We are all leaders! Health care professionals, whether nurses, pharmacists, physicians, physical therapists, or others, are all leaders at different times. Health care is complex, and all of us must be humble enough to recognize that there are times when we should let someone else lead. While not all of us will take on formal leadership roles such as deans, department chiefs, or program directors, all of us will lead in some capacity. We will, at a minimum, lead our own clinical teams and, of course, our patients. Despite the fact that we are all going to be leaders, there remains a paucity of education dedicated to leadership development for entry level positions and, in particular, graduate medical education. While there are resources for those assuming titled leadership positions, for many who are leading on a daily basis there is a gap in leadership training. Moreover, we should not wait until people are put in positions of leadership to develop their leadership skills. This so-called accidental leadership (the leadership skills we learn simply by taking part in our jobs) development model needs to change.
We need to be as explicit about leadership training as we are about our clinical training. Only when we combine strong foundational clinical skills with leadership skills will we be able to implement the changes that are desperately needed in our healthcare system. I came to Harvard Macy nearly 4 years ago aiming to develop a leadership program for Graduate Medical Education (GME) Trainees and other junior allied health professions. My team and I have learned a lot since that time and continue to work to hone leadership training at Walter Reed and now across the United States Army.
First, we reviewed the literature for GME leadership programs and recognized that there is much work to be done in this area (Sadowski et al., forthcoming, JGME). Second, we conducted a needs assessment of all the physicians at Walter Reed National Military Medical Center to determine what should be taught and how. From there, we were able to develop a curriculum for our hospital, which I brought as my project to three Harvard Macy Courses (multiple project groups had input!). We developed guiding principles based on Tom Aretz’s sessions from the Program for Educators in Health Professions course and every speaker was given these principles as well as a handout outlining best practices for developing each lesson. The speakers were introduced to both Kolb’s learning cycle and Adult Learning Theory and asked to develop talks that would take learners through each of the 4 steps. This allowed us to develop talks that were educationally sound and interactive, modeled after Harvard Macy. We ultimately created 8 lessons on leadership that would be delivered on a recurring basis, such that over the course of a resident’s training they should be able to attend all 8 sessions. We invited junior nurses and other allied health professionals to ensure we considered a wide range of voices and experiences.
The initial curriculum was implemented successfully and the Army Medical Department asked us to expand the program Army wide. We went back to work addressing areas we originally omitted (resiliency and toxic or counter-productive leadership). We ultimately had a year-long curriculum with 12 sessions still following the initial speaker guidelines and guiding principles. We created facilitator guides so that speakers across the Army would be able to implement the material. The program went live as of 1 June 2017 and multiple sites across the Army have implemented part or all of the curriculum. We are excited about where we are at, but recognize that much work is still to be done. Below are a few pieces of advice cultivated from my experience for those of you considering developing a curriculum or teaching about leadership.
Build a Leadership Team
This project involved multiple faculty who were part of the design process and selected to deliver the talks. Brian Clyne from Brown University was my first project group leader at Harvard Macy and is still an important collaborator. Colonel retired David Bitterman from the Army Medical Department Center and School helped design the Army materials and served as our web master. Don’t limit your team to your institution and make it interprofessional and interdisciplinary.
Don’t Try to Teach Everything
There are so many topics that could be taught (see our forthcoming JGME paper)! However, most of the literature continues to cycle back to the same few core topics. We would recommend starting with including leadership styles, emotional intelligence, building effective teams, and management skills.
Use Interactive Teaching Methods
There are a variety of ways to teach leadership, but small group discussion, case-studies, and project work seem to be the most effective. Teaching leadership explicitly during projects is a win-win as learners are more likely to effectively complete their project and they can learn leadership at the same time.
Integrate with current curriculum
There are already many places in your curriculum that could be incorporated into your leadership curriculum. While knowledge about leadership principles is important, ultimately leadership is about performance and action. Daily rounds offer an opportunity to talk about leadership styles, emotional intelligence, and communication. If your learners are involved in projects these are a rich opportunity to provide feedback on leadership.
While developing a formal curriculum can take time, here are three steps you can take now:
- Label it Leadership: Be explicit about leadership when providing feedback to trainees in their everyday activities. We are missing many opportunities that already exist to teach leadership. “I really liked your leadership when you delegated to the intern to go see the patient in the emergency room.” “You demonstrated outstanding leadership on rounds today by bringing in the nurses and pharmacist to ensure the proper care of Mrs. Smith.” Bring up leadership during conferences and point out examples of excellent leadership.
- Leadership Book or Journal Club: Start a formal or informal leadership journal or book club. Read a leadership book/article and talk about how it applies to health care in small groups followed by a large group discussion/wrap-up. We have done this for 3 years at Walter Reed and I am happy to discuss books and how we organized.
- Mentor: When mentoring be sure to talk leadership. Think about strengths and weaknesses and help mentees develop their leadership skills. What leadership skills do trainees need now – and what will be needed as they move forward in their careers?
Harvard Macy is a leader incubator so hopefully this blog post fuels your desire and provides a few ideas. I leave you with these three questions:
What are you doing to develop your leadership skills?
What are you doing to develop leaders at your institution?
What are you waiting for?
If you are already developing leaders in some way, please reach out to me or post your best practices below so we can all learn together!
References
- Frich JC, Brewster AL, Cherlin EJ, Bradley EH. Leadership development programs for physicians: A systematic review. J Gen Intern Med. 2015;30(5):656-674.
- Steinert Y, Naismith L, Mann K. Faculty development initiatives designed to promote leadership
in medical education. A BEME systematic review: BEME Guide No. 19. Med Teach. 2012;34(6):483-503.
- Ackerly DC, Sangvai DG, Udayakumar K, et al. Training the next generation of physician executives: an
innovative residency pathway in management and leadership. Acad Med. 2011;86(5):575-579.
- Hartzell JD, Yu CE, Cohee B, Nelson M, Wilson R. Moving Beyond Accidental Leadership: A Graduate Medical Education Leadership Curriculum Needs Assessment. Mil Med 2017; 182(7): e1815–e1822.
- Sadowski B, Cantrell S, Barelski A, O'Malley PG, Hartzell JD. Leadership Training in Graduate Medical Education: A Systematic Review. J Grad Med Educ. 2018 Apr;10(2):134-148.
- Armstrong E and Parsa-Parsi R. How can physicians' learning styles drive educational planning? Acad Med. 2005; 80:680–684.
Joshua Hartzell
Josh Hartzell, MD, MS-HPEd, FACP, FIDSA (Educators ’15, Leaders ’15, Assessment ’16) is United States Army Lieutenant Colonel and currently serves as the Assistant Dean for Faculty Development and Director of Internal Medicine Selectives at the Uniformed Services University – “America’s Medical School.” He is dedicated to developing others’ careers and creating leaders to solve problems related to health care delivery and education. You can follow him on Twitter @joshuadhartzell or email him at Joshua.d.hartzell.mil@mail.mil
Disclaimers: The opinions or assertions contained herein are the private ones of the author and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government