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Medical School Factors That Prepare Students to Become Leaders in Medicine Louise Arnold, Phd, Paul G

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Medical School Factors That Prepare Students to Become Leaders in Medicine Louise Arnold, Phd, Paul G Research Report Medical School Factors That Prepare Students to Become Leaders in Medicine Louise Arnold, PhD, Paul G. Cuddy, PharmD, Susan B. Hathaway, PhD, Jennifer L. Quaintance, PhD, and Steven L. Kanter, MD Abstract Purpose authors subjected interview comments learning environment. Graduates To identify medical school factors to directed, largely qualitative content viewed a combination of factors as graduates in major leadership positions analysis with iterative coding cycles. best preparing them for leadership perceive as contributing to their and excellence in clinical medicine; leadership development. Results together these factors enabled them to Most graduates said their experiences assume leadership opportunities after Method and the people at UMKC positively graduation. Using a phenomenological, qualitative influenced their leadership growth. approach, in August–November 2015 Medical school factors that emerged Conclusions the authors conducted semistructured as contributing to that growth were This study adds medical leaders’ interviews with 48 medical leaders the longitudinal learning communities perspective to the leadership who were 1976–1999 baccalaureate– including docents, junior–senior development literature and offers MD graduates of the University of partners, and team experiences; guidance from theory and practice for Missouri–Kansas City School of Medicine expectations set for students to medical schools to consider in shaping (UMKC). At UMKC, they participated in achieve; a clinically oriented but leadership education: Namely, informal longitudinal learning communities, the integrated curriculum; admission policies leadership preparation coupled with centerpiece for learning professional seeking students with academic and extensive longitudinal clinical education values and behaviors plus clinical skills, nonacademic qualifications; supportive in a nurturing, authentic environment knowledge, and judgment, but received student–student and student–faculty can develop students effectively for no formal leadership instruction. The relationships; and a positive overall leadership in medicine. The dynamism and mounting complete the program.1,11–14 Long- as human interactions and progressive complexities of today’s health care systems term follow-up to ascertain students’ participation in a community of practice.18 require physicians to assume leadership perspectives on whether and how their roles in medicine.1–3 Accordingly, the leadership preparation transferred to Oriented by this literature and theory on Institute of Medicine and other medical the workplace is, to our knowledge, leadership and learning, we explored the associations have highlighted the need to unavailable despite recommendations for following question: What factors during prepare physician leaders.4–8 In response, such studies.12 Additionally, the role that medical school do UMKC graduates who some medical schools have offered informal leadership education, embedded serve in major leadership positions in leadership education to students in various in students’ experiences and organizational medicine perceive to have contributed formal and less formal formats.1,5,9–13 culture, plays in students’ preparation for to their leadership development? Study They have studied outcomes of their leadership is unclear. of the insights of these medical leaders is leadership programs, but their results particularly apt because UMKC has never offer little evidence for the effectiveness To address these gaps in the literature, explicitly and formally taught leadership; 1,12,14 of their efforts or best practices. we followed up with University of rather, it stresses the development Furthermore, they have focused only Missouri–Kansas City School of Medicine and graduation of superbly educated on outcomes measured when students (UMKC) graduates who have attained clinicians. How, then, we wondered, did major leadership positions in medicine. these graduates become leaders? Did their Please see the end of this article for information These individuals’ actual leadership success medical school experiences contribute to about the authors. in the world of medicine, we reasoned, their leadership success and, if so, in what Correspondence should be addressed to Louise Arnold, would enable them to give insights into ways? University of Missouri–Kansas City School of Medicine, environmental factors that promote 2411 Holmes, Kansas City, MO 64108; telephone: leadership, which medical schools could (816) 235-5282; e-mail: [email protected]. adopt. Contemporary theory holds that Method Acad Med. XXXX;XX:00–00. leadership is a journey15 in which leaders We sought to garner a rich understanding First published online are not necessarily born but also made16 about the experiences that UMKC doi: 10.1097/ACM.0000000000001937 Copyright © 2017 by the Association of American through exposure to many experiences and graduates in major leadership positions Medical Colleges practice.15 Also, experience-based learning in medicine thought were important in 17 Supplemental digital content for this article is theory points to medical school influences their leadership growth. Accordingly, we available at http://links.lww.com/ACADMED/A483. that might be involved in this journey, such adopted a phenomenological, qualitative Academic Medicine, Vol. XX, No. X / XX XXXX 1 Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Research Report approach using semistructured interviews excellent patient care; productive graduates by prioritizing graduates with with a preponderance of open-ended researcher noted for novel, important national-level achievements and ensuring questions. The university’s institutional contributions to medical knowledge that a mix of administrators, clinicians, review board reviewed and determined and its applications; and/or excellent researchers, and educators in a variety of this study to be exempt from further educator acknowledged for effective types of medical institutions would be review and approval. teaching/mentoring; and invited for interviews. Setting 2. Type of institutional affiliation: Data collection substantial national, regional, and/or Using a nontraditional form of medical We created a semistructured interview 19 local medical institution, organization, education, UMKC admits students and/or society including, where guide to collect the data (see directly from high school into a six- relevant, those ranked in published Supplemental Digital Appendix 1 at year combined baccalaureate–MD national reports. http://links.lww.com/ACADMED/ curriculum.20 From the first week A483). This guide began with open- onward, students interact with patients, See List 1 for examples of leadership roles ended questions to elicit factors the families, physicians, and other health and institutional affiliations meeting graduates thought were important care providers in small groups. In year 3, these criteria. in their leadership development. We each student joins a learning community asked them to consider factors not only called a docent team, which is the By using AOL Search and inspecting our during, but also before and after, medical centerpiece for teaching and learning medical school and university alumni/ school to identify a comprehensive clinical knowledge, skills, and judgment development office files to find leadership set of influences in their leadership as well as professional values and evidence for each of the 1,664 eligible growth, without directing them to behaviors. graduates, we found that 213 met our two focus only on medical school factors. leadership criteria. We invited 71 (one- The guide also contained follow-up The docent team consists of three third) of these 213 graduates for interviews probes so interviewers could clarify students from each of the final four years because we wanted to obtain a sufficient graduates’ answers and gather additional of the curriculum (years 3–6), the docent but manageable number of participants information as needed. (the leader, a general internist), and other in various leadership positions to reach health care professionals, notably a doctor saturation of themes in our qualitative After initial telephone and/or e-mail of pharmacy (PharmD). The docent team study yet allow for refusals to interview.21 contact that included study information attends a weekly continuing ambulatory The senior author (L.A.) chose these 71 and the interview guide, 48 (68%) of the care clinic and serves an annual two- to three-month inpatient internal medicine rotation. List 1 Examples of Types of Leadership Roles and Institutional Affiliations Meeting The student stays on the same docent Study Inclusion Criteria for Documented Leadership Achievement Among team until graduation. Within the team, 48 University of Missouri–Kansas City School of Medicine Baccalaureate–MD each year 3 student acquires a senior Graduates (1976–1999), 2015 Interview Study partner who is a year 5 student. They Types of leadership roles remain partners for two years until the • Top administrators: CEO, chief medical officer, president/president-elect, chair/chair-elect, senior partner graduates. Then the junior vice chancellor, decanal position; partner becomes the senior partner for a • Outstanding clinicians/patient-care givers: Received national and/or regional awards, new year 3 student joining the team. The elected/appointed as head of a clinically oriented society, appointed as a named
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