PEDIATRICS Vol. 115 No. 3 March 2005, pp. 765-773 (doi:10.1542/peds.2004-1223)
SPECIAL ARTICLE |
Training Young Pediatricians as Leaders for the 21st Century
* Child and Adolescent Services Research Center, Children’s Hospital, San Diego, California
Private Practice, Marlborough, Massachusetts
Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana
|| Division of Continuing Medical Education, American Academy of Pediatrics, Elk Grove Village, Illinois
¶ Department of Cardiology, Rainbow Babies and Children’s Hospital/Case Western Reserve University, Cleveland, Ohio
# Membership, American Academy of Pediatrics, Elk Grove Village, Illinois
 |
ABSTRACT |
|---|
 TOP ABSTRACT METHODSRESULTSDISCUSSIONREFERENCES |
|---|
Objective. To conduct a needs assessment with young pediatricians who participate in a leadership training program and to evaluate the effectiveness of that program.
Methods. In concert with the Johnson & Johnson Pediatric Institute, LLC, the American Academy of Pediatrics developed a 1-year strategy to train pediatricians who are <40 years old or <5 years in practice in leadership skills. Participants were nominated by American Academy of Pediatrics chapters and/or sections and were required to complete a detailed needs assessment, attend a 3-day training program, and commit to 1 leadership-related behavior change to be implemented within 6 months. A preanalytic/postanalytic design strategy was used.
Results. A total of 56 applicants representing 33 US states participated; 44.6% were male, and more than half (51.8%) were employed at a medical school/hospital. The needs assessment indicated that participants were confident in many of their leadership qualities but desired increased training, particularly in areas of time and priority management and leading "from the middle." Postsurvey instruments (n = 54, 96% response rate) determined that participants positively evaluated the training program and improved in self-reported basic competencies; 87% also reported fully or partially achieving a leadership-related goal identified in a behavior change contract.
Conclusions. Results demonstrate that young physicians are eager for leadership training and that continuing medical education in this area can be provided with positive results. Core competencies, curriculum, and evaluative tools need to be developed further and training opportunities need to be expanded to other subpopulations of pediatricians and pediatric health care providers.
Key Words: pediatrics • leadership • leadership training • continuing medical education
Abbreviations: IOM, Institute of Medicine • PLA, Pediatric Leadership Alliance • YPL, Young Pediatric Leaders for the 21st Century Training Program • AAP, American Academy of Pediatrics • JJPI, Johnson & Johnson Pediatric Institute
The Institute of Medicine’s (IOM’s) 2001 report Crossing the Quality Chasm1 opened by stating that, although the US health care system embodies the highest levels of medical expertise and technologically advanced care, it continues to fail at meeting the minimum needs of millions of Americans. The IOM report called for a restructuring of the health care organization to serve equitably its dependents, reduce system as well as individual errors, contain costs, and ensure quality. Central to the IOM agenda for redesigning the 21st-century health care system was the need for leadership in health care.1
Most physicians are in positions of potential leadership. Reinertsen, in his article "Physicians as Leaders in the Improvement of Health Care Systems,"2 used a business-based definition of leadership, describing it as the ability to coordinate processes that begin an organization or facilitate an organization’s adaptation to changing circumstances. Whether serving in an academic medical center, working as a physician executive in a health plan or public health program, functioning as a partner in a group practice, collaborating on a community project, or advocating for effective health legislation, physicians have multiple opportunities to function as leaders in changing health care in the 21st century.
Despite these prospects, many physicians either have not taken on leadership roles or function ineffectively in those roles. Some have argued that the majority of administrative, organizational, team-building, and self-assessment skills of quality leaders are not taught in medical training programs. In fact, much of traditional medical curricula have emphasized autonomy in decision making, the individual physician-patient relationship, and hierarchical cultural processes that are counterproductive to effective leadership.3,4 In addition, although leadership development programs have been implemented in many sectors of the economy and have been accompanied by a rapid proliferation of both a scholarly evaluation and the popular inspirational literature, medicine has tended to act as though leadership were an innate characteristic and not a skill to be learned. Until recently, physicians who were interested in acquiring leadership skills training have had to search for programs in industries outside medicine.
It is only in the past decade that the medical profession has begun to recognize the need for systematic training in leadership skills.3 Programs and curriculum development have targeted specific types of physicians, for example, academicians,5–11 physician executives (www.acpe.org),12–14 public health physicians,15,16 family physicians,17–20 and women physicians.21 Modalities for leadership training have included one-on-one mentoring, workshops, externships, seminars, community service experiences, and master’s degree programs. Issues such as cost, locality, use of the Internet, and content have been widely divergent. However, aside from the few programs that culminate in certificate programs or degrees from secondary educational institutions, the status of leadership training for physicians today remains sporadic and rudimentary. Evaluation of training opportunities has also been limited; the large majority of programs are briefly described in commentary form, and few programs have received formal evaluation of specific interventions. To date, there are no formal evaluations either of the degree to which these programs encourage measurable behavior change or of the impact of these efforts on quality of care.
In this article, we describe the Pediatric Leadership Alliance’s (PLA’s) Young Pediatric Leaders for the 21st Century Training Program (YPL), a joint initiative sponsored by the American Academy of Pediatrics (AAP) and the Johnson & Johnson Pediatric Institute, LLC (JJPI), to train recently graduated pediatricians as health care leaders for the 21st century. The YPL followed established approaches for significant leadership development by fostering conceptual frameworks regarding leadership and encouraging self-assessment and personal growth, introducing topics related to systems management, and enhancing team leadership skills. We report the initial evaluative results of the program. Recognizing the need for longitudinal programs and developmental approaches for physician leadership training, we also discuss the future of the PLA and offer lessons learned that may be helpful for other organizations/branches of medicine that plan to conduct similar training.
|
METHODS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Overview: Development of the PLA
The AAP began addressing the need for formal pediatric leadership training in the mid 1990s. To generate a curriculum on leadership, the AAP sought out expertise external to the organization. The AAP had already formed the PLA, a partnership with JJPI, a subsidiary of Johnson & Johnson; the PLA’s mission was to explore and deploy cutting-edge educational technologies to advance the medical care provided to children. A proposal for formal leadership training was submitted by the AAP to the PLA, based on the premise that leadership excellence, coupled with clinical excellence, can contribute to improved quality of care and positive health system change. The concept was enthusiastically supported; not only did the PLA generate sufficient funds for the effort, but also representatives from the JJPI recruited experts from their Johnson & Johnson Consulting Group, a corporate executive leadership development program, as well as leaders in medicine and within the AAP, to create a leadership curriculum for pediatricians.
The first leadership program offered by the PLA was presented over a 12-month period from November 2000 through 2001. The program was designed for health care teams from communities, academic societies, and the AAP to come together and learn many of the skills and tools of leadership, then apply those skills to a problem specific to their institution or community. The evaluation of this first leadership program suggested strongly that a subsequent leadership program should be directed toward young pediatricians defined as those pediatricians who are <40 years old or in practice for <5 years. Those results, along with the ideas of several young pediatricians who were members of the recently developed Young Physicians’ Section at the AAP, were used to form the basis of a new proposal to apply the same program design and principles to a training program for young pediatricians.
PLA YPL
Participant Selection
In January 2002, each of the 59 US chapters of the AAP as well as the 50 surgical, medical, and multidisciplinary sections of the AAP were offered an opportunity to nominate a young pediatrician to participate in the YPL. To solidify participation and commitment to the applicant, each sponsoring chapter or section was required to pay a nominal registration fee. In addition, nominees were required to sign an agreement that they would be willing to complete a prework packet and assignments during and after the program. By the cutoff date of March 15, 2002, 65 nominations had been received, and all nominees were approved for participation in the program. Over the course of the summer of 2002, 9 nominees encountered scheduling conflicts with attending the training program, resulting in a total of 56 participants.
Curriculum Development
Curriculum development focused on 3 areas of physician organizational, management, and leadership skills and competencies described in the literature: (1) self-management skills (self-awareness, personal leadership style development, career plan, role management, and time management), (2) systems management skills (assessment of system needs and development of strategic plans), and (3) leadership competencies within the context of a team (development of a shared vision, communication of purpose, fostered collaboration, empowerment of others, and establishment of trust).8 The course curriculum drew heavily on materials from the previous PLA leadership training (2000–2001) and from the Johnson & Johnson Consulting Group. The curriculum also incorporated the perceived needs of the participants as measured by a needs assessment of participants conducted in the spring of 2002 (see "Measures" and "Results") both as content (eg, curricular topics) and as process (eg, sample case studies).
The curriculum for the YPL was finalized in the spring of 2002. The 3-day training program began with an evening event that included an overview of the meeting’s philosophy and agenda and an introduction to pediatric leaders followed by 2 full 14-hour days of didactic and small-group programming centered on the core areas of curriculum (see Table 1 for specific details). Minimal didactic sessions were offered; other modalities, shown to enhance participant interaction and provide creative opportunities to practice skills, were used, including role-playing, team projects, development of brief "infomercials," small-group discussions and reporting out, self-assessment surveys, case studies, and review of videotaped scenarios.22,23 Participants of small groups were reshuffled for each topical area to encourage exposure to a variety of perspectives, highlight challenges in team formation, and serve as an introduction of the young physicians to colleagues from around the nation.
|
An additional critical component of the program that was refined from previous events was a hands-on workshop provided by leadership trainers from the Johnson & Johnson Consulting Group to introduce pediatricians to a collection of leadership and management tools that are used in business and were designed to define a project, define and direct a team, and prepare to roll out a project. Over the course of the training, participants worked in groups using appropriate tools applied to simulated health care scenarios.
Another important element of participation in the leadership training program was the required learning contract. Systematic reviews of continuing medical education strategies have determined that education alone has little direct effect on behavior, and change strategies need to be an integral part of any educational activity.24,25 Previous research has demonstrated the importance of behavioral change contracts in influencing behavior change in drug/alcohol and smoking cessation and obesity intervention programs.26–30 Researchers in medical education similarly have found that behavioral change (or "learning") contracts reinforce the educational goals of a program once a physician returns to his or her clinical setting.23,31–36 The YPL used reflective learning strategies and asked participants to construct daily worksheets regarding possible behavioral changes that they would implement after the training program. On the last morning of the program, participants contracted to make 1 specific leadership change off of their worksheets (see Table 2). Participants were advised that they would be required to report on the success, challenges, or modifications to their learning contract 6 months after completion of the program.
|
Evaluation Procedures
We chose to use a pre/post design as it was most feasible for the scope of the project. The program was conceived as having 4 time points: (1) before the training program (baseline), (2) at the on-site registration for the program (T1), (3) on-site immediately after the completion of the program (T2), and (4) 4 months after the program (T3). The prework packet including the needs assessment was distributed before the training program at baseline. Measures for T1 to T3 were in the form of survey instruments. T1 and T2 survey instruments were obtained on site at the program. T3 survey instruments were mailed, faxed, and/or e-mailed to respondents
6 months after the program. Faculty members contacted the participants to encourage return of the T3 instruments; 54 of the 56 respondents completed the T3 survey instrument for a response rate of 96%. The proposed evaluation of the YPL targeted 3 of the 4 levels of evaluation described by Dixon37 for continuing education interventions with health professionals. Level I included general evaluation of participants’ satisfaction with program content and faculty and used evaluation forms distributed at the end of each session and at the completion of the 3-day program (T2). Level II looked at self-reported change scores regarding 20 leadership competencies measured at T1, T2, and T3. Level III examined self-report of behavior changes made directly related to leadership. Given the limited resources of the program, level IV evaluation data (direct outcomes measured at the level of the physician’s environment) were not collected. The study was approved by the AAP Institutional Review Board.
Measures
This research effort used a dual-methods approach. Qualitative data were collected as part of the prework needs assessment conducted at baseline. Quantitative data, in the form of survey instruments, was collected at T1, T2, and T3. Survey questionnaires are an accepted method for evaluating educational programs and behavioral change and have been found to provide reliable information about respondents’ intentions.38 Survey questions used in this study were based on existing instruments for some questions, including demographics of participants (questions taken from the AAP periodic surveys of the Pediatric Research in Office Settings) and general program evaluation questions (questions modified from existing AAP continuing medical education surveys). In addition, the PLA members developed a 20-question competency scale based on the learning objectives provided by faculty members. Scores on the competency scale were collected through the survey instruments at T1, T2, and T3, and change scores were created for T1 to T2 and for T1 to T3. Other outcomes measured included self-report of (1) use of the business tools presented, (2) presentation of material from training program to others in their community or medical setting, (3) pursuit of additional education in leadership training, (4) collaboration with others regarding change, and (5) recruitment of a personal mentor to help address current leadership challenges. Last, self-reported completion of the goals specified in the learning contract was also examined as an outcome.
Analyses
Narratives from the prework packet were initially coded by research staff (C.H.) and then reviewed by PLA faculty members (L.K.L., M.B.M.) using an external coding schema based on a modified framework of organizational, management, and leadership skills and competencies necessary for physician leadership described by Bogdewic et al.8 Any discrepancies in categorization were reviewed until consensus was reached. Quantitative data were analyzed using SPSS (version 9.0; SPSS, Inc, Chicago, IL). Statistical methods used included t tests and 
2 tests.
|
RESULTS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Participant Sociodemographic Characteristics
Of the 56 participants, all were <40 years old and 44.6% were male. Thirty-six percent were residents or fellows in training; the remaining were in practice or academic medicine. Participants represented 33 different states. More than half (51.8%) of the participants were employed at a medical school/hospital, 33.9% were in either private or public group practice settings, 5.4% were employed at community/staff model hospitals, and 5.4% were with the Uniformed Armed Services. Close to two thirds (62.5%) of the participants participated in administrative work at their setting, 66.1% spent part of their time teaching, and 33.4% were involved in medical research. The majority (75.9%) named general pediatrics as their area of focus.
Needs Assessment
The baseline needs assessment asked questions regarding current leadership style and challenges as well as anticipated benefits from the program.
Current Leadership Style
When asked to describe their current leadership style, 75% of participants described themselves as facilitative leaders. Key terms used included "democratic," "empowering," "walking alongside," "working together," "being a team player," and "leading a team by example." As 1 pediatrician explained, "A facilitator empowers those around him or her to set individual goals and develop independent leadership. A facilitator listens and helps provide solutions without dictating the answers." Several commented that this style was essential in a medical environment with multiple strong leaders and personalities; as 1 person commented, "The people I was attempting to ‘lead’ were all strong leaders and achievers themselves." Some commented on the potential downsides of this leadership style, for example, "I have a hard time delegating responsibilities to others, and may bend far backwards to try to ‘make everyone happy.’" Another shared that her facilitative leadership style had been effective previously but needed to change: "My style is to assume the best of people and act accordingly. This strategy has been somewhat effective, especially in nonconfrontational situations. However, I feel I have now 'outgrown’ my current leadership style. I would like to make more than an average impact in my professional and personal life."
Current Leadership Challenges From Personal and/or Professional Life
Leadership challenges were categorized within a modified framework of competencies elucidated by Bogdewic et al8 as necessary for physician leadership, specifically, self-management skills, systems management skills, and team leadership competencies. The challenge named most often by respondents fell within the category of self-management and included time and priority management. As young physicians starting out in their careers, 44% of the respondents found it especially difficult to balance professional and personal obligations; 24% discussed difficulties in prioritizing different professional roles such as administrative committees, research, and practice. A second self-management challenge identified involved having the personal skills to lead in several different types of situations that are salient to young physicians: (1) from a "powerless" position (one respondent described this as "learning the best, most tactile approach for presenting change in a well-established pediatric office of experienced physicians without offending anyone’s person or professional style"), (2) in a new location ("as an outsider and a young physician entering an established chapter, it has been a challenge to establish myself"), or (3) with very little personal experience or training in leadership ("being 6 months into my first academic job, I feel I can barely take care of myself, much less assist other faculty members. I have never needed to manage a large group of people, deal with administrative bureaucracies, as well as strategically plan for the future simultaneously"). A third area of concern among the applicants was inspiring a shared vision that would motivate all stakeholders to participate in change; respondents commented that they were often troubled with issues of motivation, limited revenue funding, program priorities, fragmented programs and departments, and cultural differences.
Anticipated Benefits
The most widely endorsed benefit was the opportunity to meet and interact with other young leaders in pediatrics (44%). Most were nonspecific in their training goals, requesting general "leadership skills" training (35%) or "training to improve" their leadership skills (22%). Some pediatricians (19%) also requested training in the ability to advocate and promote awareness of child health–related issues.
Overall Evaluation of the Program
Results from the immediate evaluation survey at T2 indicated high mean scores regarding satisfaction with the content of the course. Specifically, mean scores on 5-point Likert scales indicated that the program met attendees’ anticipated needs (x = 4.59; SD = 0.53); provided an initial, intense entry into a long-term educational process in leadership (x = 4.65; SD = 0.67); and led to solutions for leadership challenges experienced (x = 4.05; SD = 0.73). Attendees acknowledged a high likelihood of seeking out more information or speaking with colleagues about ideas presented during the program (x = 4.47; SD = 0.74) and a high likelihood of changes being made in the work setting as a result of information received at the program (x = 4.29; SD = 0.84). Last, interest in participating in other PLA leadership programs as a faculty member was high (x = 4.16; SD = 1.14). With regard to course content, participants endorsed the following topical areas as most helpful: (1) practical tools from the business literature (49.1%); (2) personality style introspective exercise and discussion of implications for working in teams (27.3%); and (3) primer in evaluation and feedback (20%).
Program Outcomes
Competency Scores and Changes Over Time
Participants were asked to complete a 20-item competency scale at T1, T2, and T3 (see Table 3). The 3 items that were endorsed with the highest mean scores at T1, before the training program, included 2 self-management skills (item 5, identifying personal and leadership goals; and item 6, defining what tasks are urgent versus important) and 1 team leadership skill (item 19, closely listening to all points of view). The 3 lowest mean scores endorsed at T1 included a self-management skill (item 1, using a defined conceptual model of leadership to examine personal leadership style) and 2 systems management skills (item 10, applying a systems perspective when making change; and item 12, applying management tools). These findings closely paralleled themes generated during the needs assessment as participants could set personal goals and lead by inclusion of others but were less sure of what it meant to be a leader and how to act to lead change in their setting.
|
Table 3 also delineates the mean score for the participants as a group on each of these competencies at T2, immediately after the YPL, and at T3,
6 months after the program. All changes were noted at a significance level of P < .05 except for the T1 to T3 mean scores for item 4, "periodically and proactively seeking out feedback on my performance." In addition to examining change scores in the aggregate, we examined individual change scores. Table 3 demonstrates whether an individual’s score on each item decreased (negative change), remained unchanged (no change), or increased (positive change). At T2, the majority of items were noted to have >50% of respondents endorsing a positive change except for several self-management items (item 4, periodically and proactively seeking out feedback on performance; item 5, identifying personal goals; and item 6, defining urgent versus important for prioritizing tasks) and several team leadership items (item 14, using particular position on team to influence change; item 15, identifying conflict occurrence; and item 17, managing people). At T3, items with <50% positive change included 1 self-management skill that had been marked low at T2 (item 4, periodically and proactively seeking out feedback on performance) and 2 team leadership skills (item 13, effectively using a team to accomplish a task; and item 19, closely listening to all points of view).
Additional Outcomes
Participants were also asked about changes that they had made since the YPL. First, participants rated on a 5-point scale 3 of the business tools presented during the meeting with respect to their usefulness to them as a leader in their particular setting; 71.7% endorsed the stakeholder analysis tool, 56.6% endorsed the threat/opportunity matrix tool, and 35.9% endorsed the force field analysis tool as useful to very useful. More than two thirds (72.7%) had shared the materials from the YPL with others, and 53.7% had pursued other educational opportunities with respect to leadership. One quarter (25.9%) had established collaborations as a result of networking that occurred at the YPL, and more than one third (35.8%) had found a mentor to work with them on a personal leadership challenge. Many had made personal changes as a result of the program. One participant provided a salient example: "I found the PLA very helpful in helping me focus on changing my leadership style. It helped me tremendously, both personally and professionally. I am a much happier worker as a result as well. Without the conference I would not have pursued becoming chief of the medical staff. Please continue to hold this conference and mentor young physicians." In addition, 3 participants planned ongoing training for their nominating bodies or institutions. One participant had returned to her chapter (Pennsylvania) and found sponsorship for a 2-day leadership training program for chapter members for fall 2003. A second planned a full day of leadership training for members of the Resident Section to be held at the 2005 AAP National Conference and Exhibition; a third had developed a series of workshops for the annual Robert Wood Johnson Faculty Scholars meeting. Last, members from the AAP Resident Section had begun a standing leadership training column to be included an all issues of its newsletter.
Participants next were asked about the accomplishment of the goals that they had set in their learning contracts; it should be noted that several laid out >1 goal in their contract. The majority (74%) were in the area of team leadership; examples included using tools provided for team building or to delegating tasks. Another 37% fell in the area of self-management (eg, develop a 5-year career plan and present to mentor, use leadership self-assessment tool to reassess myself as a leader), and 13% were in the area of systems management (eg, utilize tools to facilitate progress for a new AAP chapter group, set up system for frequent meetings with nursing staff). The majority (87.0%) of respondents reported that they had achieved or partially achieved the leadership goal identified in their learning contract. It is interesting that 62.3% found that it had not been easy to implement their goal because of competing time demands (60.4%), dysfunctional teams at the workplace (30.2%), or that their goal required system-level changes (28.3%). Almost two thirds (62.7%) had found the learning contract helpful in prompting action on the specified goal.
Desired Topical Areas Not Covered in YPL
Additional areas of content need identified in open-ended responses included (1) initiation of change, particularly when you are leading "from the middle" (12.7%); (2) conflict resolution/negotiation (10.9%); (3) application of tools in real-life situations (9.1%); and (4) team management (7.3%). Regarding the process of the training itself, the largest complaint was lack of follow-up after the program. Many cited that frequent follow-up after the YPL would have increased the benefits of the YPL, allowed for ongoing growth as a leader, and helped attendees to achieve the goals stated in their learning contracts. Participants wanted more interaction with colleagues; suggestions included e-mail list-servs of the participants, Web-site bulletins, updated contact information, and regional reunions. Participants also requested that increased follow-up include contact with faculty members as mentors for participants. Several respondents indicated that good mentoring is invaluable but difficult to find and that long-term mentoring by faculty members of the YPL would be helpful; 1 participant poignantly stated, "Long-term mentoring would be very useful to me as the few good mentors at my institution are overwhelmed with their own careers and all the junior faculty who need them." Participants also wanted more opportunities to discuss system-level changes. As 1 participant summarized, "Excellent meeting, but periodic reinforcement is necessary to make changes permanent. Unfortunately, it’s too easy to let old habits set in. Also, when only one person alone changes, it is only minimally easier to change a larger system."
|
DISCUSSION |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Our study represents 1 of the first published evaluations of the perceived needs of young pediatricians in the area of leadership skills. Although leadership training is well documented in the industrial literature, intensive leadership skills training programs for physicians have not been documented extensively in the medical literature. The area of training needs for young pediatricians specifically has not been addressed.
Our results confirm that leadership training fills a critical need for young pediatricians. Young pediatricians found themselves in positions of leadership as chief residents, junior faculty, public health administrators, armed services physicians, and practitioners. Participants were often seen as "natural leaders" but wanted formal training in leadership to address better the leadership challenges that they faced. Many were making a transition into positions of leadership and clearly expressed their struggles as they found that strategies for leading used during medical school and residency, specifically facilitative leadership, continued to be useful in their new roles but that other mechanisms for leading teams were also required.
All of the participants actively supported attending the program to acquire more leadership skills. Leadership skills have yet to become a part of medical school curricula, as evidenced in a recent review of educational programs in US medical schools in 2002–2003.39 Very few opportunities for formal leadership training for young pediatricians exist, except for individual programs at academic institutions, chief residency training programs, or workshops available at the annual Pediatric Research Societies meeting. Participants in the YPL clearly demonstrated enthusiasm for the leadership training program, reported high levels of approval with the course content, and expressed interest in ongoing training.
Our results also suggest that the program resulted in overall self-reported improvement in leadership competencies and in activities related to leadership. Although some decreases in individual change scores between T1 and T2 were noted, this is not surprising given that T2 results were obtained immediately after the training, when respondents were most cognizant of skills that they wanted to develop further. In addition, a high percentage of participants reported achieving a leadership-related goal that was defined during the YPL. The learning contract was a tool that has been used in clinical education programs but is new to the field of leadership training; our results suggest its continued use and development as an educational tool in leadership education for physicians.
The results from this study also offer some ways that the program could be enhanced. Certain topic areas of specific relevance for this cohort of physicians were requested, including more directed discussion of leading from the positions of relative powerlessness or in new settings, practical application of tools in systems analysis, and conflict management/negotiation within the context of a facilitative leadership style. Clearly, ongoing follow-up and mentorship by faculty and additional contact with colleagues were important for the participants for emotional support, strategies, and implementation of their identified leadership behavior change.
Although many of the suggested mechanisms (list-serv, regional reunions) would have helped increase contact, these strategies do not address the need for a critical mass of individuals from an organization to support change. The results of the learning contract evaluation depict young pediatricians who face significant "real-world" obstacles against effective leadership. Demanding schedules, dysfunctional team dynamics, and system-level inertia emerged prominently in the reasons that YPL participants had difficulty implementing leadership goals. In light of such impediments, it seems that in addition to the development and delivery of effective leadership training programs and mentorship, environment interventions that recognize and reward leadership, involve teams of health care providers in leadership training opportunities, and promote learning organizations are needed.40
The evaluation of the YPL also leaves many questions unanswered regarding leadership training. First, if groups such as the IOM increasingly call for leadership from physicians, then core competencies will need to be delineated further. Other professional bodies, for example, the Public Health Practice Program Office of the Centers for Disease Control and Prevention,41 have begun the process of defining core leadership competencies in their field and could serve as models for pediatrics. Second, although the content of this program was elucidated carefully with input from experts in leadership training and was well received by participants, the core elements of leadership programs for physicians have not been researched. Only a handful of articles in the literature from the field of medicine present conceptual frameworks for leadership training for physicians, and none has been formally studied.40,42,43 Clearly, this area requires more thought. Third, this research suggests that physicians may have different types of leadership training needs, depending on their stage of career and environment.
This study also suggests some areas of need with respect to research in leadership training. None of the evaluative tools used in this study has been validated, indicating the need for the development of measures that are specific to leadership educational efforts. In addition, more research that demonstrates the impact of leadership training on distal outcomes, specifically, improved health care quality for children, needs to be conducted. A small amount of literature from industrial psychology has examined the impact of leadership in fields such as mental health44; this type of research needs to be developed further within medicine. Unfortunately, educational research has many challenges: funding for educational research is limited, trials of educational events are difficult to conduct, and results may not be generalizable.45
At this point, the PLA is continuing to work with JJPI regarding leadership training for pediatricians. An interactive, Web-based module addressing leadership is being mounted through the PediaLink program. This tool provides an overview on leadership that can be accessed on-line at any time and allows for exchange among subscribers. The PLA also is participating in the development of a series of leadership programs that target various professional groups. For example, a 3-day training program was offered to the AAP Board of Directors, executive staff, incoming chapter vice presidents, and district vice chairpersons in the fall of 2004. Recognizing the importance of strong leadership in academic medical centers, the PLA is also partnering with the Association of Medical School Pediatric Department Chairs, Inc to develop a leadership curriculum for pediatric department chairs. Last, the PLA has reached outside the boundaries of pediatrics and has an ongoing collaboration in place with the American Association of Medical Society Executives and the Center for Association Leadership. The American Association of Medical Society Executives and the Center for Association Leadership had cohosted a summit in fall 2003 with >40 nationally recognized medical leaders who ranked as their highest priority filling the leadership void in an environment of continued volatility. Ongoing leadership training activities will be forthcoming as a result of these and other collaborative ventures. Additional training efforts, however, will be needed and should be mounted within the context of academic medical centers, subspecialty areas, health plans, and practice networks. Determination of a core curriculum and modification of available case studies from industries outside of medicine would make implementation of leadership programs throughout child health care settings more feasible.
The research presented here has several limitations. First, the research used a pre/postevaluation design to evaluate a leadership training program for young pediatricians. As such, it relied on self-reported behavior change and was unable to measure objectively more distal outcomes (eg, changes in the participant’s behavior in their setting of origin). A second limitation is that the study sample included pediatricians who were identified in their community as potential leaders; there is likely to be selection bias to include pediatricians who might seek out additional training experiences in leadership and work proactively to improve their leadership style. Last, we did not request that YPL participants specify their race or ethnicity on any of the program materials and cannot formally present any results based on such distinctions. However, during the course of the meeting, it was noted that there was limited black representation at the program, which sparked an impromptu on-site discussion among the participants and program planners. The basis for such racial and ethnic disparity is uncertain; however, clearly effort needs to be undertaken to foster minority participation and eliminate any inadvertent discrimination in leadership training programs.
This study is the first to evaluate a leadership training program that targets young pediatricians. It demonstrates that leadership training programs are desirable, feasible, and effective in terms of helping early career pediatricians to achieve an identified leadership goal. Additional delineation of core leadership competencies that are specific to pediatrics, curriculum development and dissemination among pediatricians, and more in-depth evaluation will be necessary if we are to heed the IOM’s summons for leadership in health care for children and adolescents in the 21st century.
|
ACKNOWLEDGMENTS |
|---|
We gratefully thank all the participants in the Pediatric Leadership Alliance Young Physicians Leadership Training Program, without whom this study could not have taken place. In addition, we thank all the members of the Pediatric Leadership Alliance Planning Committee and the faculty of the Pediatric Leadership Alliance Young Physicians Leadership Training Program, including (in alphabetical order): Errol R. Alden, MD; Antonio G. Cabrera, MD; George M. Chewning, MA; Ralph Feigin, MD; Lewis First, MD; John Forbes; Aaron L. Friedman, MD; Mark Gelula, PhD; Andrea C. Kennedy; Carole Lannon, MD, MPH; Laurel K. Leslie, MD; Gilbert Liu, MD; Joy H. Marini, MS, PA-C; Mary Beth Miotto, MD; Kristin M. Outwater, MD; Robert Perelman, MD; Kenneth M. Slaw, PhD; Fernando Stein, MD; Sean Stevens, PhD; and Suzanne Ziemnik, MEd. Last, we thank Shelia Valadez from the American Academy of Pediatrics for unending commitment to the Pediatric Leadership Alliance project and organizational and coordinating work on this manuscript’s behalf.
|
FOOTNOTES |
|---|
Accepted Jul 22, 2004.
Address correspondence to Laurel K. Leslie, MD, Child and Adolescent Services Research Center, Children’s Hospital, 3020 Children’s Way, MC 5033, San Diego, CA 92123-0282. E-mail: lleslie{at}casrc.org
No conflict of interest declared.
|
REFERENCES |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
1. Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001
2. Reinertsen JL. Physicians as leaders in the improvement of health care systems.
Ann Intern Med. 1998;128
:833
–838
3. Schwartz RW, Pogge CR, Gillis SA, Holsinger JW. Programs for the development of physician leaders: a curricular process in its infancy. Acad Med. 2000;75 :133 –140[Web of Science][Medline]
4. Prather SE, Jones DN. Physician leadership: influence on practice-based learning and improvement. J Contin Educ Health Prof. 2003;23(suppl 1) :63 –72[CrossRef]
5. Wilson MP, McLaughlin CP. Leadership and Management in Academic Medicine. San Francisco, CA: Jossey-Bass; 1984
6. Irby DM. Faculty development and academic vitality. Acad Med. 1993;68 :760 –763[Web of Science][Medline]
7. Henley CE, Magelssen D. Faculty development and organizational systems behavior. Acad Med. 1990;65 :406 –409[Web of Science][Medline]
8. Bogdewic SP, Baxley EG, Jamison PK. Leadership and organizational skills in academic medicine. Fam Med. 1997;29 :262 –265[Medline]
9. Fairchild DG, Benjamin EM, Gifford DR, Huot SJ. Physician leadership: enhancing the career development of academic physician administrators and leaders. Acad Med. 2004;79 :214 –218[CrossRef][Web of Science][Medline]
10. Morahan PS, Kasperbauer D, McDade SA, et al. Training future leaders of academic medicine: internal programs at three academic health centers. Acad Med. 1998;73 :1159 –1168[Web of Science][Medline]
11. Schwartz RW, Pogge C. Physician leadership is essential to the survival of teaching hospitals. Am J Surg. 2000;179 :462 –468[CrossRef][Web of Science][Medline]
12. Guthrie MB. Challenges in developing physician leadership and management. Front Health Serv Manage. 1999;15 :3 –26
13. Scott HM, Tangalos EG, Blomberg RA, Bender CE. Survey of physician leadership and management education. Mayo Clin Proc. 1997;72 :659 –662[Abstract]
14. Schwartz RW, Pogge C. Physician leadership: essential skills in a changing environment Am J Surg. 2000;180 :187 –192[CrossRef][Web of Science][Medline]
15. Halverson PK, Mays G, Kaluzny AD, House RM. Developing leaders in public health: the role of executive training programs. J Health Admin Educ. 1997;15 :87 –100[Medline]
16. Woltring C, Constantine W, Schwarte L. Does leadership training make a difference? The CDC/UC Public Health Leadership Institute: 1991–1999. J Public Health Manage Pract. 2003;9 :103 –122[Medline]
17. McGaghie WC, Bogdewic S, Reid A, Arndt JE, Stritter FT, Frey JJ. Outcomes of a faculty development fellowship in family medicine. Fam Med. 1990;22 :196 –200[Medline]
18. Bland CJ, Hitchcock MA, Anderson WA, Stritter FT. Faculty development fellowship programs in family medicine. J Med Educ. 1987;62 :632 –641[Web of Science][Medline]
19. Bland CJ, Reineke RA, Welch WW, Shahady EJ. Effectiveness of faculty development workshops in family medicine. J Fam Pract. 1979;9 :453 –458[Web of Science][Medline]
20. Saultz JW. Effective leadership in a reformed health care system: new skills for family physicians. Fam Med. 1995;27 :393 –396[Medline]
21. Association of American Medical Colleges. Professional Development Seminars. Available at: www.aamc.org/members/wim/meetings/start.htm. Accessed April 29, 2004
22. Davis D, Thomson O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?
JAMA. 1999;282
:867
–874
23. Mazmanian PE, Davis DA. Continuing medical education and the physician as a learner: guide to the evidence.
JAMA. 2002;288
:1057
–1060
24. Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance: a systematic review of the effect of continuing medical education strategies.
JAMA. 1995;274
:700
–705
25. Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995;153 :1423 –1431[Abstract]
26. Keane TM, Foy DW, Nunn B, Rychtarik RG. Spouse contracting to increase antabuse compliance in alcoholic veterans. J Clin Psychol. 1984;40 :340 –344[Web of Science][Medline]
27. Rodriguez L, Sandler J. The treatment of adult obesity through direct manipulation of specific eating behaviors. J Behav Ther Exp Psychiatry. 1981;12 :159 –162[CrossRef][Web of Science][Medline]
28. Ureda JR. The effect of contract witnessing on motivation and weight loss in a weight control program. Health Educ Q. 1980;7 :163 –185[Web of Science][Medline]
29. Neale AV, Singleton SP, Dupuis MH, Hess JW. The use of behavioral contracting to increase exercise activity. Am J Health Promot. 1990;4 :441 –447
30. Wilson DK, Wallston KA, King JE. Effects of contract framing, motivation to quit, and self-efficacy on smoking reduction. J Appl Soc Psychol. 1990;20 :531 –547
31. Mazmanian PE, Daffron SR, Johnson RE, Davis DA, Kantrowitz MP. Information about barriers to planned change: a randomized controlled trial involving continuing medical education lectures and commitment to change. Acad Med. 1998;73 :882 –886[Web of Science][Medline]
32. Purkis IE. Commitment for changes: an instrument for evaluating CME courses. J Med Educ. 1982;57 :61 –63[Web of Science][Medline]
33. Curry L, Purkis IE. Validity of self-reports of behavior changes by participants after a CME course. J Med Educ. 1986;61 :579 –584[Web of Science][Medline]
34. Parker FW, Mazmanian PE. Commitments, learning contracts, and seminars in hospital-based CME: change in knowledge and behavior. J Cont Educ Health Prof. 1992;12 :49 –63
35. Pereles L, Lockyer J, Hogan D, Gondocz T, Parboosingh J. Effectiveness of commitment contracts in continuing medical education. Acad Med. 1996;71 :394[CrossRef][Web of Science][Medline]
36. Campbell C, Parboosingh J, Gondocz T, Babitskaya G, Pham B. A study of the factors that influence physicians’ commitments to change their practices using learning diaries. Acad Med. 1999;74(suppl) :34 –36
37. Dixon J. Evaluation criteria in studies of continuing education in the health professions: a critical review and a suggested strategy.
Eval Health Prof. 1978;1
:47
–65
38. Martin K, Mazmanian PE. Anticipated and encountered barriers to change in CME: tools for planning and evaluation. J Cont Educ Health Prof. 1991;14 :301 –318
39. Barzansky B, Etzel SI. Educational programs in US medical schools, 2002–2003.
JAMA. 2003;290
:1190
–1196
40. Birleson P. Learning organisations: a suitable model for improving mental health services? Aust N Z J Psychiatry. 1998;32 :214 –222[Web of Science][Medline]
41. Wright K, Rowitz L, Merkle A, et al. Competency development in public health leadership.
Am J Public Health. 2000;90
:1202
–1207
42. Barker RA. How can we train leaders if we do not know what leadership is? Hum Relat. 1997;50 :343 –362
43. Corrigan PW, Lickey SE, Campion J, Rashid F. Mental health team leadership and consumers satisfaction and quality of life.
Psychiatr Serv. 2000;51
:781
–785
44. Webster L, Hackett RK. Burnout and leadership in community mental health systems. Adm Policy Ment Health. 1999;26 :387 –399[CrossRef][Web of Science][Medline]
45. Cantillon P, Jones R. Does continuing medical education in general practice make a difference?
BMJ. 1999;318
:1276
–1279
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  from the AAP Department of Community, Chapter and Leaders flourish in AAP chapters thanks to pediatric alliance AAP News, July 1, 2008; 29(7): 33 - 33. [Full Text] [PDF]
|
|
|
|
 |
|
 T. L. Cheng, D. Markakis, and T. G. DeWitt The Status of Academic General Pediatrics: No Longer Endangered? Pediatrics, January 1, 2007; 119(1): e46 - e52. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Boulanger, A. Buencamino, and S. Dovichi Training Young Pediatricians as Leaders Pediatrics, August 1, 2005; 116(2): 518 - 518. [Full Text] [PDF]
|
|
|
|
|
|
L. K. Leslie, G. C. Liu, M. B. Miotto, and K. Slaw Training Young Pediatricians as Leaders: In Reply Pediatrics, August 1, 2005; 116(2): 518 - 519. [Full Text] [PDF]
|
|
|
|
|
|
C.-C. Huang and J. Raphael Leadership in Pediatrics Pediatrics, June 1, 2005; 115(6): 1791 - 1791. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
