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On the road to becoming a responsible leader: A simulation-based training approach for final year medical students.

ABSTRACT: Background and objective: There is a need for young physicians to take a responsible role in clinical teams, comparable to a leadership role. However, today's medical curricula barely consider the development of leadership competencies. Acquisition of leadership skills are currently a by-product of medical education, even though it seems to be a competency relevant for physicians' success. Therefore, an innovative leadership training program for young physicians was developed and validated. Training conceptualisation were based upon findings of critical incidents interviews (N=19) with relevant personnel (e.g. experienced doctors/nurses, residents) and upon evidence-based leadership contents focusing on ethical leadership behaviors. Method: The training consists of four sessions (3-4 hours each) and provided evidence-based lectures of leadership theory and effective leader behaviors, interactive training elements and a simulation-based approach with professional role players focusing on interprofessional collaboration with care staff. Training evaluation was assessed twice after completion of the program (N=37). Assessments included items from validated and approved evaluation instruments regarding diverse learning outcomes (satisfaction/reaction, learning, self-efficacy, and application/transfer) and transfer indicators. Furthermore, training success predictors were assessed based on stepwise regression analysis. In addition, long-term trainings effects and behavioral changes were analysed. Results: Various learning outcomes are achieved (self-reported training satisfaction, usefulness of the content and learning effects) and results show substantial transfer effects of the training contents and a strengthened awareness for the leadership role (e.g. self-confidence, ideas dealing with work-related problems in a role as responsible physician). We identified competence of trainer, training of applied tools, awareness of job expectations, and the opportunity to learn from experiences of other participants as predictors of training success. Additionally, we found long-term training effects and participants reported an increase in specific competencies, relevant for effective interprofessional collaboration (active perspective-taking, communication, conflict management, personal competencies). Conclusion: The training of leadership competencies for young physicians seems feasible to develop constructive influence strategies for a successful interprofessional collaboration in early career stages. The simulation-based approach is beneficial for residents to practice leadership behaviour in realistic job situations.

SUBMITTER: Schmidt-Huber M

PROVIDER: S-EPMC5569988 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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On the road to becoming a responsible leader: A simulation-based training approach for final year medical students.

Schmidt-Huber Marion M Netzel Janine J Kiesewetter Jan J

GMS journal for medical education 20170815 3

<b>Background and objective:</b> There is a need for young physicians to take a responsible role in clinical teams, comparable to a leadership role. However, today's medical curricula barely consider the development of leadership competencies. Acquisition of leadership skills are currently a by-product of medical education, even though it seems to be a competency relevant for physicians' success. Therefore, an innovative leadership training program for young physicians was developed and validate ...[more]

PMID: 28890925

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Project description:Aim: In the final (practical) year (PY), students have the opportunity to become familiar with their potential future place of work. At the same time, university hospitals and teaching hospitals compete to recruit the best junior staff from this pool. The aim of this study is to present students' selection criteria for the location of the final year in detail. Methods: On the formal evaluation of the final year at the Mannheim Medical Faculty, students were asked after each training period which reasons led to the selection of the location. Thirty-one subcategories were formed from the free-text responses, sorted according to their controllability and then grouped into 11 main categories. The Mannheim University Hospital introduced an expense allowance in November 2015. The data from the period before and after its introduction, the reasons given for choosing the location for the compulsory and elective subjects, and the reasons given for choosing a teaching hospital or university hospital were evaluated and compared separately. Results: A total of 1,164 questionnaires were evaluated from the period before the introduction of the expense allowance, and 1,120 questionnaires were evaluated from the period after the introduction. Overall, Proximity (19%), Financial incentives (18%) and Subject (18%) were the most frequently cited reasons. The Financial incentives subcategory was the most frequent in period 1 (32%), but lost relevance in period 2 (6%). In contrast, Recommendation gained in importance (from 8% to 15%). A comparison of the lead categories shows that teaching hospitals benefit more from their public image and university hospitals more from the subjects they offer. Conclusion: Students primarily choose the location for their final year for pragmatic reasons, such as Incentives and Living environment, but the Public image of the hospitals also plays a significant role. The frequency of the reasons given differs between compulsory and elective subjects, as well as between university hospitals and teaching hospitals. The results can help to improve the attractiveness of the location in a targeted manner and to present a specific image to the public.

Project description:BackgroundDiscrimination due to gender and ethnicity has been found to be widespread in medicine and healthcare. Swedish and European legislation list seven discrimination grounds (age, sex, ethnicity, religion, sexuality, non-binary gender identity, and disability) which may intersect with each other; yet these have only been sparsely researched. The aim of this study was to assess the extent of discrimination, based on these seven discrimination grounds, amongst final-year medical students in Sweden.MethodsA web-based survey, based on the CHERRIES-checklist, was disseminated to course coordinators and program directors in charge of final year medical students at all seven medical schools in Sweden. Quantitative data were analyzed using descriptive statistics, Fisher's exact test, and logistic regression. Free-text answers were analyzed thematically using the "Master Suppression techniques" conceptual framework.ResultsOf the 1298 medical students contacted, 247 (19%) took part in the survey. Almost half (n = 103, 42%) had experienced some form of discrimination, and this difference was statistically significant by gender (p = 0.012), self-perceived ethnicity (p < 0.001), country of birth other than Scandinavia (p < 0.001) and visible religious signs (p = 0.037). The most common type of discrimination was gender-based (in 83% of students who had experienced discrimination), followed by age (48%), and ethnicity (42%). In the logistic regression, women/non-binary gender (p = 0.001, OR 2.44 [95% CI 1.41-4.22]), country of birth not in Scandinavia (p < 0.001, OR 8.05 [2.69-24.03]), non-Caucasian ethnicity (p = 0.04, OR 2.70 [1.39-5.27]), and disability (p = 0.02, OR 13.8 [1.58-12040]) were independently associated with discrimination. Half of those who had experienced religion-based discrimination and nearly one-third of victims of ethnicity-based discrimination reported "large" or "extreme" impact of this. Clinical staff or supervisors were the most common offenders (34%), closely followed by patients and their relatives (30%), with non-Caucasian respondents significantly more likely to experience discrimination by patients (p < 0.001).ConclusionsDiscrimination appears to be frequent in medical school, even in one of the world's "most equal countries". Discrimination is most commonly gender- or ethnicity-based, with ethnicity- and religion-based discrimination appearing to have the largest impact. Future research should continue to evaluate discrimination from an intersectional perspective, adapted for local contexts and legislations.

Project description:BackgroundUndergraduate medical education is supposed to equip medical students with basic competences to select any specialty of their choice for postgraduate training. Medical specialties are characterized by a great diversity of their daily work routines and require different sets of competence facets. This study examines the self-assessed competence profiles of final-year undergraduate medical students and their specialty choice for postgraduate training. Students' profiles, who wish to choose anaesthesiology, internal medicine, or paediatrics, are compared with the physicians' competence profiles from these three disciplines.MethodsIn this study, 148 volunteer final-year undergraduate medical students completed the modified requirement-tracking (R-Track) questionnaire for self-assessment of their competence profiles. The R-Track questionnaire contains 63 competence facets assigned to six areas of competence: "Mental abilities", "Sensory abilities", "Psychomotor & multitasking abilities", "Social interactive competences", "Motivation", and "Personality traits". The expression of the different competence facets had to be assessed on a 5-point Likert scale (1: "very low" to 5: "very high"). Additionally, socio-demographic data and the participants' first choice of a medical speciality for postgraduate education were collected. We used analysis of variance (ANOVA) for mean score comparison of subgroups and least significant difference (LSD) tests for post hoc analysis.ResultsThe competence area with the highest rating was "Motivation" (3.70 ± 0.47) while "Psychomotor & multitasking abilities" received the lowest rating (3.34 ± 0.68). Individual facets of competence ranked from "In need of harmony" (4.36 ± 0.72), followed by "Tactfulness" (4.26 ± 0.64), and "Cooperation/Agreeableness" (4.24 ± 0.53) to "Risk orientation" (2.90 ± 0.92), "Mathematical reasoning" (2.87 ± 1.25), and "Sanctioning" (2.26 ± 0.93). The students' competence profiles showed 100 % congruence with physicians' competence profiles of the postgraduate specialty of their choice for internal medicine, 33.3 % for paediatrics, and 0 % for anaesthesiology.ConclusionsUndergraduate medical students could define their competence profiles with the modified R-Track questionnaire and compare them with the profile of their desired specialty for postgraduate training to discover possible learning gaps or to detect good specialty matches. A combination of students' competence self-assessment with an external assessment of students' facets of competence could provide curricular planners with useful information how to design learning opportunities for specific facets of competence.

Project description:BackgroundFinal-year undergraduate medical students often do not feel well prepared for their start of residency training. Self-assessment of competences is important so that medical trainees can take responsibility for their learning. In this study, we investigated how final-year medical students self-assessed their competences as they neared their transition to postgraduate training. The aim was to identify areas for improvement in undergraduate training.MethodsIn the academic year 2019/2020, a national online survey was sent to final-year undergraduate medical students via their respective medical schools. The survey included ten facets of competence (FOC) most relevant for beginning residents. The participants were asked to self-assess their competence for each FOC on a 5-point Likert scale (1: strongly disagree to 5: strongly agree). We established an order of self-assessed FOC performance by means and calculated paired t-tests. Gender differences were assessed with independent t-tests.ResultsA total of 1083 students from 35 medical schools completed the questionnaire. Mean age was 27.2 ± 3.1 years and 65.8% were female. Students rated their performance highest in the FOCs 'Teamwork and collegiality' and 'Empathy and openness' (97.1 and 95.0% 'strongly agree' or 'agree', respectively) and lowest in 'Verbal communication with colleagues and supervisors' and 'Scientifically and empirically grounded method of working' (22.8 and 40.2% 'strongly disagree', 'disagree', or 'neither agree nor disagree', respectively). Women rated their performance of 'Teamwork and collegiality', 'Empathy and openness', and 'Knowing and maintaining own personal bounds and possibilities' significantly higher than men did (Cohen's d > .2), while men showed higher self-assessed performance in 'Scientifically and empirically grounded method of working' than women (Cohen's d = .38). The FOCs 'Responsibility', 'Knowing and maintaining own personal bounds and possibilities', 'Structure, work planning, and priorities', 'Coping with mistakes', and 'Scientifically and empirically grounded method of working' revealed lower self-assessed performance than the order of FOC relevance established by physicians for beginning residents.ConclusionsThe differences between the level of students' self-assessed FOC performance and physicians' ranking of FOC relevance revealed areas for improvement in undergraduate medical education related to health system sciences. Final-year students might benefit from additional or better training in management skills, professionalism, and evidence-based medicine. Surveys of self-assessed competences may be useful to monitor competence development during undergraduate training.

Project description:BackgroundThe medical specialities chosen by doctors for their careers play an important part in the workforce planning of health-care services. However, there is little theoretical understanding of how different medical specialities are perceived or how choices are made, despite there being much work in general on this topic in occupational psychology, which is influenced by Holland's RIASEC (Realistic-Investigative-Artistic-Social-Enterprising-Conventional) typology of careers, and Gottfredson's model of circumscription and compromise. In this study, we use three large-scale cohorts of medical students to produce maps of medical careers.MethodsInformation on between 24 and 28 specialities was collected in three UK cohorts of medical students (1981, 1986 and 1991 entry), in applicants (1981 and 1986 cohorts, N = 1135 and 2032) or entrants (1991 cohort, N = 2973) and in final-year students (N = 330, 376, and 1437). Mapping used Individual Differences Scaling (INDSCAL) on sub-groups broken down by age and sex. The method was validated in a population sample using a full range of careers, and demonstrating that the RIASEC structure could be extracted.ResultsMedical specialities in each cohort, at application and in the final-year, were well represented by a two-dimensional space. The representations showed a close similarity to Holland's RIASEC typology, with the main orthogonal dimensions appearing similar to Prediger's derived orthogonal dimensions of 'Things-People' and 'Data-Ideas'.ConclusionsThere are close parallels between Holland's general typology of careers, and the structure we have found in medical careers. Medical specialities typical of Holland's six RIASEC categories are Surgery (Realistic), Hospital Medicine (Investigative), Psychiatry (Artistic), Public Health (Social), Administrative Medicine (Enterprising), and Laboratory Medicine (Conventional). The homology between medical careers and RIASEC may mean that the map can be used as the basis for understanding career choice, and for providing career counselling.

Dataset Information

On the road to becoming a responsible leader: A simulation-based training approach for final year medical students.

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On the road to becoming a responsible leader: A simulation-based training approach for final year medical students.

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