Project Objectives:
Report Overview of the Project Physicians must possess a variety of project management and leadership skills in order to lead transformational changes in medical practice. As a result, medical schools and residency programs are called upon to consider new ways they can help medical and surgical residents acquire these leadership skills, yet creating a formal leadership curriculum at the residency level is fraught with inherent challenges (e.g., residency scheduling, accreditation mandates, faculty time constraints). The goal of this project is to create a comprehensive leadership curriculum with multiple learning tracks and then pilot at least two of the targeted areas. The initiative offers a rare opportunity for interdisciplinary collaboration among faculty in the Department of Family Medicine (DFM), Ross School of Business and the School of Public Health, and also for innovative partnering with university professional staff. The proposed project and planning process are an important departure from both existing and traditional curricular planning practices. The enhanced learning experiences will have an impact on hundreds of resident learners over time given that participation in the leadership curriculum is intended as a requirement for all residents in the Department of Family Medicine (DFM). The resulting curricular framework is also relevant to other residencies at the University of Michigan and across the country.Project ObjectivesThe goal of this project is to develop and implement a comprehensive, competency-based leadership curriculum that offers residents a core leadership curriculum (i.e. values and vision, team building and teamwork, finance and human resources, persuasion and influence, etc.) and the opportunity for individualized training in self-selected focus areas (i.e., research, clinical practice, education, policy, healthcare administration, international medical practice, and delivery of medical care to the underserved). Targeted outcomes included the development of a leadership curriculum that: (1) promotes independent and individualized learning; (2) extends resident knowledge, skills and attitudes with regard to leadership and managerial competencies; (3) provides residents with tools for self-assessment and improvement; (4) offers residents (and departments) a mechanism through which they can address and document progress toward competencies identified by the Accreditation Council for Graduate Medical Education (ACGME); and (5) provides a vehicle for faculty engaged in the project to extend their own skills in designing, developing, piloting and evaluating leadership curricula for resident learners.
Project Achievements:
a. Summary of achievements/impact. We conducted a needs assessment by reviewing current ACGME requirements and American Board Family Medicine certification and in-training exam performance reports. We also examined program evaluation data collected from current residents, alumni and faculty. Once completed, we met on a monthly basis with planning team members to develop a leadership curriculum that would meet the needs identified. This core planning team consisted of representatives from the Department of Family Medicine (Residency Director, Education Specialist) and two faculty experts on healthcare leadership training from the School of Public Health and Ross School of Business. Residents and additional faculty were later brought in to assist with the design of curricular tracks. One Undergraduate Research Opportunity Program (UROP) student also participated. Following completion of an extensive literature review, we identified a targeted set of competencies, instructional methods, and assessment strategies that we were able to meld into a comprehensive leadership curriculum with multiple learning tracks. We piloted four sessions with a focus on core leadership topics, including: values and creating a vision, personal wellness and resilience, team building and teamwork, and persuasion and influence during the 2010-11 academic year. Just recently, we launched the additional required sessions: leadership track introduction/selection, finance/human resources, change management, and measuring performance. For each session we developed written goals and objectives (linked to specific ACGME core competencies), preparatory readings, in-class exercises, and self-directed learning assignments. Instructional strategies include periodic lectures by university faculty and staff, case study discussions, and critical thinking/interactive learning activities. We developed and piloted the two proposed curricular tracks and an additional nine tracks were launched in July 2011 for a total of twelve elective tracks: (1) sports medicine; (2) global health; (3) healthcare policy and advocacy; (4) integrative medicine; (5) education; (6) research; (7) clinical practice; (8) healthcare administration; (9) delivery of medical care to the underserved; (10) obstetrics; (11) geriatrics and palliative care; and (12) behavioral science. Each track has unique components, but all encompass advisor selection, electives, extracurricular involvement, a senior project, both small and large group presentations, and self-directed study. Appendix A contains our vision statement and a conceptual framework that we use to guide curricular development.Teaching evaluations of the piloted sessions were positive, ranging from 4.0-5.0/5.0. Residents ratings of the simulation exercises (4.0/5.0) and class discussion/debriefings (4.5/5.0) were also positive. Several residents have now taken on leadership roles within the program, including: UMHS House Officer Association (HOA) Representative, American Medical Association Resident Delegate, and many others have sought more active roles in local and regional committees and organizations. Faculty report satisfaction with the leadership core curriculum as implemented to date, and with their involvement in developing and advising residents about the various leadership tracks. Many faculty commented about the fact that leadership tracks of this sort would have significantly contributed to their own residency training, had such programming been available. The department has incorporated leadership curriculum outcomes in its approach to addressing and documenting progress toward ACGME accreditation requirements. New items have been added to our alumni survey to gather input on the application of leadership training on clinical care delivery. The opportunity for cross-disciplinary collaboration has allowed faculty engaged in the process to extend their skills in designing, developing, piloting and evaluating leadership curricula for resident learners, as well as offering opportunities for faculty to participate in activities across schools at the University of Michigan, publish in the area of leadership training as it relates to resident training and engaging UROP undergraduates in leadership research.b. Students impacted by this project. Undergraduate students: 1 UROP research assistant (resulting in poster presentation) Graduate students: 41 (medical residents to date)c. Courses impacted by this project. 2 four-week rotations (required curricula) 4 six-week rotations (elective tracks)
Continuation:
Continuation Yes. We have plans to continue this project beyond the grant period. We will launch additional required course sessions (i.e. finance and human resources) and elective tracks during the 2011-12 academic year and beyond. To this end, we have designed a total of twelve leadership tracks, the final nine of which were approved by the Residency Education Committee and piloted in July 2011. We also plan to evaluate the impact of the leadership curriculum over time. Ongoing curricular modification may be required to address the needs of future family medicine physicians while taking into account the demands of a continually changing healthcare environment.
Dissemination:
DisseminationWe reported our results to health care providers in April 2011 at the Society of Teachers of Family Medicine (STFM) national conference. The results of our initial literature review were also presented at the 2010 UROP Research Symposium by Kelly Flanagan, a University of Michigan freshman, as part of her student research project. We have one manuscript in preparation for journal publication based on the Phase 1 findings and another in the planning stages. At the Medical School, the results of this project have been presented to our DFM Education Steering and Executive Committees and we plan to share with colleagues from the Departments of Pediatrics, Internal Medicine, combined Medicine/Pediatrics and Obstetrics. Our work has been disseminated to faculty in the Schools of Public Health and Business through partnerships that resulted from this project. Continued dissemination opportunities are expected over the next few years, including at least one additional presentation at the STFM national conference.
Advice to your Colleagues:
Advice to Colleagues (optional)Engaging with colleagues from the fields of public health, business and education proved essential to the curriculum development process. We learned early on that we each had a somewhat unique view of what the project might involve and that more time was required than we initially anticipated to get ourselves onto the “same page.” At the department level, we learned that personal contact with faculty and residents was required in order to cultivate an appropriate level of elective track ownership.
