Leadership Root Cause Analysis: Using a Formal Analysis Tool to Dissect and Promote Intrusive Leadership in a U.S. Naval Hospital.

Intrusive leadership is a method that looks for signs that might indicate a problem within or outside of the workplace that can affect a member's performance and, subsequently, the mission. Our scenario demonstrates how intrusive leadership can identify potential problems which, when coupled with accountability, can prevent more significant complications.

Results of a Formal Mentorship Program for Internal Medicine Residents: Can We Facilitate Genuine Mentorship?

BACKGROUND: Mentorship programs are perceived as valuable, yet little is known about the effect of program design on mentoring effectiveness. INTERVENTION: We developed a program focused on mentoring relationship quality and evaluated how subsequent relationships compared to preexisting informal pairings. METHODS: Faculty members were invited by e-mail to participate in a new mentoring program. Participants were asked to complete a biography, subsequently provided to second- and third-year internal medicine residents. Residents were instructed to contact available mentors, and ultimately designate a formal mentor. All faculty and residents were provided a half-day workshop training, written guidelines, and e-mails. Reminders were e-mailed and announced in conferences approximately monthly. Residents were surveyed at the end of the academic year. RESULTS: Thirty-seven faculty members completed the biography, and 70% (26 of 37) of residents responded to the survey. Of the resident respondents, 77% (20 of 26) chose a formal mentor. Of the remainder, most had a previous informal mentor. Overall, 96% (25 of 26) of the residents had identified a mentor of some kind compared to 50% (13 of 26) before the intervention (P < .001), and 70% (14 of 20) who chose formal mentors identified them as actual mentors. Similar numbers of residents described their mentors as invested in the mentorship, and there was no statistical difference in the number of times mentors and mentees met. CONCLUSIONS: Facilitated selection of formal mentors produced relationships similar to preexisting informal ones. This model may increase the prevalence of mentorship without decreasing quality.

Sedative use during continuous positive airway pressure titration improves subsequent compliance: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: The initial experience with continuous positive airway pressure (CPAP) may predict subsequent compliance. In a retrospective study, we found that premedication with nonbenzodiazepine sedative-hypnotic agents during CPAP titration polysomnography independently predicted short-term compliance. To validate these findings, we conducted a prospective clinical trial to assess whether premedication with eszopiclone prior to CPAP titration would improve short-term CPAP compliance. METHODS: Subjects in this randomized, double-blind, placebo-controlled trial received 3 mg of eszopiclone or matching placebo prior to undergoing CPAP titration polysomnography. We compared the quality of CPAP titrations and objective measures of compliance during the first 4 to 6 weeks of therapy between the two groups. RESULTS: We enrolled 117 subjects, and 98 subjects completed the protocol (eszopiclone, 50 subjects; placebo, 48 subjects). Other than there being more women in the eszopiclone group, the groups were similar at baseline. Compared with placebo, premedication with eszopiclone significantly improved mean (+/- SD) sleep efficiency (87.8 +/- 5.8% vs 80.1 +/- 10.5%, respectively; p = 0.002) and mean total sleep time (350.9 +/- 33.6 min vs 319.7 +/- 48.7 min, respectively; p = 0.007). A trend toward improved sleep latency (19.4 +/- 16.1 min vs 31.8 +/- 30.4 min, respectively; p = 0.08) and the number of residual obstructive events observed at the final CPAP pressure (6.4 +/- 7 events/h vs 12.8 +/- 14.6 events/h, respectively; p = 0.08) during polysomnography was found. Eszopiclone significantly improved CPAP compliance. Among subjects premedicated with eszopiclone, CPAP was used on a higher percentage of nights (75.9 +/- 20.0% vs 60.1 +/- 24.3%, respectively; p = 0.005) and for more hours per night (4.8 +/- 1.5 h vs 3.9 +/- 1.8 h, respectively; p = 0.03). CONCLUSIONS: Premedication with eszopiclone on the night of CPAP titration improved the quality of CPAP titration and led to significantly greater short-term compliance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00507117.