Toronto International Summit on Leadership Education for

Toronto International Summit on Leadership Education for Physicians

Toronto, Canada | October 22, 2014

Report of Proceedings

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TORONTO INTERNATIONAL SUMMIT ON LEADERSHIP EDUCATION FOR PHYSICIANS | TORONTO, CANADA | OCTOBER 22, 2014

The Purpose Statement for TISLEP was:

An international audience of thought leaders and educators will meet to advance the conversation on the many physician leadership types and their requisite competencies, and discuss how stakeholders can collaborate to build the physician leaders of tomorrow.

The goal will be to create guiding principles for developing a physician leadership curriculum that will complement implementation of CanMEDs 2015 thereby driving improvement of the healthcare system.

The programme was designed to maximize the input of stakeholders on issues related to physician leadership education. The morning breakout groups were categorized as Wicked questions, i.e. those topics that are both relevant and important but for various reasons are often overlooked. The afternoon breakout groups addressed core issues relevant to curriculum development and scholarship. The programme was designed to maximize the input of the stakeholders on issues related to physician leadership education. The panel discussion included representation across different physician leadership archetypes as well as the resident and patient voice.

BACKGROUND

Physician leadership and teamwork are considered key concepts in transforming the healthcare system at both a local and a systems level. As a result, physician leadership development has become a growing conversation in medical education circles. The Future of Medical Education in Canada (FMEC) Undergraduate and Postgraduate Reports as well as other publications from the General Medical Council (GMC) and the Accreditation Council for Graduate Medical Education (ACGME) and others, emphasized leadership development as one of the critical steps needed to move medical and health professions education forward, and foster the changes needed to improve patient care.

Recognizing the imperative to advance physician leadership education across the professional continuum, the University of Toronto’s Faculty of Medicine and Institute of Health Policy, Management and Evaluation entered into a collaboration with the Royal College of Physicians and Surgeons of Canada (RCPSC) to bring together individuals from diverse backgrounds. They gathered patient representatives, learners, faculty from medicine and other health care professions, administrators, educators and leaders from across Canada and around the world to discuss how stakeholders can work together to build the physician leaders of tomorrow. To this end, a one day, by-invitation-only Summit focusing on physician leadership education in postgraduate medical education titled the Toronto International Summit on Leadership Education for Physicians (TISLEP) was convened in Toronto, Canada on October 22, 2014.

Building on the work already done in the development of the CanMEDS 2015 Competency Framework, the goal of TISLEP was to articulate key principles for leadership development in postgraduate education and exchange ideas around core curriculum and milestone stages, implementation issues, program evaluation strategy and scholarship agenda.

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TISLEP REPORT OF PROCEEDINGS

The following draft guiding principles (The Toronto Statement) for leadership development were pre-circulated to participants for discussion at the Summit:

1 All physicians are expected to be leaders within their clinical practice environment;

2 Leadership (in healthcare) is a people business so it must be taught and learned around the people with whom leaders will need to work;

3 Leadership training tailored to the clinical or system level should be guided by a framework that pays attention to competency, character, and managerial skills;

4 Because of the importance of the character traits needed by leaders, training should be grounded in situations and experiences that reflect the challenges that physicians will face; and

5 Leadership training goals should ultimately focus on better health system performance.

LEARNING OBJECTIVESTISLEP was accredited by both the RCPSC and the College of Family Physicians of Canada (CFPC) with the following preset learning objectives:

At the end of the Summit, participants will be able to:

Discuss the importance of physician leadership throughout the professional life cycle and its impact on the quality and safety of patient care,

Articulate and outline some of the challenges associated with developing physician leadership,

Summarize leadership competencies that should be attained by the end of residency training, and

Commit to at least one activity that enhances physician leadership education within and outside their own context.

TISLEP CO-CHAIRSAdalsteinn Brown PhD, Director, Institute of Health, Policy, Management & Evaluation, University of Toronto, and

Fiona Moss MD, Co-Chair of ICRE, Editor-in-Chief, Postgraduate Medical Journal

PLANNING COMMITTEEAnne Matlow MD, FRCPC, Co-Chair, University of Toronto

Ming-Ka Chan MD, FRCPC, Co-Chair, University of Manitoba

Deepak Dath MD, FRCSC, McMaster University

Joshua Tepper MD, CFPC CEO, Health Quality Ontario

Geneviève Moineau MD, FRCPC, CEO Association of Faculties of Medicine of Canada, Ottawa

Adalsteinn Brown PhD, Director, Institute of Health, Policy, Management & Evaluation, University of Toronto

Fiona Moss MD, Co-Chair of ICRE, Editor-in-Chief, Postgraduate Medical Journal

Lisa Bevacqua Project Coordinator, University of Toronto

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Toronto International Summit on Leadership Education for Physicians

Programme Wednesday, October 22nd, 2014

St. Andrews Club and Conference Facility – 150 King Street West – 16th Floor – The Garden Suite

0730 – 0800 Breakfast & Registration

0800 – 0805 Welcome from the Dean, Faculty of Medicine, University of Toronto

0805 – 0815 Welcome Address – Introductions and Objectives for the Summit Dr. Fiona Moss and Dr. Adalsteinn Brown

0815 – 0900 Plenary – Dr. Wiley Souba – Flipping the Leadership Paradigm

0900 – 1010 AM BREAK-OUT SESSIONS – WICKED QUESTIONS

1 Reconciling Physician Leadership with Leadership Development in other Professions

2 Shifting the mind-set to Leader as Influencer

3 Fostering leadership without titles or role models

4 Promoting diversity at the top

5 Reconciling “leadership” within the CanMEDS competency framework

1010 – 1030 Refreshment Break

1030 – 1145 Report Back: 5 minute presentation from each group with a 5 minute Q&A, Large Group Discussion, Closing Remarks

1145 – 1245 Lunch

1245 – 1330 Panel Discussion — Personal Perspectives on Physician Leadership Michael Apkon, MBA, MD, PhD, President and CEO, The Hospital for Sick Children (SickKids), Toronto; Jordan Bohnen, MD, MBA, General Surgery, Resident, PGY4. Massachusetts General Hospital, Boston MA, USA; Jamiu O. Busari, MB, ChB, MD, PhD, MHPE, Associate Professor & Clinical Director, Pediatric residency training program, Atrium Medical Center, Maastricht, NL; Sydney Graham, Care to Collaborate, Toronto Canada; Joshua Tepper, MD, CPFC, MPH, MBA, President and Chief Executive Officer, Health Quality Ontario; Mark Walton, MD, FRCSC, Professor, Pediatric Surgery. Assistant Dean, Postgraduate Medical Education, McMaster University

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1330 – 1430 PM BREAK-OUT SESSIONS

1 Milestones for leadership development

2 Meeting the Needs of the Advanced Resident Leader

3 Program Evaluation

4 Educational strategies and implementation -Classroom setting

5 Educational strategies and implementation - Clinical setting

6 MD leadership scholarship agenda

1430 – 1500 Refreshment Break

1500 – 1615 Report Back: 5 minute presentation from each group with a 5 minute Q&A, Large Group Discussion, Closing Remarks

1615 – 1645 Conclusion and Synthesis of Summit Key Themes

16:45 - 1700 Closing Remarks/Next Steps

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THE DAYSixty four participants from eight different countries attended the Summit. Attendees included physicians and other healthcare professionals, non-healthcare professionals, patient representatives, teachers and learners. The distribution of these demographic data are displayed on page 6.

The plenary lecture was delivered by Dr Wiley ‘Chip’ Souba, past Dean of the Geisel School of Medicine and Vice President for Health Affairs at Dartmouth College. His passion for the topic of physician leadership is reflected by 40 published peer-reviewed articles on leadership topics and by the popular leadership course he teaches at Dartmouth. His talk, “Flipping the leadership paradigm”, challenged us to reconsider the prevailing model of leadership which is anchored in theories and effected by the leader's skills, to one where insights from the lived experience of being a leader iteratively inform one's actions and perspectives. This latter model is expounded upon further in Souba's publication, A new model of leadership performance in healthcare, published in Academic Medicine October 2011 (Acad Med. 2011;86:1241–1252).

Participants then broke into small groups to elaborate on some wicked questions in leadership development to round out the morning. After a networking lunch, a panel discussion highlighted perspectives from different lenses for groups to consider when developing leadership curricula. The afternoon's work then focused on different aspects of curriculum development, program evaluation and scholarship. All breakout groups had one or two designated facilitators and a scribe. We reconnected as a group to hear the highlights of each breakout session and gather further thoughts and feedback.

The spaces between the Summit's agenda items were filled with enthusiasm, networking and a lot of buzz about the potential of an international community dedicated to advancing leadership education for postgraduate trainees. As the Chairs summarized and connected the day's proceedings, it was apparent that the guiding principles put forward before the Summit were on the right track and with minor edits would capture the nuances highlighted during the day.

Following the Summit, all transcribed notes and the Twitter feed from the Summit were reviewed and a thematic analysis performed. Preliminary analysis reveals that similar issues were raised across many of the breakout groups. Comments regarding the roles and competencies of leaders align well with the themes in the LEADS in a Caring Environment Framework leadership capabilities framework. These include Lead self, Engage others, Achieve results, Develop coalition and Systems transformation (http://www.leadersforlife.ca/site/framework?nav=02). Other emerging themes include perception of power, interprofessional education and practice, and education (curriculum, teaching and learning). Further analysis is underway.

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Total Representation

Affiliation

Country: City

Learner: Medical Student

Learner: Resident/Trainee

MDNon-MD: Health/Education

Non-MD: Non-Health

Patient Total

Australia: Sydney

2 2

Canada 2 5 35 8 1 3 54

Chile: Santiago

1 1

Mexico: Mexico City

1 1

Netherlands: Amsterdam

1 1

Sweden: Stockholm

1 1

United Kingdom: London

1 1

USA: Boston, Hanover and Iowa City

1 2 3

Total 2 6 44 8 1 3 64

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Canadian Representation

Affiliation

By ProvinceLearner: Medical Student

Learner: Resident/Trainee

MDNon-MD: Health/Education

Non-MD: Non-Health

Patient Total

British Columbia 1 1

Manitoba 2 2

Newfoundland & Labrador

1 1

Nova Scotia 1 1

Ontario 2 5 29 7 1 3 47

Quebec 2 2

Total 2 5 35 8 1 3 54

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FINAL WORDS, OUTPUTS AND FUTURE DIRECTIONSFrom the informal and formal feedback generated during and after the Summit, the event clearly met its objectives and an international community is starting to grow. Additional collaborations and networks have been initiated globally to develop leadership education resources. Publication of the finalized guiding principles as a White Paper, as well as the thematic analysis of the content of the Summit is planned.

Our post-Summit electronic survey rated the speakers and Summit highly and generated further commitment to collaborate on curriculum development. This represents a resounding success for the summit! Thirty-four individuals have already volunteered to participate in working groups. They will begin work shortly and present their output at the Second Toronto International Summit on Leadership Education for Physicians to be held Tuesday October 20, 2015, as an open pre-conference Summit before the International Conference on Residency Education (ICRE) and the International Resident Leadership Summit (IRLS) in Vancouver, British Columbia, Canada. This community will grow and meet regularly at annual educational venues.

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Strongly Disagree

Disagree Somewhat Disagree

Somewhat Agree

Agree Strongly Agree

N/A Number of Respondents

Rating (out of 6)

Plenary: “Flipping the Leadership Paradigm” Dr. Wiley “Chip” Souba

0 %

0

0 %

0

2 %

1

5 %

2

23 %

9

63 %

25

8 %

3

40 5.6

Panel Discussion: Michael Apkon, Jordan Bohnen, Jamiu Busari, Sydney Graham, Joshua Tepper & Mark Walton

0%

0

0 %

0

8 %

3

13 %

5

62 %

24

15 %

6

8 %

3

39 4.9

Synthesis of the Summit Themes: Drs. Adalsteinn Brown & Fiona Moss

0 %

0

0 %

0

0 %

0

0 %

0

43 %

15

46 %

16

11 %

4

35 5.5

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Toronto International Summit on Leadership Education for