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Implementation of an Innovative Residency Leadership Development Curriculum

Grantham, Ashley PhD; Hauck, Jennifer MD; Stafford-Smith, Mark MD; Mathew, Joseph P. MD; Thompson, Annemarie MD

doi: 10.1213/XAA.0000000000000952
Innovation
Free

The role of the anesthesiologist in the perioperative environment requires facility in leadership; however, leadership education is not part of the traditional curriculum for anesthesiology trainees. To address this educational gap, we developed a leadership program for anesthesiology residents at an academic medical center to build competency in the areas of teamwork, emotional intelligence, integrity, selfless service, critical thinking, and patient-centeredness, constructs that correlate with the Accreditation Council for Graduate Medical Education competencies of interpersonal and communication skills and professionalism. This report describes the design and implementation of the program, including the curriculum, and offers recommendations for implementation at other institutions.

From the Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.

Accepted for publication November 19, 2018.

Funding: None.

The authors declare no conflicts of interest.

Ashley Grantham and Jennifer Hauck contributed equally to this manuscript.

Address correspondence to Ashley Grantham, PhD, Department of Anesthesiology, Duke University School of Medicine, DUMC 3094, Durham, NC 27710. Address e-mail to ashley.grantham@duke.edu.

The Accreditation Council for Graduate Medical Education and the American Board of Anesthesiology have indicated the importance of learning leadership skills during anesthesiology training. The Accreditation Council for Graduate Medical Education Milestones for Anesthesiology contain 8 leadership-related milestones, and the new Objective Structured Clinical Examination emphasizes skills related to communication and professionalism.1,2 Despite the increased focus on leadership skills, residency education in anesthesiology traditionally lacks instruction on these topics.3,4 This most likely reason stems from multiple competing time demands and challenges; however, perhaps the largest barrier to leadership training has been a paucity of curricula and programs specific to anesthesiology.

Leadership education programs for trainees have been described in other specialties;5–7 however, to our knowledge, there are no reports in the literature of programs specific to anesthesiology residents. This report describes the design and implementation of a leadership curriculum for anesthesiology trainees, providing a model and review of our experience for leaders seeking to implement a leadership training program within their departments. Although institutional review board approval was obtained, written Health Insurance Portability and Accountability Act authorization was not needed for this report.

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DESCRIPTION OF THE LEADERSHIP PROGRAM

Population and Setting

The target population for the leadership program is postgraduate year 2–4 anesthesiology residents at a medium-sized residency program in the southeastern United States. Interns (postgraduate year 1) were excluded from the program due to the structure of the intern year at the authors’ institution. The program sessions were held during a regularly scheduled didactic lecture series focused on the Accreditation Council for Graduate Medical Education competencies of practice-based learning and improvement, interpersonal and communication skills, and systems-based practice. Participation in the program was considered part of didactic attendance requirements for all postgraduate year 2–4 trainees.

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Curriculum Development and Program Structure

Curriculum development was co-led by a board-certified anesthesiologist who completed the Feagin Leadership Program (https://www.feaginleadership.org/) (J.N.H.) and a PhD in education research and policy analysis with expertise in organizational theory, professional development programming, and curriculum design (A.E.G.).

Five key sources of information guided curriculum development: (1) the results from a resident leadership needs assessment; (2) the Accreditation Council for Graduate Medical Education core competencies; (3) the Anesthesiology Milestones; (4) the Duke Healthcare Leadership Model competencies; and (5) the recommendations of individuals involved in medical education and leadership development across the medical center (Tables 1 and 2 and the Figure).8 The program leads used Qualtrics (Provo, UT) to conduct a needs assessment9 to determine what trainees hoped to gain by participating in a leadership program. At least 4 face-to-face discussions were held with the department chair (J.P.M.), residency program director (A.T.), vice chair of education (M.S.-S.), and residency program coordinator to gain their feedback on possible curriculum topics for the program.

Table 1.

Table 1.

Table 2.

Table 2.

Table 3.

Table 3.

Figure.

Figure.

Next, the leadership model competencies (Figure) were divided into 3 years, with roughly 2 competencies assigned to each year. The program codirectors then reviewed the needs assessment results and developed session topics based on the feedback plus the feedback of the advisory group. The program codirectors ensured that all leadership-related core competencies and milestones were represented in the curriculum by reviewing the session topics and mapping them to the milestones. Themes were generated for each year of the 3-year curriculum. These themes inform the individual session topics.

A learner-centered teaching philosophy for the program was decided on during initial curriculum planning.10 In addition, the decision was made to incorporate active learning strategies such as role playing11 and small group discussions into each session to encourage the application of course content to clinical practice.12

A team-based structure was chosen to foster interaction, reflection, and near-peer teaching among residents of different training years. The residents were divided into 7 teams, with each team consisting of 2 residents from each program year (postgraduate year 2–4). Thirteen faculty anesthesiologists and one doctor of philosophy educator were recruited to act as facilitators for team-based active learning activities. While all the faculty small group facilitators had teaching experience within the clinical or traditional didactic settings, not all faculty had experience or a high level of comfort in an active learning environment. To meet this need, faculty small group facilitators were required to attend a 2-hour training session that included techniques such as leading small group debriefing sessions,13 active listening,14 and facilitating role-play activities and small group discussions to prepare them for their roles and ensure quality and consistency (Table 3).

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Program Implementation

At the time of submission of this article, eight 1-hour leadership sessions have occurred during the first 2 years of the program (July 2016 to February 2018). Table 1 lists session topics to date.

Each session follows a similar structure. Sessions begin with a brief presentation from a local expert with advanced training in the leadership topic being discussed. This is followed by small group active learning activities designed to help residents apply the content knowledge to scenarios they encounter in their clinical practice. After the application of concepts to clinical scenarios, a guided debriefing is conducted to help residents reflect on the workshop content. The sessions are conducted in a standard meeting room within the institution and require minimal materials; however, the room is rearranged from a traditional lecture setting into small table groups to foster communication and small group interaction. Minimal prework (15–30 minutes) such as completing self-assessments, watching videos, or reading academic articles is assigned before each session via email to free up face-to-face meeting time for active learning strategies.

The costs associated with these sessions have been minimal. Lecturers are recruited through personal networks of the program leads or through the recommendations of others involved in leadership training at the institution and do not receive honoraria for their participation. Backgrounds of presenters include a professor of orthopedic surgery who founded a medical leadership program, an executive coach and change consultant, and the chief patient safety officer of the institution. All presenters had experience facilitating adult learning events related to the course curriculum. Food is served at the sessions; however, this is not a cost unique to the program because snacks are served at all resident didactics. The largest cost, beyond program co-leads’ time, has been the purchase of the Myers–Briggs type indicator instruments ($1396.50) as well as the 1-time Myers–Briggs type indicator training for the program codirector ($1807.00).

More than half of eligible residents were in attendance at each of the sessions during the first 2 years of the program. Although attendance is occasionally affected by clinical responsibilities or other conflicts, there is a priority placed on these seminars by the faculty. Session evaluations were solicited via Qualtrics by the residency office after each session to measure the participants’ affective response to the training.12 Evaluations indicated that the majority of learners strongly agreed or agreed with the following statements: “The facilitator was effective,” “I learned something new today,” and “This session was relevant to my clinical practice.”

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DISCUSSION

We describe the creation and implementation of a leadership program for anesthesiology residents at an academic medical center.

First, the implementation of this program demonstrates that a longitudinal leadership development program for “all” anesthesiology residents can be incorporated into an existing didactic schedule without the need for additional protected time, a finding that is important because training programs strive to balance educational, clinical, and wellness needs. Second, the curriculum has been implemented with little recurring cost to the department. Third, this program has used innovative instructional strategies, including near-peer teaching, learner-centered teaching, and course flipping.

While further research is needed to determine secondary outcomes of the program, the small group facilitator model also has potential positive impacts on the learning environment for residents. The small group facilitators also likely benefited from faculty development in the form of leadership training and facilitator training by attending these learning sessions.

Finally, the implementation of this program highlights the value of an interdisciplinary team in creating a rigorous leadership development curriculum in academic medicine. The combination of clinical and education expertise generated an educational resource rooted in best practices from both fields and enriched the overall learning experience.

While this leadership development program has ultimately been successful, implementation has not been without challenges. The initial planning and coordination of individual sessions are time intensive. In addition, while speakers have been willing to donate their time to the program pro bono, the ability to offer honoraria would likely lend professional credibility to the initiative. Finally, while a strength of this program has been its ability to fit within given time constraints, additional time dedicated to the content would allow for deeper exploration of the concepts covered, as well as additional time for peer discussions and application activities.

Areas for future research include examining whether resident learning transfer12 from the program translated into behaviors observed by other health care practitioners through the administration of 360° evaluations, evaluating the influence of the program on departmental culture, and examining whether the program scales to other types of environments (eg, larger/smaller residency programs, fellowship programs, and potentially nontrainee populations such as junior faculty).

This report has outlined the efforts of one anesthesiology department to create a leadership development program for residents at an academic medical center. Through description of our leadership education program and lessons learned, we hope to serve as a guide for others initiating similar efforts at other institutions.

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DISCLOSURES

Name: Ashley Grantham, PhD.

Contribution: This author helped write the manuscript.

Name: Jennifer Hauck, MD.

Contribution: This author helped write the manuscript.

Name: Mark Stafford-Smith, MD.

Contribution: This author helped revise the manuscript.

Name: Joseph P. Mathew, MD.

Contribution: This author helped revise the manuscript.

Name: Annemarie Thompson, MD.

Contribution: This author helped provide direction and revise the manuscript.

This manuscript was handled by: Kent H. Rehfeldt, MD.

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