ABSTRACT

Background

Leadership is a critical component of physician competence, yet the best approaches for developing leadership skills for physicians in training remain undefined.

Objective

We systematically reviewed the literature on existing leadership curricula in graduate medical education (GME) to inform leadership program development.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we searched MEDLINE, ERIC, EMBASE, and MedEdPORTAL through October 2015 using search terms to capture GME leadership curricula. Abstracts were reviewed for relevance, and included studies were retrieved for full-text analysis. Article quality was assessed using the Best Evidence in Medical Education (BEME) index.

Results

A total of 3413 articles met the search criteria, and 52 were included in the analysis. Article quality was low, with 21% (11 of 52) having a BEME score of 4 or 5. Primary care specialties were the most represented (58%, 30 of 52). The majority of programs were open to all residents (81%, 42 of 52). Projects and use of mentors or coaches were components of 46% and 48% of curricula, respectively. Only 40% (21 of 52) were longitudinal throughout training. The most frequent pedagogic methods were lectures, small group activities, and cases. Common topics included teamwork, leadership models, and change management. Evaluation focused on learner satisfaction and self-assessed knowledge. Longitudinal programs were more likely to be successful.

Conclusions

GME leadership curricula are heterogeneous and limited in effectiveness. Small group teaching, project-based learning, mentoring, and coaching were more frequently used in higher-quality studies.

ABSTRACT

Background

Role models in medical school may influence students' residency specialty choice.

Objective

We examined whether medical students who reported clinical exposure to a role model during medical school would have an increased likelihood of selecting the role model's specialty for their residencies.

Methods

We conducted a 5-year prospective, national longitudinal study (2011–2016) of medical students from 24 US allopathic medical schools, starting from the middle of their third year. The primary outcome measure was type of residency specialty choice 4 years after graduation. Main predictors were the clinical specialty of a student's most admired physician and the relative importance of 7 potentially influential factors for specialty choice in the fourth year of medical school.

Results

From 919 eligible participants, 564 (61%) responded to the first survey; 474 of the respondents (84%) completed the follow-up survey. We excluded 29 participants who were not in their fourth year by the time of the follow-up survey. Of the follow-up respondents, 427 (96%) had specialty data 4 years after graduation. In our multivariate models, exposure to an admired generalist physician prior to medical school (odds ratio [OR] = 2.21, 95% confidence interval [CI] 1.03–4.73) and during medical school (OR = 2.62, 95% CI 1.69–4.05) had the strongest odds with respect to training in a generalist residency 4 years after graduation. Role model exposure also predicted specialty choice among those training in surgical and radiology, ophthalmology, anesthesiology, and dermatology (ROAD) specialties.

Conclusions

Personal exposure to role models in medical school is an important predictor of residency training in that role model's specialty.

ABSTRACT

Background

Despite considerable federal investment, graduate medical education financing is neither transparent for estimating residency training costs nor accountable for effectively producing a physician workforce that matches the nation's health care needs. The Teaching Health Center Graduate Medical Education (THCGME) program's authorization in 2010 provided an opportunity to establish a more transparent financing mechanism.

Objective

We developed a standardized methodology for quantifying the necessary investment to train primary care physicians in high-need communities.

Methods

The THCGME Costing Instrument was designed utilizing guidance from site visits, financial documentation, and expert review. It collects educational outlays, patient service expenses and revenues from residents' ambulatory and inpatient care, and payer mix. The instrument was fielded from April to November 2015 in 43 THCGME-funded residency programs of varying specialties and organizational structures.

Results

Of the 43 programs, 36 programs (84%) submitted THCGME Costing Instruments. The THCGME Costing Instrument collected standardized, detailed cost data on residency labor (n = 36), administration and educational outlays (n = 33), ambulatory care visits and payer mix (n = 30), patient service expenses (n = 26), and revenues generated by residents (n = 26), in contrast to Medicare cost reports, which include only costs incurred by residency programs.

Conclusions

The THCGME Costing Instrument provides a model for calculating evidence-based costs and revenues of community-based residency programs, and it enhances accountability by offering an approach that estimates residency costs and revenues in a range of settings. The instrument may have feasibility and utility for application in other residency training settings.

I'm not sure where

to rank your program.

Your faculty were nice enough

though I felt I had wandered

into someone else's party.

The motel was fine and my cab driver

was the friendliest person. On my entire trip.

The residents seemed stressed but

assured me it was just a busy week,

unusually so.

Your secretary kept getting my name wrong,

but you gave me the impression that

I was a great candidate

(I bet you say that to all the boys …)

I don't know. I'm a little uneasy …

Everyone says, “listen to your gut.”

I don't have