LEAD 2.0: A Model For Interprofessional Leadership Curriculum Development · 2020-05-19 · LEAD 2.0: A Model For Interprofessional Leadership Curriculum Development Delete this box

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

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?


Leadership Training Opportunities


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 else?

Let’s get to work





• What else?

Let’s get to work





• 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

Questions

@joshuadhartzell

[email protected]