, SD = 0.65). USU graduates also indicated being well prepared for the challenges of residency education in the domain of professionalism (M = 4.02, SD = 0.72). Self-reports were also high for competencies related to patient care (M = 3.86, SD = 0.68), communication and interpersonal skills (M = 3.88, SD = 0.66), and medical knowledge (M = 3.78, SD = 0.73). Consistent with expectations, systems-based practice (M = 3.50, SD = 0.70) and practice-based learning and improvement (M = 3.57, SD = 0.62) were the lowest rated competencies, although self-reported preparedness was still quite high. DISCUSSION: Our findings suggest that, from the perspective of our graduates, USU is providing both an effective military-unique curriculum and is preparing trainees for residency training. Further, these results support the notion that graduates are prepared to lead and to practice medicine in austere environments. Compared to other competencies that were assessed, self-ratings for systems-based practice and practice-based learning and improvement were the lowest, which suggests the need to continue to improve USU education in these areas.

The long-term career outcome study: lessons learned and implications for educational practice.

The work of the Long-Term Career Outcome Study has been a program of scholarship spanning 10 years. Borrowing from established quality assurance literature, the Long-Term Career Outcome Study team has organized its scholarship into three phases; before medical school, during medical school, and after medical school. The purpose of this commentary is to address two fundamental questions: (1) what has been learned? and (2) how does this knowledge translate to educational practice and policy now and into the future? We believe that answers to these questions are relevant not only to our institution but also to other educational institutions seeking to provide high-quality health professions education.

Evaluation and comparison of current fetal ultrasound image segmentation methods for biometric measurements: a grand challenge.

This paper presents the evaluation results of the methods submitted to Challenge US: Biometric Measurements from Fetal Ultrasound Images, a segmentation challenge held at the IEEE International Symposium on Biomedical Imaging 2012. The challenge was set to compare and evaluate current fetal ultrasound image segmentation methods. It consisted of automatically segmenting fetal anatomical structures to measure standard obstetric biometric parameters, from 2D fetal ultrasound images taken on fetuses at different gestational ages (21 weeks, 28 weeks, and 33 weeks) and with varying image quality to reflect data encountered in real clinical environments. Four independent sub-challenges were proposed, according to the objects of interest measured in clinical practice: abdomen, head, femur, and whole fetus. Five teams participated in the head sub-challenge and two teams in the femur sub-challenge, including one team who tackled both. Nobody attempted the abdomen and whole fetus sub-challenges. The challenge goals were two-fold and the participants were asked to submit the segmentation results as well as the measurements derived from the segmented objects. Extensive quantitative (region-based, distance-based, and Bland-Altman measurements) and qualitative evaluation was performed to compare the results from a representative selection of current methods submitted to the challenge. Several experts (three for the head sub-challenge and two for the femur sub-challenge), with different degrees of expertise, manually delineated the objects of interest to define the ground truth used within the evaluation framework. For the head sub-challenge, several groups produced results that could be potentially used in clinical settings, with comparable performance to manual delineations. The femur sub-challenge had inferior performance to the head sub-challenge due to the fact that it is a harder segmentation problem and that the techniques presented relied more on the femur's appearance.

40 years of military medical education: an overview of the Long-Term Career Outcome Study (LTCOS).

In 2005, the Long-Term Career Outcome Study (LTCOS) was established by the Dean, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU). The original charge to the LTCOS team was to establish an electronic database of current and past students at USU. Since its inception, however, the LTCOS team has broadened its mission and started collecting and analyzing data on a continuous basis for the purposes of program evaluation and, in some cases, research. The purpose of this commentary is to review the history of the LTCOS, including details about USU, a brief review of prior LTCOS work, and progress made since our last essay on LTCOS efforts. This commentary also provides an introduction to the special issue, which is arranged as a series of articles that span the medical education continuum (i.e., before, during, and after medical school). The relative balance of articles in each phase of training represents the LTCOS team's efforts to address the entire continuum of medical education.

Identifying themes within a medical school admission committee's reviews of applicants.

BACKGROUND: Admissions committees attempt to select the most qualified applicants based on many cognitive and "noncognitive" factors. PURPOSE: Identify common themes cited in the admissions committee member summaries of medical school matriculants and determine the relative frequency and importance of these themes. METHODS: After reviewing a convenience sample of 150 reviewer comments, 14 qualitative themes were identified. Utterances (thematic word strings) from each of the three reviewer comments for each matriculant for 7 academic years (1989-1996) were then categorized and coded as being positive, negative, or neutral. Intra-rater and inter-rater reliabilities were calculated. RESULTS: Utterances (n = 9299) about 981 matriculants were categorized by theme and sorted as being positive, neutral, or negative. Intra-rater reliabilities were excellent (mean K = 0.98, range 0.90-1.00). Similarly, inter-rater reliabilities were also excellent (mean K = 0.94, range 0.55-1.00 and mean K = 0.90, range 0.08-1.00). Four themes (overall summarizing comments, academic, test scores, and motivation) accounted for more than half (56%) of the utterances. CONCLUSIONS: We were able to qualitatively identify themes and provide information about how one committee weighs both cognitive and "noncognitive" factors. Admission committees should consider reexamining their process and potentially expanding, eliminating, or modifying application components.

Relationship between admissions committee review and student performance in medical school and internship.

PURPOSE: To investigate the association between tertiary reviewer (admissions committee member) comments and medical students' performance during medical school and into internship. METHODS: We collected data from seven year-groups (1993-1999) and coded tertiary reviewer comments into 14 themes. We then conducted an exploratory factor analysis to reduce the dimensions of the themes (excluding the Overall impression theme). Subsequently, we performed Pearson correlation analyses and multiple linear regression analysis to examine the relationship between the factors and seven outcome measures: medical school preclinical grade point average (GPA), medical school clinical GPA, cumulative medical school GPA, U.S. Medical Licensing Examination Step 1 and 2 scores, and scores on a program director's evaluation measuring intern professionalism and expertise. RESULTS: We extracted seven factors from the 13 themes and found small-to-moderate, significant correlations between the factors, the Overall impression theme, and the outcome measures. In particular, positive comments on Test and Maturity were associated with higher U.S. Medical Licensing Examination Step 1 and 2 scores. Negative comments on Interview and Recommendations were associated with lower ratings of professionalism during internship. Comments on Overall impression were significantly associated with all the outcome measures. CONCLUSIONS: Tertiary reviewer comments were weakly associated with performance in medical school and internship. Compared with positive comments, negative comments had stronger associations with medical school and internship performance measures.

Leadership success and the Uniformed Services University: perspectives of flag officer alumni.

UNLABELLED: The Uniformed Services University of the Health Sciences (USU) houses the nation's only federal medical school, the F. Edward Hébert School of Medicine. A key aspect of the curriculum at USU is leadership education as graduates go on to serve the Department of Defense through a variety of senior positions in the military. We surveyed a specific group of USU graduates who have achieved the rank of General or Admiral ("flag officers") to enhance our understanding of successful leadership for military physicians and to gain an understanding of how USU might shape its curriculum in the future. METHODS: We sent an Internet-based survey to 13 flag officer graduates. The first section of the survey contained items from the multifactor leadership questionnaire-6S, a questionnaire with evidence of reliability and validity for evaluating leadership styles. The second section of the survey contained open-ended questions addressing key characteristics of an effective leader in the Military Health System, experiences that prepared them for leadership, USU's role in leadership positions, and advice for USU for better educating future leaders. The second section of the survey was coded using the constant comparative method. RESULTS: Eight flag officers (63%) responded to the survey. They all scored highly on transformational leadership style. Qualitative themes reached saturation for each open-ended question. The flag officers identified characteristics consistent with published literature from other fields regarding effective leadership. They endorsed USU's role in achieving their leadership positions and suggested areas for improvement. CONCLUSIONS: Characteristics of effective leadership (transformational leadership style) identified by the flag officers surveyed in this study are consistent with the literature from other fields. These finding have important implications for leadership education at USU and potentially other institutions. The results also provide additional data to support the notion that USU is meeting its societal obligation to educate future leaders in military medicine.

Where are they now? USU School of Medicine graduates after their military obligation is complete.

The Uniformed Services University's (USU) F. Edward Hébert School of Medicine was chartered in 1972, with the goal of providing high-quality physicians for the Uniformed Services. In exchange for their education, USU graduates incur an active duty service obligation, after which they may choose to stay on active duty or transition to civilian practice. The purpose of this study is to describe the practice characteristics of USU graduates after this obligation has been completed in order to determine the societal benefits during this phase of their careers. To accomplish this purpose, we performed a retrospective cohort study of the first 20 years of USU graduates (1980-1999). We used the American Medical Association Physician Masterfile to determine the graduates' current practice location and characteristics, as well as their board certification status. Of these 2,760 graduates, nearly all (91%) were involved in active clinical practice in over 100 self-declared specialties, the vast majority (89%) practiced in locations other than the immediate vicinity of the medical school (i.e., Maryland and the District of Columbia), and most still worked for the federal government (71%). Finally, USU graduates in full-time clinical practice had a board certification rate of 93%, which was better than the average of all other graduates of U.S. Medical Schools (88%) in the same time period. Thus, it seems USU is attaining its goal of producing high-quality physicians who continue to benefit the nation after their service obligation has been completed, with many still in federal service.

The Long-Term Career Outcome Study (LTCOS): what have we learned from 40 years of military medical education and where should we go?

The work of the Long-Term Career Outcome Study (LTCOS), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU) has been a multidisciplinary effort spanning more than 5 years. Borrowing from the established program evaluation and quality assurance literature, the LTCOS team has organized its evaluation and research efforts into three phases: before medical school, during medical school, and after medical school. The purpose of this commentary is to summarize the research articles presented in this special issue and to answer two fundamental questions: (1) what has been learned from LTCOS research conducted to date, and (2) where should the LTCOS team take its evaluation and research efforts in the future? Answers to these questions are relevant to USU, and they also can inform other medical education institutions and policy makers. What is more, answers to these questions will help to ensure USU meets its societal obligation to provide the highest quality health care to military members, their families, and society at large.