Development of Physician Leaders.

The complexity of health care today along with the drive towards value-based care are strong forces in support of growing and expanding the physician leadership workforce. Physician led organizations are associated with improved physician engagement, quality of care and cost efficiency. Physicians would benefit from more formal leadership training which incorporates a structed leadership curriculum, mentorship and on the job progressive leadership experience. Special attention must be placed on increasing the diversity of our physician leaders. There are many important characteristics to look for in our physician leaders including emotional intelligence, integrity, visioning, humility, persuasion and the ability to listen.

Can Education and Enhanced Medical Director Oversight Improve Definitive Airway Control in the Prehospital Environment?

BACKGROUND: Endotracheal intubation (ETI) is the most definitive technique for airway management. However, supraglottic airway (SGA) may be used when ETI is not feasible. The purpose of this study was to determine the effect of updated field sedation protocols, simulation teaching, robust Quality Assurance/Continuing Quality Improvement (QA/CQI) program, and enhanced emergency medical services (EMSs) medical director oversight on ETI and SGA usage at a Level 1 trauma center. METHODS: After the transition of EMS directors in May 2016, field sedation protocols were updated, a new QA/CQI was instituted, and multiple teaching and simulation sessions were conducted. A retrospective review of EMS data was conducted on all prehospital airway interventions performed by EMS personnel. Intubations occurring from July 2013 to May 2016 served as controls. Intubations from May 2016 to December 2017 served as the comparison group. Data collected included intubation type/indication, age, and successful or unsuccessful. RESULTS: There were 967 ETI and SGA performed on 84% and 15% of patients, respectively. Success rates were 75% for ETI and 82% for SGA. ETI increased from 83% in the control group to 88% in the study group, and SGA decreased from 16% in the control group to 11% in the study group (P = .029). The success rate for ETI increased by 2% in the study group (P = .539). DISCUSSION: This study showed that definitive airway control could be positively impacted by incorporating education and medical director oversight into EMS training. ETI increased and SGA decreased after implementation.

Leading by Design: Lessons for the Future From 25 Years of the Executive Leadership in Academic Medicine (ELAM) Program for Women.

The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women is designed to promote the careers of senior female leaders in academic health care in a way that ultimately seeks to transform culture and promote gender equity far beyond the careers of its participants. In an era of increased awareness of gender inequity within academic medicine, the longevity of the ELAM program raises several important questions. First, why is such a program still needed? Second, what exactly does it do, and what has been its influence on its participants and beyond? And third, what lessons can ELAM's example provide to help guide the medical profession as it strives to promote gender equity in the field? In this Invited Commentary, the authors seek to answer these questions from the perspective of a recent program participant and the current program director. The authors review the evidence that identifies how women, even today, face accumulating disadvantage over the course of their academic careers, stemming from repeated encounters with powerful unconscious biases and stereotypes, societal expectations for a gendered division of domestic labor, and still-present overt discrimination and sexual harassment. They describe ELAM's approach, which builds the knowledge and skills of the women who participate in the program, while also intentionally raising their visibility within their home institutions so that they have opportunities to share with institutional leaders what they have learned in ways that not only promote their own careers but also support gender equity in the broader environment. The authors conclude by offering thoughts on how ELAM's model may be leveraged in the future, ideally in partnership with the numerous professional societies, funding agencies, and other organizations that are committed to accelerating the rate of progress toward gender equity at all levels of academic medicine.

Embryo transfer training in fellowship: national and institutional data.

OBJECTIVE: To evaluate current national practices in embryo transfer (ET) training in United States reproductive endocrinology and infertility (REI) fellowship programs and live birth rates after ET performed by fellows versus attending physicians. DESIGN: Cross-sectional survey of U.S. fellowship program directors and fellows in 2019 and retrospective cohort study of IVF cycle outcomes after ET performed by fellows versus attending physicians. SETTING: Not applicable. PATIENT(S): Fellowship program directors and fellows completed a survey. Embryo transfers from 2015-2018 were analyzed. INTERVENTION(S): A survey assessed experiences with ET training. Cycle outcomes were analyzed. MAIN OUTCOME MEASURE(S): Proportion of fellows performing ET during training, and live birth rate following fellow and faculty ETs. RESULT(S): Anonymous surveys were sent to 51 REI fellowship program directors and 142 fellows. Twenty-one percent (15/73) reported that no ETs were performed by fellows. Forty-four percent of third-year fellows had performed fewer than ten ETs during fellowship training. Retrospective review of 940 blastocyst ETs revealed no difference in live birth rates between fellows and attending physicians: 51.6% (131/254) versus 49.4% (339/686), respectively. CONCLUSION(S): This study revealed striking differences between fellowship programs regarding the adequacy of ET training; nearly one-half of third-year fellows had performed fewer than ten ETs. With appropriate supervision, there is no difference in live birth rate between ETs performed by fellows and attending physicians. Efforts should be made to address barriers and set minimums for the number of transfers performed during fellowship.

Teaching Safe Opioid Prescribing During the Opioid Epidemic: Results of the 2018 Clerkship Directors in Internal Medicine Survey.

BACKGROUND: Educating medical trainees across the continuum is essential to a multifaceted strategy for addressing the opioid epidemic. OBJECTIVE: To assess the current state of internal medicine clerkship content on safe opioid prescribing and opioid use disorder, and barriers to curriculum implementation. DESIGN: National Annual (2018) Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey. PARTICIPANTS: One hundred thirty-four clerkship directors at all Liaison Committee of Medical Education accredited US medical schools with CDIM membership as of October 1, 2018. MAIN MEASURES: The survey section on safe opioid prescribing and opioid use disorder education in the internal medicine clerkship addressed assessment of current curricula, perceived importance of curricula, barriers to implementation, and plans to start or expand curricula. Descriptive statistics were used to summarize responses, and Pearson's chi-square and Fisher's exact tests for statistical comparisons. KEY RESULTS: The survey response rate was 82% (110/134). Overall 54.1% of responding institutions reported covering one or more topics related to safe opioid prescribing or opioid use disorder in the internal medicine clerkship. A preponderance of clerkship directors (range 51-86%) reported that various opioid-related topics were important to cover in the internal medicine clerkship. Safe opioid prescribing topics were covered more frequently than topics related specifically to opioid use disorder. The main barriers identified included time (80.9%) and lack of faculty expertise (65.5%). CONCLUSIONS: Clerkship directors agreed that incorporating safe opioid prescribing and opioid use disorder topics in the internal medicine clerkship is important, despite wide variation in current curricula. Addressing curricular time constraints and lack of faculty expertise in internal medicine clerkships will be key to successfully integrating content to address the opioid epidemic.

Sanokondu.

Purpose This paper aims to describe the evolution of Sanokondu, highlighting the rationale, achievements and lessons learnt from this initiative. Sanokondu is a multinational community of practice dedicated to fostering health-care leadership education worldwide. This platform for health-care leadership education was conceived in 2014 at the first Toronto International Summit on Leadership Education for Physicians (TISLEP) and evolved into a formal network of collaborators in 2016. Design/methodology/approach This paper is a case study of a multinational collaboration of health-care leaders, educators, learners and other stakeholders. It describes Sanokondu's development and contribution to global health-care leadership education. One of the major strategies has been establishing partnerships with other educational organizations involved in clinical leadership and health systems improvement. Findings A major flagship of Sanokondu has been its annual TISLEP meetings, which brings various health-care leaders, educators, learners and patients together. The meetings provide opportunities for dialog and knowledge exchange on leadership education. The work of Sanokondu has resulted in an open access knowledge bank for health-care leadership education, which in addition to the individual expertise of its members, is readily available for consultation. Sanokondu continues to contribute to scholarship in health-care leadership through ongoing research, education and dissemination in the scholarly literature. Originality/value Sanokondu embodies the achievements of a multinational collaboration of health-care stakeholders invested in leadership education. The interactions culminating from this platform have resulted in new insights, innovative ideas and best practices on health-care leadership education.

Clinical leadership training: an evaluation of the Welsh Fellowship programme.

Purpose UK fellowship schemes have been set up to address low-level engagement of doctors with leadership roles. Established in 2013, the Welsh Clinical Leadership Fellowship (WCLF) programme aims to recruit aspiring future clinical leaders and equip them with knowledge and skills to lead improvements in healthcare delivery. This paper aims to evaluate the 12-month WCLF programme in its first two years of operation. Design/methodology/approach Focused on the participants ( n = 8), the authors explored expectations of the programme, reactions to academic components (provided by Academi Wales) and learning from workplace projects and other opportunities. The authors adopted a qualitative approach, collecting data from four focus groups, 20 individual face-to-face or telephone interviews with fellows and project supervisors and observation of Academi Wales training days. Findings Although from diverse specialties and stages in training, all participants reported that the Fellowship met expectations. Fellows learned leadership theory, developing understanding of leadership and teamwork in complex organisations. Through workplace projects, they applied their knowledge, learning from both success and failure. The quality of communication with fellows distinguished the better supervisors and impacted on project success. Research limitations/implications Small participant numbers limit generalisability. The authors did not evaluate longer-term impact. Practical implications Doctors are required to be both clinically proficient and influence service delivery and improve patient care. The WCLF programme addresses both the need for leadership theory (through the Academi Wales training) and the application of learning through the performance of leadership roles in the projects. Originality/value This work represents an evaluation of the only leadership programme in Wales, and outcomes have led to improvements.

Leadership in Ophthalmology: The Role of Physician-MBAs.

PURPOSE: As American health care evolves, an increasing number of doctors are pursuing MBAs. However, relatively little is known about how business training translates into their future careers. This study characterizes ophthalmologists who have completed MBAs and identifies opportunities for physician leadership in the field. DESIGN: Cross-sectional study. METHODS: We identified 120 ophthalmologists who hold MBAs. We searched each individual's online profiles to collect information on demographics, training, and professional activities. RESULTS: Physician-MBAs in ophthalmology are 80% male; 80% are fellowship trained; and 28% are in primarily nonclinical roles and 55% participate in significant nonclinical activity. Hospital administration is most common (31%), followed by pharmaceutical administration (7%) and consulting (5%). Older ophthalmologist-MBAs were more likely to work in nonclinical roles, with 79% of those who completed residency before 2000 engaged in significant nonclinical activity compared to 30% of those who completed residency after 2000. The most common employers of physician-MBAs in ophthalmology are academic medical centers (43%), large group practices (30%), and private practices (13%). CONCLUSIONS: The majority of ophthalmologist-MBAs work in primarily clinical roles, although a sizable proportion hold nonclinical positions. Moving forward, we anticipate an increased role for physician leaders in health care administration, policy, and entrepreneurship. While formal management training is not necessary for these roles, a growing number of physicians have sought out MBAs to support their nonclinical interests.

Competitive Advantage of MBA for Physician Executives: A Systematic Literature Review.

In response to systemic challenges facing the US healthcare system, many medical students, residents and practicing physicians are pursuing a Master in Business Administration (MBA) degree. The value of such proposition remains poorly defined. The aim of this review is to analyze current literature pertaining to the added value of MBA training for physician executives (PEs). We hypothesized that physicians who supplement their clinical expertise with business education gain a significant competitive advantage. A detailed literature search of four electronic databases (PubMed, SCOPUS, Embase and ERIC) was performed. Included were studies published between Jan 2000 and June 2017, focusing specifically on PEs. Among 1580 non-duplicative titles, we identified 23 relevant articles. Attributes which were found to add value to one's competitiveness as PE were recorded. A quality index score was assigned to each article in order to minimize bias. Results were tabulated by attributes and by publication. We found that competitive domains deemed to be most important for PEs in the context of MBA training were leadership (n = 17), career advancement opportunities (n = 12), understanding of financial aspects of medicine (n = 9) and team-building skills (n = 10). Among other prominent factors associated with the desire to engage in an MBA were higher compensation, awareness of public health issues/strategy, increased negotiation skills and enhanced work-life balance. Of interest, the learning of strategies for reducing malpractice litigation was less important than the other drivers. This comprehensive systemic review supports our hypothesis that a business degree confers a competitive advantage for PEs. Physician executives equipped with an MBA degree appear to be better equipped to face the challenge of the dynamically evolving healthcare landscape. This information may be beneficial to medical schools designing or implementing combined dual-degree curricula.

Medical student healthcare consulting groups: A novel way to train the next generation of physician-executives.

Meeting the challenges of the evolving healthcare environment requires leadership of physicians well-trained in clinical medicine and healthcare management. However, many physicians lack training in business and leadership. While some residency programs have management tracks, training at the medical school level is currently lacking. We developed the Hopkins Health Management Advisory Group, an extracurricular program at Johns Hopkins University School of Medicine that exposes medical students to healthcare management and fosters development of leadership skills. Teams of students work directly with health system executives on 3-6 month-long projects using management consulting principles to address problems spanning health system domains, including strategy, operations, and quality improvement. Since the program's inception, 23 students have completed seven projects, with 13 additional students currently working on three more projects. Sponsors leading six out of seven completed projects have implemented recommendations. Qualitative survey respondents have found the program beneficial, with students frequently describing how the program has helped to develop professional skills and foster knowledge about healthcare management. These early assessments show positive impact for both students and the institution, and suggest that such programs can train students in management early and concurrently in their medication education by immersing them in team-based health system projects.

Educational interventions to enhance competencies for interprofessional collaboration among nurse and physician managers: An integrative review.

Collaborative leadership and management structures are critical to transforming care delivery. Both nurse and physician managers are uniquely positioned to co-lead. However, little is known on how to prepare and support individuals for these co-leader arrangements. The re-design of healthcare professional education focuses on interprofessional collaboration, mutual learning, and a competency-based approach. While competencies for interprofessional collaboration have been delineated, competencies for collaborative management practice have yet to be addressed. An integrative review of empirical studies on existing educational interventions was conducted to critically appraise and synthesise the results regarding collaborative competence among nurse and physician leaders. We reviewed how these interventions have been designed, implemented, and evaluated within workplace settings in order to inform our understanding of what components are effective or ineffective for the future development of an educational programme. This review reports on key characteristics of nine empirical studies and emphasises that: a uniprofessional approach to leadership development is predominant within educational programmes and that the assessment of shared learning experiences are not addressed; there are inconsistency in terms used to describe competencies by individual researchers and limitations within the competency frameworks used in the studies reviewed; and there is a lack of suitable instruments available to assess whether competencies have been achieved through the educational programmes. None of the studies discussed the process of how individuals learned specific competencies or whether learning outcome were achieved. Educational programmes were developed based on a perceived lack of leadership preparation and orientation programmes for leaders in formal management positions and used multiple interventions. Only two of the programmes involved organisational or systems level competencies. Interprofessional co-leading requires enhanced capabilities and capacity for managers. There is a need for developing an in-action education intervention that addresses the unique learning needs of co-leader arrangements particularly among nurses and physicians who are new to their role.

Medical management and leadership: a time of transition?

Perspectives on medical management and leadership are in a time of transition, but there is much we still need to understand better. This paper explores some of the tensions and dilemmas inherent in understandings of medical management and leadership.