LEAD 2.0: A Model For Interprofessional Leadership Curriculum Development · 2020-05-19 · LEAD...
Transcript of LEAD 2.0: A Model For Interprofessional Leadership Curriculum Development · 2020-05-19 · LEAD...
LEAD 2.0: A Model For Interprofessional Leadership Curriculum Development
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Joshua D. Hartzell, MD, FACP, FIDSA
Assistant Dean for Faculty Development
Associate Professor of Medicine
Uniformed Services University
‘America’s Medical School’
21 October 2017
Disclosures & Disclaimers
The opinions or assertions contained herein are the private ones of the authors/speakers and are not to be construed as official or reflecting
the views of the Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S.
Government.
The author has no disclosures related to this talk.
Acknowledgements
Brett Sadowski, MD
LEAD 2.0 Speakers COL Todd Villines
CAPT Patrick Young
MAJ Erin Seefeldt
LTC Laurel Neff
COL Lisa Moores
LTC (P) John Sherner
Dr. George Ruiz
LEAD 2.0 Advisors COL Michael Nelson COL Clifton Yu LTG Eric Schoomaker MAJ Brian Cohee Dr. Neil Grunberg Dr. John McManigle Dr. Page Morahan Dr. Brian Clyne David Bitterman
MGH/USU Team Deb Navedo Peter Cahn Liz Armstrong Lou Pangaro
Objectives
• Review models of leadership curricula for graduate medical education trainees
• Identify, describe, and discuss barriers to the implementation of leadership curricula in medical education
• Determine the most relevant competencies for GME trainees
• Identify best practices for teaching leadership to GME trainees
How many of you have a leadership program?
What would the ideal leadership program look like?
“All physicians (nurses, pharmacists…) take a
leadership role at some point in their career; while
most exert influence in their practices and
communities as informal leaders, some are
appointed to formal leadership roles with great
responsibility.”
Stewart Gable, MD
Gable S. Acad Med. 2014;89(6):1-4.
Accidental leadership…
“Physicians (nurses, pharmacists…) find
themselves in leadership positions at some
point in their career, and most have no
formal leadership training or experience.”
Steinhilber S and Estrada C. J Gen Intern
Med 30(5):543–5.
“As a staff member in a major leadership role, who was trained by GME at this institution (Walter Reed), I feel like I was completely unprepared as far as leadership
training goes.”
The debate is over! All physicians (health care providers)
are leaders.
It is our responsibility to train ALL
residents in leadership.
It comes down to trust and patient safety.
How do we develop leadership skills?
Education Training
Coaching Mentoring
Learning on the Job Stretch Assignments
Slide adapted from Tom Aretz and http://www.cfar.com/Documents/bestpractices-gen.pdf
Gap determination
New knowledge and skills
Supervision and feedback
MS1 & MS2
MS3 & MS4
Residency
https://s-media-cache-ak0.pinimg.com/originals/39/80/85/398085bd586ea0bb67a7bb13e3de641b.png
Medical School
LEAD
Residency Training
LEAD 2.0 - Walter Reed Residency Leadership Curriculum
Faculty Development
Academic Leadership Course for Program Directors
Certificate Program
• Leadership
• Teaching
• Research
Advanced Degrees
MS of Health Care Administration
MS in Health Professions Education
PhD in Med Ed
Masters in Public Health
Uniformed Services University
Leadership Lifecycle for
Physicians
Medical Leadership Competency Framework
•Undergraduate
•Graduate
•Continuing Practice
https://www.leadershipacademy.nhs.uk/wp-content/uploads/2012/11/NHSLeadership-Leadership-Framework-Medical-Leadership-Competency-Framework-3rd-ed.pdf
“While the mandate to train leaders is clear, there has
been little research to date exploring leadership
training and/or curricula in PGME. Of the research
studies to examine innovative leadership programs for
postgraduate medical trainees, only a few have
rigorously evaluated the interventions using
quantitative measures.”
Danilewitz M and McLean L.
Can Med Educ J. 2016 Oct 18;7(2):e32-e50.
What is the mandate?
• Does not identify leadership
as a separate competency
• Leadership is described in
milestones
ACGME
CanMEDS 2015 Leadership Role Key Competencies
• Contribute to the improvement of healthcare delivery in teams, organizations and systems
• Engage in the stewardship of healthcare resources
• Demonstrate leadership in professional practice
• Manage their practice and career
CanMEDS 2015 Leadership Role 11 Enabling Competencies
• Apply the science of quality improvement
• Analyze adverse events to enhance systems of care
• Use health informatics to improve the quality/safety
• Set priorities and manage time to balance practice and personal life
• Manage career planning, finances, and health human resources in a practice
• Implement processes to improve personal practice
Global Leadership Competencies
• Working group establishing international leadership curriculum
• Identified 11 key concepts related to curriculum
• Developing competency based modules
• Must be adaptable to local institutions
Matlow, A., et al., Collaborating internationally on physician leadership education:
first steps. Leadersh Health Serv (Bradf Engl), 2016. 29(3): p. 220-30.
https://sites.google.com/site/sanokondu/ Toronto International Summit on Leadership Education for Physicians is available at: http://tislep.pgme.utoronto.ca
Defining Leadership Exercise
Write your definition of leadership
Share and compare your definition
with the person sitting to your right
and left
Definitions of Leadership
As Leaders, physicians engage with others to contribute to a vision of a high-quality health care system and take
responsibility for the delivery of excellent patient care through their activities as clinicians, administrators,
scholars, or teachers.
CANMEDS 2015 Physician Competency Framework
The process of influencing people by providing purpose,
direction, and motivation to accomplish the mission and
improve the organization.
Army Doctrinal Publication 6-22, August 2012
Graduate Medical Education Leadership Curriculum
https://www.google.com/search?q=kern%27s+curriculum+cycle&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi5qJC-r7jUAhUB7CYKHUFGCQIQ_AUIBigB&biw=1600&bih=808#tbm=isch&q=kern+curriculum&imgrc=RPqnyrtsI1R6CM:&spf=1497272834629
Leadership training: what exists
• Systematic review of leadership programs
• 45 studies total - 26 involved trainees
• 29 programs for leaders without a title
• Survey of Dermatology Program Directors
• 91% of program directors and trainees thought leadership
could be taught
• 78% of respondents agreed leadership training is important
• Only 13% of programs had formal curriculum
Frich JC, et al. J Gen Intern Med. 2015;30(5):656-74. Baird DS, et al. J Am Acad Dermatol. 2012;66(4):622-5.
• Survey about leadership sent to 70 program directors
• 2 program directors with strong leadership programs were interviewed
• 56% response rate
• 77% reported leadership training is important
• Only 38% assess leadership knowledge or skills
• 29% offer Chief Resident leadership training
A landscape analysis of leadership training in
postgraduate medical education training programs
at the University of Ottawa.
Danilewitz M, McLean L. Can Med Educ J. 2016 Oct 18;7(2):e32-e50.
• 89% -- develop residents leadership skills
• 59% -- facilitate change in healthcare to enhance services and outcomes
• 69% design and organize elements of healthcare delivery
How prepared/somewhat prepared are program
directors to teach about?
Danilewitz M, McLean L. Can Med Educ J. 2016 Oct 18;7(2):e32-e50.
Leadership Training Opportunities
Danilewitz M, McLean L. Can Med Educ J. 2016 Oct 18;7(2):e32-e50.
So somebody must be
doing this…
Methods
• Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines
• Systematically searched MEDLINE, ERIC, EMBASE, and MedEdPORTAL from inception of the databases through October 2015
• Abstracts were reviewed by two independent reviewers for relevance
• Included studies were retrieved for full-text analysis
Methods
• Inclusion Criteria • Full length peer-reviewed publications that outlined a
program to teach leadership in GME
• Broad inclusion criteria were used to maximize examples of existing leadership curricula
• Exclusion Criteria • Papers that solely addressed the topic of
professionalism or team work in a particular setting
Example PubMed Search
(“Leadership”[mh] OR “Physician executives/education”[mh] OR leader*[tiab] OR problem-solving[tiab] OR "emotional intelligence"[tiab] OR self-awareness[tiab] OR "strategic planning"[tiab] OR "team skills"[tiab] OR "team building"[tiab] OR "people management"[tiab] OR "change management"[tiab] OR "conflict resolution"[tiab] OR "conflict management"[tiab]) AND (“Curriculum”[mh] OR “Teaching”[mh] OR “Learning”[mh] OR curricul*[tiab] OR teach[tiab] OR teaching[tiab] OR learn[tiab] OR learning[tiab] OR train[tiab] OR training[tiab] OR “lesson plan”[tiab] OR “lesson plans”[tiab] OR “lesson planning”[tiab] OR education[tiab] OR “educational model”[tiab] OR “educational models”[tiab]) AND ("Internship and Residency"[mh] OR "Education, Medical, Graduate"[mh] OR intern[tiab] OR interns[tiab] OR resident[tiab] OR residents[tiab] OR internship*[tiab] OR residency[tiab] OR trainee*[tiab] OR "junior staff"[tiab] OR "house staff"[tiab] OR fellow[tiab] OR fellows[tiab] OR fellowship*[tiab])
Results
• Accepted 52 papers - 65% of published in the last 5 years
• 56% of papers related to primary care
• Only 13% had multiple disciplines and only 1 study was interprofessional
• 81% for residents with 15% for Chief Residents alone
• Only 3 (6%) targeted fellows
Teaching methods
n (%)
• 24 (46%) used
projects as
teaching tool
• 25 (48%) assigned
mentors or
coaches
Content n (%)
Assessment and Outcomes
• Published papers are heterogeneous in design,
delivery, and reporting
• Subspecialties and surgery were
underrepresented
• Topics are consistent but driven by local need
and specialty
• Assessments are primarily focused on
Kirkpatrick Levels 1 and 2
• Recommendations moving forward…
Summary
Recommendations for leadership curricula
development and reporting criteria
• 32 question survey using Likert-type scales was
developed using survey best practices
• Cognitive interviews and expert review
• Survey constructs of respondent satisfaction and
effectiveness were used to assess:
• Perceptions of current leadership abilities
• Characteristics of an optimal curriculum
• Survey was emailed to 2041 providers
Rickards G et al. J Grad Med Educ. 2012;4(4):407-10.
Gehlbach H et al. Acad Med. 2010;85:925.
Hartzell JD et al. Mil Med. 2017 Jul;182(7):e1815-e1822.
Moving Beyond Accidental Leadership: A Graduate Medical
Education Leadership Curriculum Needs Assessment
Demographics
• Overall response rate of 21%
• 122 trainees (70% male - 30% female)
• 207 staff (59% male – 41% female)
• 38 program directors/associate program directors
• 131 teaching staff
Trainee PGY Level
n %
Intern 36 30
PGY2 Resident 12 10
PGY3 Resident 23 19
PGY4+ Resident 23 19
Fellow 27 22
Top 10 Leadership Topics Topic Likert Score
Conflict resolution 4.07
How to motivate a subordinate 4.01
How to implement change 4.00
Providing feedback 3.99
How to mentor 3.96
How to build a team 3.94
Toxic leadership 3.86
How to evaluate 3.83
How to coach 3.82
How to run a meeting 3.79
Topics were ranked from 1-5 on Likert scale (Not at all important to Extremely important). All topics except Myers-Briggs and generational differences were considered at least moderately important.
1.88
2.04
2.16
2.37
2.53
2.66
2.88
3.18
3.31
On-line powerpoints
Reflectivewriting…
Book club
Video ondemand…
Journal club(reviewing…
Role Play
Lecture (inperson)
Small groupexercises
Leadershipcase studies…
How effective would the following formats be for teaching leadership to trainees?
Not At all Effective Slightly Effective
Moderately Effective
Significantly Effective
Extremely Effective
2.03
2.69
3.04
3.05
3.57
AppropriateMaterials
FacultyExpertise
PercievedNeed forTraining
FacultyAvailability
TraineeAvailability
Barriers to Leadership Curriculum
Slight Amount
Moderate Amount
None Significant Amount
Extreme Amount
• “Staff will never let us get away for this so
despite leadership telling us to go it will never
happen until rest of staff are onboard…”
• “Time away from patient care is an issue. We
are constantly asked to see more patients, so
is the Command willing to take a loss on
productivity???”
Quotes on Barriers
What are the primary barriers you are facing in developing a leadership
curriculum?
How do we get buy in?
• From faculty?
• From learners?
Building the case for leadership
• Survey of graduated residents
• Junior faculty stories
• Senior level leader support
Shanafelt, T, et. al. Mayo Clinic Proceedings April 2015, 90:4;432–440.
Better leadership resulted in less burn-out and improved job satisfaction.
LEAD 2.0 Overview
• Adult Learning Theory and Kolb Learning Cycle
• Based on PITO Model
• P - Personal
• I - Interpersonal
• T - Team
• O - Organization
• Leadership 101: Fundamentals of Leadership
• Mentoring and Coaching
• Emotional Intelligence
• Conflict Resolution
• Feedback
• Managing Effectively
• Building an Effective Team
• Implementing Change
Walter Reed Core Leadership Topics
P
I
T O
List the top 8 categories for your leadership curriculum
• Pre-course work
• Readings
• Videos
• Self-assessments
• Mini-lecture
• Small groups, Pair-share
• Panel discussions
• Case studies
What sessions look like?
Armstrong E and Parsa-Parsi R. Acad Med. 2005; 80:680–684.
Kolb Learning Styles and Experiential Learning
Pre-reading on Kotter model of change.
Mini-lecture and video (Start with Why – Simon Sinek) on
managing change. Apply principles to ongoing
QI/PI Project in class
Use Kotter approach or Start with why
Activate Prior Knowledge
Teach New Knowledge, Skill, Attitude
Practice
Just do it!
Walter Reed GME Leadership Certificate
• 15 hours
• Anytime during residency
8 Core Topics
• 5 Hours
• Learner choice
• USU, WRNMMC, or outside speakers
3 Electives
• Ongoing
• PD or designee Mentoring
• The speaker inspired me to take on more of a leadership role.
• 85% (17/20) agree or strongly agree
• The speaker inspired me to learn more about leadership. • 95% (19/20)
Leadership 101: Feedback
“These sessions inspire me to continue
working on leadership in my every day life,
which I think is a great outcome.”
• 100% agreed (62%) or strongly agreed (38%) session was useful
• 90% said they would change the way they mentor following the session
Mentoring, Coaching, and
Sponsorship for Career
Development: Feedback
“…this was a very good session. It made
me look at coaching and mentoring in
different ways that I had not thought
about.”
Leadership Program at
• Brand it • PLUS – Pediatric Leadership for the Underserved
• Feagin Leadership Program at Duke
• Creating Opportunities for Organization Leadership (COOL)
• Identify stakeholders and supporters
• Pilot or use found pilots
• Show Grit! Dickey, C., R. Dismukes, and D. Topor, Academic Psych 2014. 38(3): p. 383-387. Kuo, A.K., et al. Academic Medicine. 2010. 85(10): 1603-1608.
Who are your faculty?
• Program faculty
• Department/hospital leadership (may or may not be physicians)
• Nurses
• University faculty
• Consultants….
• Who is available in your area
Let’s get to work
• What are innovative/interactive ways to teach leadership?
• How do we synchronize with existing curriculum? • Running ward teams, quality improvement projects, research, etc
• How do we make it interprofessional?
• How do we assess leadership?
• What else?
Let’s get to work
• What are innovative/interactive ways to teach leadership?
• How do we synchronize with existing curriculum? • Running ward teams, quality improvement projects, research, etc
• How do we make it interprofessional?
• How do we assess leadership?
• What else?
Let’s get to work
• What are innovative/interactive ways to teach leadership?
• How do we synchronize with existing curriculum? • Running ward teams, quality improvement projects, research, etc
• How do we make it interprofessional?
• How do we assess leadership?
• What else?
Let’s get to work
• What are innovative/interactive ways to teach leadership?
• How do we synchronize with existing curriculum? • Running ward teams, quality improvement projects, research, etc
• How do we make it interprofessional?
• How do we assess leadership?
• What else?
Develop a Culture of Leadership
• Reinforce the importance of leadership throughout the residency and department
• Label it leadership
• Send out articles on leadership intermittently
• Leadership book club
• Leadership Grand Rounds
• Leadership book club
• Leadership breakfasts