Leadership Experiences of Internal Medicine Residents: A Needs Assessment for Leadership Curricula

Abstract

Purpose Leadership development during medical training is critical. Accrediting bodies strongly recommend and residents desire leadership training. However, limited needs assessment data exist regarding trainee perceptions of and experiences with leadership training. Our objective is to describe residents’ perceptions of leadership and desires for leadership training with the goal of informing effective curricular development. Patients and Methods In 2019 a trained qualitative interviewer conducted semi-structured interviews with volunteer second-year categorical internal medicine residents recruited via email across four institutions. Interviews were audio-recorded, transcribed, and inductively coded by two independent coders. After adjudicating discrepancies, coders synthesized codes into broader themes. Final thematic analysis was triangulated with the entire author group. Results Fourteen residents were interviewed (50% female). Few reported prior leadership training. Thematic analysis yielded six main themes. First, residents perceive “leadership” to be related to formal, assigned, hierarchical roles. Second, residents identify their own leadership primarily in the inpatient clinical setting. Third, residents identify clinical competence, emotional intelligence, and communication as important skills for effective leadership. Fourth, residents struggle to identify where leadership is currently being taught. Fifth, residents desire additional leadership development. Finally, residents prefer well-labeled, interactive methods for leadership development. Conclusion Although residents desire leadership development, these skills are not often explicitly taught, labeled, or assessed. Curriculum developers may consider explicitly contextualizing leadership training within an “everyday leadership” framework, dovetailing leadership coaching with daily teaching workflow and feedback structures, and implementing faculty development initiatives to allow for appropriate feedback and assessment of these skills.

Developing Leadership Among Dental Residents: An Exploratory Study

“…However, the residents showed their struggle and variations in developing leadership skills relying on their learning environment only. A recent study among internal medicine residents showed the same struggle that might provide inconsistent leadership background, which does not ensure equivalent development of leadership skills [ 17 ]. To support the development of leadership skills, leadership skills must become a standard part of medical training at all levels and in all specialties [ 5 ].…”

A Growing Mandate in American Medicine: Teaching Our Internal Medicine Residents About Healthcare Administration and Leadership

“…There is an expanding interest in leadership development programs among physicians, and formal training is currently available in 65% of academic health centers in the United States of America [ 1 ]. The enthusiasm for physician leadership training among residents is increasing [ 2 ], and the necessity to educate them on such a topic is evident [ 3 ], as residents are expected to participate in multidisciplinary rounds, lead a team, be active advocates of patient safety, and share the responsibilities of educating junior residents and students. The most recent Accreditation Council of Graduate Medical Education (ACGME) 2.0 Milestones [ 4 ] highlight the importance of advancing resident performance in leadership in most competency areas; thus, early exposure to healthcare administration and leadership is paramount to the contemporary internal medicine (IM) trainee.…”

“…Existing evidence about the efficacy of leadership programs for graduate medical trainees [ 5 ] is sparse and conflicting. There is a significant misconception among trainees who appreciate that leadership development is primarily about enhancing individual knowledge and skills in the hierarchical and archaic model of leadership [ 2 ] at the level of a microsystem. The existent leadership programs have not adopted contemporary views of leadership as a collective practice, and there is little evidence to support their efficacy.…”

“…The first is the absence of quality evidence to define the competencies and structure required by a formal curriculum [ 2 ]. The Healthcare Leadership Alliance [ 6 ] and the Academy of Medical Royal Colleges [ 7 ] endorse a comprehensive but equally extensive leadership competency framework that exemplifies the complexity of a physician-leadership role.…”

“…The second challenge is choosing the setting and the duration. Hospital-based programs [ 2 , 10 ] appear feasible due to the immediate availability of the stakeholders. Approximately 13% of existing training in leadership are hospital-based electives [ 5 ], like ours.…”