Leadership Development in Postgraduate Medical Education: A Systematic Review of the Literature

Abstract

CanMEDS is an initiative to improve patient care by enhancing physician training and practice. From its beginning in the 1990s, its main purpose has been to articulate a comprehensive definition of the competencies that physicians need to deliver high-quality patient care. These competencies are now well established in the Royal College's training standards. In 2012, the Royal College began a multi-year review and update of the CanMEDS 2005 Physician Competency Framework. As part of the CanMEDS 2015 project, the Royal College engaged a wide variety of contributors (experts, partners and stakeholders) to ensure that the third edition of the framework provides a valid and practical foundation for excellence in patient care now and in the future. The revision process started with a thorough review of the 2005 framework to determine whether it needed updating for contemporary practice. The contributors, led by a set of expert working groups (EWGs), identified many ways to update and improve the framework. This document describes the Royal College's rationale for one of these changes: the decision to emphasize leadership competencies in CanMEDS 2015. "In CanMEDS's 20-year history, Manager is the only role to undergo a name change: this change to leader represents a timely evolution for contemporary health care." Key Messages The positive, collaborative frame of the CanMEDS 2015 Leader Role will encourage physicians to develop and use leadership skills to advance the care of their patients and to contribute to improving the health care system. CanMEDS has always included leadership competencies, but in the past the framework emphasized managerial competencies. All physicians lead in their everyday practice; some hold titled leadership positions. Physicians need to lead the health care system in collaboration with other professionals. A physician does not have to be the boss to be a leader. Stakeholders in the CanMEDS 2015 review process included patients, medical students and residents, Royal College fellows, leaders in medical education, other health care professionals, specialty bodies, governing institutions and partner organizations, and international collaborators. Stakeholders want a greater emphasis on the physician as leader without sacrificing managerial competencies. The Future of Medical Education in Canada undergraduate and postgraduate projects both endorse leadership competencies for physicians.

Leadership Training in Pediatric Residency Programs: Identifying Content, Characterizing Practice, and Planning for the Future

“…Comprehensive reviews on leadership education have noted an over-emphasis on cognitive and intellectual-related leadership competencies, without enough attention to the domains of character and emotional intelligence development. 5 It is encouraging to see that pediatric program directors identified a balanced set of leadership skills as high-value, in keeping with recent educational calls to action.…”

“…Comprehensive reviews of current educational practices in leadership in medicine have found variability in content, teaching modalities, and evaluation strategies. 5,6 The lack of a shared conceptual framework makes it challenging for residency programs to develop new content or expand upon existing leadership education programs. Existing heterogeneity across curricula complicates comparative analyses, limiting the evaluation of the longitudinal impact of leadership training.…”

The Legacy of Leadership: Our Commitment to Future Generations of Family Medicine Leaders

“…Additionally, leaders of all residency programs should begin to incorporate formal leadership development into the curriculum and consider adding leadership as a core competency in our training. 3,4 You have selected us into your programs, and we have proven to you our leadership potential, now we ask you to help us become the leaders our patients and our hospitals need.…”

“…2 These pedagogical methods can incorporate didactic, theoretical learning, interactive discussion, self-reflection exercises, mentorship/coaching, experiential (direct placement in a leadership setting or role), and project-based deliverables to the larger health system. 3 However we choose to accomplish our goal of preparing our learners and faculty to be engaged health systems leaders, we must start now. The legacy of leadership in family medicine within an embattled health care system is likely of greater importance now than ever.…”

Avoiding Death by Meeting: An Interactive Workshop for Academic Faculty Highlighting Strategies to Facilitate Effective Team Meetings

“…[10][11][12][13][14][15][16][17][18] As such, the need for ongoing leadership education and training is increasingly recognized. [19][20][21][22][23][24][25] The call to action 1,2,[25][26][27][28] to increase formal and comprehensive leadership training for physicians is not a new one, and leadership training opportunities for physicians within academic health centers are increasingly common. 27 However, a recent systematic review 27 highlighted that current programming more often focuses on broader leadership competencies (e.g., leadership style, feedback), with only a minority of programs covering specific skillsets, such as those skills involved in running an effective team meeting (e.g., group facilitation, group problemsolving and decision-making, oral presentation skills, coaching skills to address specific behaviors).…”