General Internists as Change Agents: Opportunities and Barriers to Leadership in Health Systems and Medical Education Transformation.
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ABSTRACT:
SUBMITTER: Gonzalo JD
PROVIDER: S-EPMC7280380 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveThe purpose of this study was to determine self-reported knowledge, attitudes, prior experience, and perceived needs for the management of overweight and obese patients within a General Internal Medicine Practice.Patients and methodsAn emailed cross-sectional survey was sent between June 20, 2019 and September 12, 2019 to 194 healthcare workers (93 primary care providers (PCPs) and 101 nurses) which focused on management of patients with weight issues.ResultsIn total, 80 of the eligible 194 participants completed the survey (nurses = 42, PCPs = 38). Up to 87% were white, 74.7% female (74.7%). Most of the responders were either in the age group of 30's (30%) or 50's (30%). Among the responders, 48.8% reported some type of specialty training in weight management since their medical training with lectures being the most common form of training (36%). When asked about their interest in either weight management training or strategies to initiate weight conversations, 79% of the respondents reported an interest in education on weight management or strategies to initiate weight conversations, while 65.8% indicated they would be interested in both topics.ConclusionOur study suggests that healthcare workers have a self-reported need for further training in management of overweight and obese patients, irrespective of previous training in this area.
| S-EPMC8114257 | biostudies-literature
Project description:BackgroundEffective team performance is essential in the delivery of high-quality health-care. Leadership skills therefore are an important part of physicians' everyday clinical life. To date, the development of leadership skills are underrepresented in medical curricula. Appropriate training methods for equipping doctors with these leadership skills are highly desirable.ObjectiveThe review aims to summarize the findings in the current literature regarding training in leadership skills in medicine and tries to integrate the findings to guide future research and training development.MethodThe PubMED, ERIC, and PsycArticles, PsycINFO, PSYNDEX and Academic search complete of EBSCOhost were searched for training of leadership skills in medicine in German and English. Relevant articles were identified and findings were integrated and consolidated regarding the leadership principles, target group of training and number of participants, temporal resources of the training, training content and methods, the evaluation design and trainings effects.ResultsEight studies met all inclusion criteria and no exclusion criteria. The range of training programs is very broad and leadership skill components are diverse. Training designs implied theoretical reflections of leadership phenomena as well as discussions of case studies from practice. The duration of training ranged from several hours to years. Reactions of participants to trainings were positive, yet no behavioral changes through training were examined.ConclusionsMore research is needed to understand the factors critical to success in the development of leadership skills in medical education and to adapt goal-oriented training methods. Requirements analysis might help to gain knowledge about the nature of leadership skills in medicine. The authors propose a stronger focus on behavioral training methods like simulation-based training for leadership skills in medical education.
| S-EPMC3839077 | biostudies-literature
Project description:Background Continuous medical education is essential for the individual patient care, the society, and the wellbeing of the general practitioner. There has been research into the reasons for participation in continuous medical education, but little is known about the barriers to participation. To tailor continuous medical education targeting general practitioners who are currently deselecting education, systematic knowledge of the barriers is needed. Continuous medical education can in addition to professional growth stimulate job satisfaction, diminish burnout, and reinforce feelings of competence. Continuous medical education may have positive implications for patients and for healthcare expenditures. Despite renumeration and a comprehensive continuous education model some Danish general practitioners do not participate in continuous medical education. Methods From a total of 3440 Danish general practitioners 243 did not apply for reimbursement for accredited continuous medical education in a two-year period. Ten general practitioners were selected for an interview regarding maximum variation in practice form, number of listed patients, seniority as a general practitioner, geography, gender, and age. All ten selected general practitioners accepted to be interviewed. The interviews were analysed using Systematic Text Condensation. Results Each of the ten interviewed general practitioners mentioned several barriers for participating in continuous education. The barriers fell into three main categories: barriers related to the individual general practitioner barriers related to the clinic barriers related to the accredited continuous medical education offered Conclusions Approximately 7% of the Danish general practitioners did not participate in accredited remunerated continuous medical education. A knowledge of the barriers for participating in accredited continuous medical education can be used to better target continuous medical education to the general practitioners. Supplementary Information The online version contains supplementary material available at 10.1186/s12909-023-04432-9.
| S-EPMC10278246 | biostudies-literature
Project description:Background?:Leadership is a critical component of physician competence, yet the best approaches for developing leadership skills for physicians in training remain undefined. Objective?:We systematically reviewed the literature on existing leadership curricula in graduate medical education (GME) to inform leadership program development. Methods?:Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we searched MEDLINE, ERIC, EMBASE, and MedEdPORTAL through October 2015 using search terms to capture GME leadership curricula. Abstracts were reviewed for relevance, and included studies were retrieved for full-text analysis. Article quality was assessed using the Best Evidence in Medical Education (BEME) index. Results?:A total of 3413 articles met the search criteria, and 52 were included in the analysis. Article quality was low, with 21% (11 of 52) having a BEME score of 4 or 5. Primary care specialties were the most represented (58%, 30 of 52). The majority of programs were open to all residents (81%, 42 of 52). Projects and use of mentors or coaches were components of 46% and 48% of curricula, respectively. Only 40% (21 of 52) were longitudinal throughout training. The most frequent pedagogic methods were lectures, small group activities, and cases. Common topics included teamwork, leadership models, and change management. Evaluation focused on learner satisfaction and self-assessed knowledge. Longitudinal programs were more likely to be successful. Conclusions?:GME leadership curricula are heterogeneous and limited in effectiveness. Small group teaching, project-based learning, mentoring, and coaching were more frequently used in higher-quality studies.
| S-EPMC5901791 | biostudies-literature
Project description:The purpose of this scoping review is to fill the gap in understanding the current status of intervention-based studies regarding leadership training in undergraduate medical education. As of late, there is an increased focus on the role of physicians as leaders in their fields, and communities. In order to evaluate these studies, both the PubMed and ERIC databases were searched, and an ultimate total of 35 articles methodologies were evaluated for their general methodology, curricular content, specific teaching methods, and evaluation methodologies. There were a number of trends identified, as well as remaining gaps.Supplementary informationThe online version contains supplementary material available at 10.1007/s40670-021-01308-9.
| S-EPMC8131083 | biostudies-literature
Project description:BACKGROUND:With the increasing recognition that leadership skills can be acquired, there is a heightened focus on incorporating leadership training as a part of graduate medical education. However, there is considerable lack of agreement regarding how to facilitate acquisition of these skills to resident, chief resident, and fellow physicians. METHODS:Articles were identified through a search of Ovid MEDLINE, EMBASE, CINAHL, ERIC, PsycNet, Cochrane Systemic Reviews, and Cochrane Central Register of Controlled Trials from 1948 to 2019. Additional sources were identified through contacting authors and scanning references. We included articles that described and evaluated leadership training programs in the United States and Canada. Methodological quality was assessed via the MERSQI (Medical Education Research Study Quality Instrument). RESULTS:Fifteen studies, which collectively included 639 residents, chief residents, and fellows, met the eligibility criteria. The format, content, and duration of these programs varied considerably. The majority focused on conflict management, interpersonal skills, and stress management. Twelve were prospective case series and three were retrospective. Seven used pre- and post-test surveys, while seven used course evaluations. Only three had follow-up evaluations after 6 months to 1 year. MERSQI scores ranged from 6 to 9. CONCLUSIONS:Despite interest in incorporating structured leadership training into graduate medical education curricula, there is a lack of methodologically rigorous studies evaluating its effectiveness. High-quality well-designed studies, focusing particularly on the validity of content, internal structure, and relationship to other variables, are required in order to determine if these programs have a lasting effect on the acquisition of leadership skills.
| S-EPMC7268469 | biostudies-literature
Project description:To identify and empirically investigate the dimensions of leadership in medical education and healthcare professions.A population-based design with a focus group and a survey were used to identify the perceived competencies for effective leadership in medical education.The focus group, consisting of five experts from three countries (Austria n=1; Germany n=2; Switzerland n=2), was conducted (all masters of medical education), and the survey was sent to health professionals from medical schools and teaching hospitals in six countries (Austria, Canada, Germany, Switzerland, the UK and the USA).The participants were educators, physicians, nurses and other health professionals who held academic positions in medical education. A total of 229 completed the survey: 135 (59.0%) women (mean age=50.3 years) and 94 (41.0%) men (mean age=51.0 years).A 63-item survey measuring leadership competencies was developed and administered via electronic mail to participants.Exploratory principal component analyses yielded five factors accounting for 51.2% of the variance: (1) social responsibility, (2) innovation, (3) self-management, (4) task management and (5) justice orientation. There were significant differences between physicians and other health professionals on some factors (Wilk's ?=0.93, p<0.01). Social responsibility was rated higher by other health professionals (M=71.09) than by physicians (M=67.12), as was innovation (health professionals M=80.83; physicians M=76.20) and justice orientation (health professionals M=21.27; physicians M=20.46).The results of the principal component analyses support the theoretical meaningfulness of these factors, their coherence, internal consistency and parsimony in explaining the variance of the data. Although there are some between-group differences, the competencies appear to be stable and coherent.
| S-EPMC3323822 | biostudies-other
Project description:The COVID-19 pandemic has reinforced Germany's role as global health player, but the education system is lagging behind and does not adequately prepare health professionals for the new challenges. This study aims to strengthen global health in undergraduate medical education in Germany. Major objectives include: to review the current situation, explore changing demand for global health and introduce innovative teaching models and the drivers for change. Mixed methods and an explorative approach were applied, comprising a scoping review, online surveys carried out at Hanover Medical School, March/April 2020. Target groups were undergraduate medical students (n = 384) and additionally lecturers (n = 172), and finally new multiprofessional teaching courses initiated by students and developed collaboratively. The results reveal only slow pace of change on the level of the education system, while demand for global health education has increased markedly in all actor groups, but strongest in the group of students in the preclinical phase. Implementation of global health programmes illustrates how students can become change agents and enhance institutional innovation bottom-up. However, in order to achieve wider transformative potential, these efforts must be flanked by macro-level policy changes and integrated in future pandemic preparedness strategies.
| S-EPMC8207038 | biostudies-literature
Project description:IntroductionDesign thinking is a creative problem-solving framework that can be used to better understand challenges and generate solutions in health professions education, such as the barriers to rural education. Rural education experiences can benefit students, providers, and patients; however, placement in and maintenance of rural education experiences offer unique challenges. Design thinking offers strategies to explore and address these challenges.MethodsThis study used a design thinking framework to identify barriers of student placement in rural locations; this was accomplished using strategies to empathize with users (eg, students, practitioners, and administrators) and define the problem. Data were collected from focus groups, interviews, and a design thinking workshop. Design activities promoted participant discussion by drawing pictures, discussing findings, and creating empathy maps of student experiences. Qualitative data were analyzed to identify salient barriers to rural experience selection and opportunities for support.ResultFocus group (n = 6), interview (n = 13), and workshop participants (n = 18) identified substantial advantages (eg, exposure to a wider variety of patients, less bureaucracy and constraints, more time with faculty) and disadvantages (eg, isolation, lack of housing, and commuting distances) of rural experiences. Participants identified physical, emotional, and social isolation as a significant barrier to student interest in and engagement in rural experiences. Workshop participants were able to generate over 100 ideas to address the most prominent theme of isolation.DiscussionDesign thinking strategies can be used to explore health professions education challenges, such as placement in rural settings. Through engagement with students, practitioners, and administrators it was identified that physical, social, and emotional isolation presents a significant barrier to student placement in rural experiences. This perspective can inform support systems for students, preceptors, and communities that participate in rural educational experiences.
| S-EPMC7890746 | biostudies-literature
Project description:IntroductionExposing trainees to roles within medical school offices is an important, but often overlooked, component of academic medicine career development. This module described the roles and responsibilities of staff within the Office of Student Affairs (OSA) and opportunities for trainees to become engaged, lead, and develop student affairs-related competencies.MethodsThe 90-minute workshop was presented at three regional conferences at US medical schools between September and December 2019. Participants were medical students, residents, and fellows from multiple institutions. The workshop consisted of a didactic portion describing OSA responsibilities and guiding principles, reflection exercises to gauge learners' engagement with the OSA, and case discussions on how trainees have led scholarly student affairs-related projects.ResultsAmong 28 participants, over 90%, agreed that each of the workshop objectives was met. Using the Wilcoxon signed-rank test, there was a statistically significant increase (p < .001) in participants' confidence to "list skills to be an effective advisor in the OSA," and, "Advocate for student issues through the OSA."DiscussionTrainees not only have the opportunity to access services through the OSA, but also serve and develop foundational competencies to eventually serve in an OSA leadership position. This workshop provided trainees early exposure to OSA administration to realize a career in academic medicine beyond the faculty role.
| S-EPMC7880253 | biostudies-literature