An Innovative Residency Program Designed to Develop Leaders to Improve the Health of Children

Abstract

Physician-leaders are needed to address the widening gap in health disparities in an increasingly complex health care system. To be effective leaders, physicians need specific training; yet despite its importance, leadership training is rarely addressed during graduate medical education. As a result, most physician leadership training occurs after residency training. To address this gap in medical education, in 2004 the authors developed the Pediatric Leadership for the Underserved (PLUS) program at the University of California, San Francisco. The PLUS program incorporates leadership development into the framework of standard clinical training by providing specific sessions in personal leadership development and in related skills such as team building, negotiation, and conflict management. Leadership training is explicitly tied to clinical experiences to maximize relevance and opportunities for "real-time" application of new skills and knowledge. In addition, the curriculum includes sessions to develop and implement a three-year longitudinal child health project. Trainees are organized into advising groups to provide structured faculty and peer-peer advising. Key lessons learned in the implementation include the importance of having a skill-based, rather than a topic-based curriculum, and of exposing trainees to concrete examples of the many career paths of physician-leaders. Early outcomes from 2004 to 2009 include program evaluation data, trainee accomplishments, and postgraduate careers. This paper aims to inform other training programs about the development and feasibility of a residency program that incorporates leadership and underserved medicine curricula into the framework of standard clinical training.

A Systematic Review of Physician Leadership and Emotional Intelligence

“…127,128 Another training program reported positive results in training residents 129 and attributed the program's success to a longitudinal and skill-based structure that supported the residents in their leadership paths to advocate for children's health. Another small study showed that the Thomas-Kilmann Conflict Mode Instrument predicted Accreditation Council for Graduate Medical Education (ACGME) evaluations of residents, 129 suggesting the relevance of EI evaluation to ACGME competencies.…”

“…In this way, the paucity of studies examining the impact of EI in medical leadership mirrors the lack of rigorous studies of the impact of leadership development in medicine in general. 83 On the basis of this review of available literature, perhaps the best available evidence supporting the role of EI as an essential competency for medical trainees and for senior physicians is the experience of programs that have used EI in their leadership development programs over extended periods of time, for example, the advocacy-focused program for residents at the University of California, San Francisco, which reported career and performance benefits from their intervention 128 ; the Cleveland Clinic's program, which has generated innovative business plans that helped improve care delivery 101 ; and the Mayo Clinic's programs, which have provided specialized support to program participants and helped them use their new skills and insights in a productive way within their institutions. 88 Although even these results are incomplete, the favorable experience of these and other programs seems to fuel growing enthusiasm for EI training in health care and justifies further study.…”

A pilot study of a practice management training module for medical residents

“…Our suggestions would be to divide the topics into subjects suitable for junior medical residents and for residents who are more advanced in their specialist training program. In the literature, of the 32 training programs described, 21 used a subjective evaluation of which 21 [14,15,17,19,20,22,27-40] were positive and one was neutral [13]. Based on our own evaluation and the evaluations in the literature we also suggest that medical management training should be mandatory since we feel that all doctors should have a basic knowledge of these subjects and residents seem to have a need for it.…”

“…We used the same search strategy as for the earlier literature review [8]. We found nine new articles describing a management program designed for medical residents [12-20]. In combination with our previous literature review a total of 32 articles described management training programs which focused on medical residents.…”

A Longitudinal Career-Focused Block for Third-Year Pediatrics Residents

“…6,7 An internal medicine program implemented a yearlong ambulatory block that provided flexible time for residents to pursue additional research or elective experiences within that year. 8 In addition, focused training throughout residency was used to prepare hospitalists 9 ; there is a longitudinal curriculum in pediatrics that encompasses the entire training period, 10 and Vinci et al 11 developed a 3-month research experience for senior pediatrics residents interested in an academic career. However, none of these innovations use resident learning goals to create a truly resident-specific individualized program that emphasizes self-directed learning.…”