“Hybrid” medical leadership emergency medicine training for international medical graduates

Subedi, Prakash; Aylott, Jill; Khan, Naushad; Shrestha, Niki; Lamsal, Dayaram; Goff, Pamela

doi:10.1108/lhs-05-2020-0027

Cited by 5 publications

(9 citation statements)

References 32 publications

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“…Firstly, the total number of doctors enrolled on the MIP was nine and all of the doctors were from the same country. Consequently, our sample size was small, but our sample size and findings were similar to other studies exploring interventions to recruit and retain international workforce (Al-Mohawes et al, 2021;Subedi et al, 2020). Secondly, we were not able to collect demographic information as this was a small sample and we prioritised anonymity.…”

Section: Limitationsmentioning

confidence: 72%

A qualitative study exploring the experience of the Medical Intern Programme: Supportive transition for international doctors working in the NHS

Conen

et al. 2021

Preprint

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Background: The UK is experiencing a shortage of doctors. Consequently, the Medical Intern Programme, a unique two year programme consisting of an observership, four clinical rotations at the level of a foundation doctor within an NHS Trust and a postgraduate diploma from a university in the north of England, was set up to enhance the NHS workforce by facilitating the entry of international medical graduates into UK medicine via a supported transitional programme. We aimed to explore the experiences of the doctors enrolled on the Medical Intern Programme. Methods: Semi-structured interviews were conducted via the telephone with seven doctors enrolled on the programme. The interview guide was informed by the research questions and data were analysed using a thematic analysis. Results: We identified four themes that were important in the experiences of the doctors: preparing to work in the UK, feeling supported, weighing up the pros and cons of the programme and comparisons between countries. Conclusions: The Medical Intern Programme successfully facilitated international doctors' transition to the UK and working in the NHS. Support needs to be provided at the organisational, team and individual level including a period of observing and shadowing to enable the doctors to understand the systems and multidisciplinary team working in the NHS.

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Section: Limitationsmentioning

confidence: 72%

A qualitative study exploring the experience of the Medical Intern Programme: Supportive transition for international doctors working in the NHS

Conen

et al. 2021

Preprint

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“…Doctors trained in leadership development are more likely to become engaged in the organisation and will take an active role in leading the improvement of performance of hospitals (Fulop, 2012; Ham et al , 2003; Goodall, 2011; Subedi et al , 2018, 2020). Doctors have specialist knowledge to make long-term strategic decisions around service delivery and system transformation (Mountford and Webb, 2009) and are, therefore, best placed in the health system to be actively involved in the dual role of clinical practice and health system improver.…”

Section: Leadership In Emergency Departmentmentioning

confidence: 99%

“…Doctors have specialist knowledge to make long-term strategic decisions around service delivery and system transformation (Mountford and Webb, 2009) and are, therefore, best placed in the health system to be actively involved in the dual role of clinical practice and health system improver. Despite this evidence, there continues to be a fragmented and disjointed approach to developing the leadership capability of doctors (Giri et al , 2017; Frich, et al , 2015; Subedi et al , 2020).…”

Section: Leadership In Emergency Departmentmentioning

confidence: 99%

“…With increasing support for a new type of collective, non-hierarchical leadership (Yammarino et al , 2012; West et al , 2014; Buyan et al , 2020; Subedi et al , 2020) clinical practice in the ED is more likely to be multi-disciplinary with clinical leadership that is shared and distributed within the team. The emergency physician in charge (EPIC) is still required to maintain their role as the senior decision maker in the Emergency Department, however, mechanisms that support more multi-disciplinary team working, with effective leadership strategies are encouraged.…”

Section: Leadership In Emergency Departmentmentioning

confidence: 99%

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Unprecedented times in the emergency department: are “board rounds” and leadership the missing links to improve patient flow?

Lahiri

Indrasena²,

Aylott³

2021

LHS

Self Cite

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Purpose National Health Service (NHS) Emergency Department (ED) attendances are at the second highest level ever recorded, (RCEM, 2021a) and as they soar, performance plummets, putting patient safety at risk (RCEM, 2021b). Managing patient flow in the ED is critical to reduce patient safety incidents and crowding, however, this needs effective leadership (Jensen and Crane, 2014). This paper aims to introduce an innovative form of managing patient flow in ED, which is a two hourly “Board Rounds”, providing a managed process to pull patients through the system meeting pre-determined time critical standards and preventing patient harm. Board Rounds combined with effective leadership can play a contributory role preventing crowding in the ED. Design/methodology/approach An evaluation of two hourly ED Board Rounds was undertaken using the hospitals’ ED Board Round Standard Operating Procedure to develop a series of short questions. As leadership is the responsibility of all clinicians (Darzi, 2008; Moscrop, 2012), a separate survey was undertaken for clinicians of all grades and managers to self-assess their own leadership styles using the Path-Goal Leadership Theory (House and Mitchell, 1974; Indvik, 1985; Northhouse, 2013). Findings were reported to the team to explore ideas for improvement not only to develop more effective leadership in the ED but also to raise awareness of how to optimise leadership in Board Rounds. Findings In total, 27 (n = 27) clinicians and managers reported support for a 2 hourly Board Round, for a period of 15 min, in both minor and major injuries departments in ED. A multi-disciplinary Board meeting, led by the lead nurse with support from the Emergency Physician in Charge, was preferred, locating it at the nurse’s station. A validated Path-Goal Leadership survey instrument was returned (n = 24). The findings reveal that leaders and managers are using a high level of the directive leadership style, where there is more potential to use the supportive, participative and achievement approaches to leadership. Research limitations/implications This was a small sample, returned from a Hospital ED located in a semi-rural location, department requiring “improvement” from the Health Regulator. This research would benefit from being undertaken in a medium/large NHS ED department to identify if the findings report on a wider leadership culture in the NHS ED. The implications for this study are that improvement interventions such as a “Board Round” can be usefully evaluated alongside a review of leadership styles and approaches to understand the wider implications for continuous improvement and change in the ED. Originality/value NHS EDs are facing unprecedented challenges and require innovative evidence-based solutions combined with leadership at this time. The evidence base for improving patient flow is limited, however, this study provides some initial findings on the positive perception and experience of staff to Board Rounds. Board Rounds combined with leadership has the potential to contribute to the wider strategy to prevent crowding in ED. This paper is the first of its kind to evaluate perceptions of Board Rounds in the ED and to engage clinicians and managers in a self-assessment of their own leadership styles to reflect on optimum leadership styles for use in ED.

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Purpose -The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al, 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al, 2016); however, significant barriers affect its implementation worldwide (Nolan et al, 2014;Wild et al, 2020).

…”

mentioning

confidence: 99%

Challenges and barriers to implementing the WHO Trauma Care Checklist in an emergency department in Nepal: the need for Transformational Leadership

Pokhrel,

Lamsal,

Indrasena

et al. 2023

LHS

Self Cite

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Purpose The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation. Design/methodology/approach Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant’s knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006). Findings The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time. Research limitations/implications The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC. Practical implications International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country. Social implications The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients. Originality/value To the best of the authors’ knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme.

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“Hybrid” medical leadership emergency medicine training for international medical graduates

Cited by 5 publications

References 32 publications

A qualitative study exploring the experience of the Medical Intern Programme: Supportive transition for international doctors working in the NHS

A qualitative study exploring the experience of the Medical Intern Programme: Supportive transition for international doctors working in the NHS

Unprecedented times in the emergency department: are “board rounds” and leadership the missing links to improve patient flow?

Challenges and barriers to implementing the WHO Trauma Care Checklist in an emergency department in Nepal: the need for Transformational Leadership

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