Leadership Training

WHAT?                                                                                                                                                   

The goals of this intervention are to: 

• 󠄀 Identify and leverage local resources to develop leadership training
•  Incorporate leadership training into your residency curriculum

WHY?                                                                                                                                                   

Leadership is an important skill for both residents and faculty members. [1] Improved teamwork has been shown to be associated with decreased medical errors and improved performance. [2,3] Fostering leadership and other nontechnical skills may lead to more successful team structures. [4-6] Furthermore, leadership skills will be necessary for residents as they transition into senior residents leading multidisciplinary teams, practicing physicians, and ultimately leadership positions within their local and national organizations. [7] This intervention seeks to incorporate leadership development training, focused on the skills and expertise needed in surgery, within your residency curriculum.  

Resident Camaraderie	Great leaders improve team morale and the sense of community. Teaching residents leadership skills may therefore improve camaraderie within the program.
Organizational Culture and Values	Improving leadership helps teams function more effectively. Developing residents as leaders also sends a visible message to residents that you care about their career development.

How?                                                                                                                                                   

Step 1: Assess the situation

1. Evaluate whether leadership development is an important goal for residents in your program. As explained in our Getting Started Guide, sometimes a well-designed intervention fails because it seems irrelevant to users. If residents are still concerned about basic physiologic needs (Maslow level 1) like food availability while taking overnight call, this level 5 intervention with more abstract goals may feel tone-deaf. To gather this information, we recommend one or more of the following:

1. Consulting with your Wellness Committee
2. Consulting with your administrative and/or education chief residents
3. A survey of your residency
4. Having your resident leaders speak with their co-residents

2. Determine your budget. You may be able to put together a curriculum for relatively little money, depending on your local resources, but this will require more groundwork. Alternatively, you could hire a consulting firm to do all the planning.

3. Identify existing resources and their costs.                                                                                                                                                                                                                 

• 󠄀 existing GME curricula at your institution
• 󠄀 leaders at your institution
  • Department Chair
  • Program Director
  • Hospital or Health System CEO
  • Hospital CMO
  • Dean of medical school
• 󠄀 faculty at a local business school. You may use/adapt our outreach email.
• 󠄀 books
  • The One Minute Manager, Ken Blanchard and Spencer Johnson
  •  The Fearless Organization, Amy Edmondson
  •  Total Leadership, Stewart Friedman
  • Team of Teams, Gen. Stanley McChrystal
  • Radical Candor, Kim Scott
  • An Everyone Culture, Robert Kegan
  • Start with Why, Simon Sinek
  • No Ego, Cy Wakeman
  • 5 Voices, Jeremie Kubicek and Steve Cockram
• 󠄀 consulting companies
  • GiANT Corporation https://www.giantworldwide.com/consulting (e.g., used by St. Joseph’s)                                                                                                                                          

Step 2: Determine the format of your curriculum.

1.Determine your target audience. Options include any or all of the following: 

•  interns and junior residents: will have years to reflect on and practice these skills (e.g., St. Joseph’s)
•  senior residents: will have imminent need for these skills (e.g., Brigham & Women’s, St. Joseph’s)
• 󠄀 lab residents: will have more time to take these courses seriously (e.g., Leadership Development Course at University of Michigan)
• 󠄀 select residents, by application: will be pre-selected for success by interest/motivation (e.g., Leadership Development Course at University of Michigan)
• 󠄀 faculty: allows residents and faculty to learn a common language and share a mental model of team dynamics (e.g., St Joseph’s, University of Michigan Leadership Development Course)

2. Determine the time course.

1. A single, intensive day: At Brigham and Women’s Hospital, there is a dedicated Leadership Retreat for all of the chief residents prior to starting their final year of residency. Sample agendas from 2016 and 2019, and introductory slides are available.
2. A series of sessions spread throughout the academic year:
   1. At University of Michigan, there are 2 options:
      1. The Leadership Development Course that meets for 8 full days over the course of the year; this is primarily available for residents in their academic development/research years.
      2. Leadership lectures, each 1 hour in length, incorporated into the resident didactic schedule 4 times a year. These lectures are intended to be the introduction to the full Leadership Development Course, and are available for all residents.
   2. St. Joseph’s hired a consulting company which runs six 1-hour sessions over the course of the year, which are based on the 5 Voices book. After each, homework is assigned. 
      

3. Determine the content. 

1. Consider conducting a needs assessment with your residents to determine what topics may be of particular interest and relevance that year. 
2. Sample topics for junior and senior residents include: 
   1. Providing Feedback to Colleagues and Peers
   2. Leading Up
   3. Teaching
   4. Conflict Management
3. Sample topics for rising chief residents include: 
   1. Psychological Safety
   2. Leading your Team
   3. Leadership Style
4. Other potential topics include:
   • Emotional Intelligence
   • Empathy 
   • Program Culture
   • Strategy 
   • Finances 
   • Innovation
   • Communication Skills
   • Purpose in Work
5. Sample agendas are available for:
   • Brigham & Women’s
   • St. Joseph’s, which is a modification of the GiANT Corporation Transforming Team Communication Workshops described here.
6. University of Michigan is willing to share more details about their curriculum through directed outreach. Please contact Dr. Dossett

Step 3: Identify and outfit a space, and purchase materials.                                                                                          

1. Identify a space large enough to comfortably fit all of your intended participants. Ideally, this room should have AV capability, as well as chairs and tables for group-based discussion. The Brigham holds their Leadership Retreat in the C suite of the hospital to communicate that the leadership recognizes the importance of instilling leadership in the residents, and that it takes this aspect of residents’ development seriously and encourages residents to do the same.   

2. Purchase course materials (e.g., books listed above, online resources).

3. Bonus items for consideration: snacks, drinks, program-branded swag.

Step 4: Follow-Up                                                                                                                                                             

1. Maintain ongoing communication with residents regarding effectiveness of curriculum. Consider an exit survey.

    a. St. Joseph’s uses their MyEvaluations system to coordinate an evaluation at the end of the curriculum, which is then discussed by their Program Evaluation Committee

2. Consider revising curriculum based upon feedback.

Helpful Resources                                                                                                                                  

Webinars                                                                                                                                                                                                                                                                    Webinar recording available here                                                                                                                                                                                                                                   

Coaches/Successful Implementations                                                                                                                                                                                                                         

                                                                                                                                                                                                                  St. Joseph’s Hospital                                                                                                                                                                                                                                                  Coach: PD: Jason Johnson, DO, FACS, FASMBS                                                                                                                                                                                                              

                                                                                                                                         

Brigham and Women’s Hospital                                                                                                                                                                                                                                 Coach: PD: Douglas Smink, MD, MPH                                                                                                                                                                                                                            

                                                                                                                                                                                                                   University of Michigan                                                                                                                                                                                                                                                Coach: Vice Chair, Faculty Life: Lesly Dossett, MD, MPH                                                                                                                                                                                                 

References                                                                                                                                             

1. Hill, D.A., Jimenez, J.C., Cohn, S.M., and Price, M.R. How to be a Leader: A Course for Residents. Cureus 2018;10(7):e3067. 

2. Herzberg, S., Hansen, M., Schoonover A., et al. Association between measured teamwork and medical errors: an observational study of prehospital care in the USA. BMJ Open 2019; 9(10):e025314. 

3. Schmutz, J.B., Meier, L.L., Manser, T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open 2019;9(9):e028280

4. Doumouras, A.G., Hamidi, M., Lung, K, et al. Non-technical skills of surgeons and anaesthetitists in simulated operating theatre crises.  Br J Surg 2017;104(8):1028-1036. 

5. Davis, W.A., Jones, S., Crowell-Kuhnberg, A.M., et al. Operative team communication during simulated emergencies: Too busy to respond? Surgery 2017;161(5):1348-1356. 

6. Kissane-Lee, N.A., Yule, S., Pozner, C.N., and Smink, D.S. Attending Surgeons’ Leadership Style in the Operating Room: Comparing Junior Residents’ Experiences and Preferences. J Surg Educ 2016;73(1):40-44. 

7. Kuo, L.E., Lee, G.S., and Morris, J.B. Addressing gaps in modern surgical training-the professional development course of residents. JAMA Surg 2019;154(2):170-171.