Автор неизвестен - Mededworld and amee 2013 conference connect - страница 120

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important performance characteristics and are shown to correlate well with experience level and currently validated metrics.

Take-home messages: Force information can be used to develop performance metrics that relate to patient safety and instrument control.

9DD Posters: Leadership

Location: South Hall, PCC


Developing physicians as managers of care: a systematic review of assessment methods

JO Busari (Atrium Medical Center, Pediatrics, H. Dunantstraat 5, Heerlen 6401 CX, Netherlands) L Stammen (Maastricht University, FHML, Maastricht, Netherlands)

L Gennissen (Maastricht University, FHML, Heerlen, Netherlands)

R Moonen (Atrium Medical Center, Pediatrics, Heerlen, Netherlands)

Background: The increasing demands for effective and efficient health care delivery systems worldwide have resulted in an expansion of the desired competencies that physicians need to possess upon graduation. Presently, medical residents require additional professional competencies that can prepare them to practice adequately in a continuously changing health care environment. Recent studies show that despite the importance of competency-based training, the development and evaluation of management competencies in residents during the residency training is inadequate. The aim of this systematic literature review was to find out which assessment methods are currently being used to evaluate trainees' management competencies, and which, if any, of these methods make use of valid and reliable instruments. Summary of work: In September 2012 a systematic search of the literature was performed using the Pubmed, Cochrane, Embase, Medline and ERIC databases. Additional searches included scanning the references of relevant articles and sifting the 'related topics' displayed by the databases. Summary of results: 25 out of 178 articles were selected for final review. Four broad themes emerged after analysis that best reflected their content: Category 1. Assessment tools used to evaluate the effect of implemented curricular interventions; Category 2. Assessment tools based on recommendations or views from consensus surveys or conventions; Category 3. Assessment tools intended for assessing general competencies; and Category 4. Assessment tools that focused exclusively on systems-based practice or management competencies. Conclusions: Little information was found about (validated) assessment tools being used to measure management competence in practice. Take-home messages: Our findings suggest that a combination of assessment tools should be used when evaluating residents' management competencies.



Medical students as Managers of their university hospital, a pilot course

Konstantinos Dimitriadis (Ludwig-Maximilians-University (LMU), Department of Neurology, Petenkoferstr. 8a, Munich 80336, Germany) Stefan Moder (Ludwig-Maximilians-University (LMU), Department of Medical Education, Munich, Germany) Severin Pinilla (Ludwig-Maximilians-University (LMU), Department of Medical Education, Munich, Germany) Tanja Pander (Ludwig-Maximilians-University (LMU), Department of Medical Education, Munich, Germany) Martin Fischer (Ludwig-Maximilians-University (LMU), Department of Medical Education, Munich, Germany) Philip von der Borch (Ludwig-Maximilians-University (LMU), Department of Medicine IV, Munich, Germany)

Background: Doctors are expected to develop competencies beyond medical patient care in order to succeed in modern health care delivery systems. The Manager role has been defined by various competency catalogues for health care professionals, however concrete pedagogical implementation concepts are lacking.

Summary of work: We established an innovative course at LMU Medical School aiming to foster the Manager role in our curriculum. Students initially develop an understanding of the basic principles of the German health care system and hospital management through PBL tutorials, lectures and workshops. Subsequently, we organize a simulated hospital board meeting, with students posing as members of the university hospital's supervisory board. They develop a viable solution for a current issue the supervisory board is tasked with and ultimately present their results to their role models. Summary of results: 24 Students evaluated with a response rate of 95.8%. The course was graded with a mean of 1.08 (SD ± 0.2, 1=excellent and 6=poor). Questions about the German health care system were rated with means ranging from 3.17 to 4.69 (1="excellent knowledge" to 6="very poor knowledge") prior to the course. After completion, significant improvement could be detected in all core points assessed with the questionnaire (means ranging from 1.85 to 2.55). These results were confirmed by semi-structured interviews.

Conclusions: The course was evaluated positively and students seem to have gained some management competencies, including the development of a realistic business plan for complex management tasks. Take-home messages: In our setting, teaming up medical educators and management personnel has created a win-win situation while teaching the Manager role.


Taking the lead - medical management and leadership training in the pre-clinical medical curriculum, one year on

Adam M Gwozdz (UCL Medical School, Department of Medical Education, London, United Kingdom) Liana Zucco (St. George's University of London, Division of Biomedical Sciences, London, United Kingdom) Deborah Gill (UCL Medical School, Department of Medical Education, London, United Kingdom)

Background: Following a needs analysis amongst 1st-year undergraduate medical students at UCL one year ago, which highlighted a need and a desire for management and leadership training early in the undergraduate curriculum, a student selected component (SSC) entitled "Taking the Lead" was piloted. Summary of work: The medical management and leadership SSC at UCL Medical School comprised eight ninety-minute seminars, delivered by UCL faculty, and members of the independent-sector, including KPMG and BUPA. The SSC was designed to meet the undergraduate learning and development outcomes outlined in the Medical Leadership and Competency Framework by the NHS. A modified Hennessy-Hicks training needs assessment questionnaire was administered to students who completed the SSC (n=14), and compared with results from 1st-year medical students who had not participated in the pilot (n=60). The importance attributed to, and students' stated performance of management/leadership tasks was assessed.

Summary of results: Analysis revealed that students who completed the SSC perceived that management/supervisory tasks would play a more important role in their future success as clinicians, compared with students who did not participate in the SSC. Furthermore, students who had completed the SSC reported their own performance in management/supervisory tasks as being significantly higher compared with their undergraduate peers who had not completed the SSC. UCL Medical School has decided to make this SSC a permanent fixture in their undergraduate curriculum.

Conclusions: Early education in medical management and leadership helped to address the training need identified in our earlier study. Take-home messages: Medical management and leadership training should form part of the undergraduate curriculum at medical school.


Leadership-trained residents as a bridge between undergraduates and professionals providing greater focus on professional competence in medical education

Liisa Carlzon (Sahlgrenska University Hospital, Medicine, Omrade 3, Verksamhetsomrade Medicine, Molndal 43180, Sweden)


Background: To be able to provide effective, safe and high quality care in the future, clinicians as well as medical teachers need to be more involved in leadership and in health care improvement. Faculty development is a central issue in improving quality of education in leadership and professionalism in medical education. Summary of work: The Sahlgrenska University Hospital in Gothenburg, Sweden, runs an advanced leadership programme for residents (leadership residency) with individually planned leadership education up to 18 months in addition to clinical residency. Leadership residents representing various specialities form a group that collaborates in several issues while having their individual profiles in leadership, management, tutoring, team work and quality improvement. By 2013 five residents have finished and ten more are enrolled in the programme.

Summary of results: The group of leadership residents has become to play an important role in teaching leadership, professionalism and quality improvement for residents as well as undergraduates. They have roles as tutor, project leader, lecturer, manager and medical advisor leading to parallel professional development of residents and their students. Conclusions: Advanced leadership programme for residents with various professional competences is a possible way for faculty development and enables co­operation between university and medical clinics in order to reach more focus on professionalism in clinical education.

Take-home messages: Leadership-trained residents are a resource that can be used in teaching professionalism and faculty development.


Situated learning for registrars on post-take ward rounds

Tom Levett (Royal Sussex County Hospital, Brighton University Hospital NHS Trust, Elderly Medicine, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, United Kingdom)

Gordon Caldwell (Worthing Hospital, Western Sussex Hospitals NHS Trust, Diabetes and Endocrinology, Worthing, United Kingdom)

Background: The post-take ward round (PTWR) provides formal consultant review of acutely unwell patients admitted to hospital, yet specialist medical registrars, the consultants of tomorrow, receive little to no formal training in this area. An expectation exists that 'on the job' experience provides sufficient preparation for this important aspect of clinical leadership. Summary of work: We aimed to seek the opinions of medical registrars on the use of a structured considerative checklist and learning by example approach in PTWR leadership training, assessing whether this model influences current and future practice. This was studied through a questionnaire-based survey of registrars working in Worthing Hospital

from 2009 to 2011.

Summary of results: 18/25 registrars (72%) across a range of specialties returned questionnaires. Though one third of respondents had considered how they conduct ward rounds, none had received formal training. Most felt such skills were acquired 'on the job' from observation and experience of those conducted by senior colleagues. Exposure to the considerative checklist changed thinking in 94% and practice in 88%. Common positive themes included enhanced pre-ward round preparation, the importance of inclusion and communication and need for structure (facilitated by physical or mental checklist). 17/18 participants felt that this training would influence their consultant practice. Conclusions: Trainees respond positively to participation in a structured PTWR utilising a considerative checklist as a model of good practice, promoting changes to current and future practice, and could be considered a training tool.

Take-home messages: PTWR leadership represents a training need and efforts should be made to aid trainee development, potentially through a checklist model.


Foundation Doctor Leadership in Friday Handover: How a pilot medical rota redesign produced unexpected benefits

Nik Tomanovic (William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust , General Medicine, Kennington Road, Willesborough, Ashford, Kent TN24 0LZ, United Kingdom) Bandipalyam Prathibha (William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Respiratory Medicine, Ashford, Kent, United Kingdom)

Background: In response to profound changes brought about by the European Working Time Directive, East Kent Hospitals University NHS Foundation Trust has engaged in a Health Education England pilot to redesign the medical rota. Creating "hot" and "cold" teams has led to an enhanced weekend ward-cover team, adding a registrar, senior nurse and healthcare assistant to the Foundation doctor covering the medical wards. Summary of work: Designating a ward-cover team has improved Friday handover in terms of highlighting patients requiring review, important jobs to be completed and potential discharges. Due to hospital practicalities, this process has been led by Foundation doctors, allowing them to practice and develop many of the qualities outlined in the Medical Leadership Competency Framework.

Summary of results: In leading the handover meeting, on-call Foundation doctors have taken the opportunity to use their clinical knowledge to: obtain necessary information, triage patients accordingly, discuss difficult cases, question the indication or importance of certain requests, and subsequently use that information to lead the ward-cover team by setting priorities and allocating time and resources appropriately. Conclusions: This scheme has succeeded in ensuring that patients are reviewed in a timely fashion by appropriate people, that investigations ordered are


justified and that resources are maximised. This has led to an overall reduction in mortality and an increase in safe discharges over the weekend. Take-home messages: Allowing appropriately supported Foundation doctors to take the lead in Friday handover meetings, and thereafter guide the ward-cover team's duties, has provided valuable opportunities to develop their medical leadership competencies whilst still providing better care to patients.


What is the return on investing in Leaders of the Future: The Yorkshire and The Humber Deanery "Fellows in Clinical Leadership" Programme?

Rebekah Molyneux (Yorkshire and The Humber Deanery, Hull Institute for Learning and Simulation, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, United Kingdom) Madeleine Macdonald (Sheffield Teaching Hospitals, Obstetrics and Gynaecology, Sheffield, United Kingdom) Faiza Chowdhury (Yorkshire and The Humber Deanery, Hull Institute for Learning and Simulation, Hull, United Kingdom)

Henry Reynolds (Bradford Teaching Hospitals, Anaesthetics, Bradford, United Kingdom) Kirsty Forrest (Yorkshire and The Humber Deanery, Clinical Education at Yorkshire and The Humber Deanery, Leeds, United Kingdom)

Background: The development of leadership skills in doctors has been highlighted as essential for effective and safe patient care. The Yorkshire and Humber Deanery has introduced 35 (2012-13) Management and Leadership Fellowships for specialty trainees. Summary of work: The trainees are involved in projects that enable them to gain practical and academic competencies in medical education, patient safety, service evaluation and leadership from local and national experts in the field. The Fellows are also funded to complete an academic qualification. Summary of results: The Fellows' outcomes for one year will be assessed using a tool which consists of matching projects completed, with the five domains of the Medical Leadership Competency Framework. Qualitative data will also be collated to show the impact that interventions have had in several areas; eg the number of trainees benefitting from an educational intervention. Conclusions: Trainees are encouraged to continue personal development in areas relating to leadership, education and management. This ensures the creation of a solid foundation upon which to build their future careers. In addition, organisations will also benefit from the outcomes of the projects undertaken by each fellow. Take-home messages: The end of year assessment of the Fellow, using the outcome tool, will act as evidence for the stakeholders to quantify return of investment, allowing for future strategic planning.


Management programme for junior doctors at the University of Helsinki

Minna Kaila (University of Helsinki, Hjelt Institute, POB

41, Helsinki 00041, Finland)

Taina Mantyranta (Karolinska Institute, Medical

Management Centre, Stockholm, Sweden)

Santeri Huvinen (University of Helsinki, Hjelt Institute,

Helsinki, Finland)

Marjo Parkkila-Harju (City of Helsinki, Department of Social Services and Health Care, Helsinki, Finland) John Ovretveit (Karolinska Institute, Medical Management Centre, Stockholm, Sweden) Mats Brommels (Karolinska Institute, Medical Management Centre, Stockholm, Sweden)

Background: Effective clinical leadership has been shown to improve patient outcomes, and patient and provider satisfaction. Published literature indicates that medical schools provide little or no structured management training for young doctors. Summary of work: Since August 2009 a management development programme of 30 ETCS is mandatory for all physicians and dentists in specialty training, with around 250 starting annually in Helsinki. A framework for competencies was developed nationally. The aim is for participants to obtain knowledge, skills and attitudes of frontline clinical managers. The individually planned programme can be completed in 3-5 years. The design is based on principles of experiential learning. Summary of results: Real-life experiences of the young doctors are systematically used. Effective interactive adult learning facilitation and problem and case-based learning methods as suitable for these learners are used. Both individual and shared reflection is endorsed. Practice-based improvement projects allow active experimentation and create concrete experiences. An e-learning platform and e-portfolio enhance individual planning, tailoring and evaluation of learning. Evaluation of improvements in learning and practice will be gathered.

Conclusions: A mandatory management development programme as part of specialist training gives frontline management competence to young physicians and dentists.

Take-home messages: Young doctors receive structured management training to become competent frontline clinical managers.


Leadership Assessment in the Consultant Application Process: How prepared are our SAS Doctors?

Rags Subramaniam (East Kent Hospitals University NHS

Foundation Trust, Medical Education, Queen Elizabeth

the Queen Mother Hospital, Education Centre, Ramsgate

Road, Margate CT9 4DD, United Kingdom)

Susan Kennedy (East Kent Hospitals University NHS

Foundation Trust, Medical Education, Canterbury, United



Adrian Simoes (East Kent Hospitals University NHS Foundation Trust, Medical Education, Canterbury, United Kingdom)

Background: Trusts are using leadership assessment tools as part of the application/ interview process for consultant posts. In East Kent Hospitals University NHS Foundation Trust (EKHUFT), we found internal applicants were ill-prepared for such assessments. Our objective was to work with potential SAS doctors applying for consultant posts, using a devised intervention to improve their preparedness and confidence levels and help identify specific professional development needs.

Summary of work: Participants were sent current, sample leadership assessment materials. These consist of scenarios requiring applicants to submit a report and a presentation in advance of interview which are scored against a leadership competency framework. An online questionnaire was followed up with a workshop. After this intervention, a follow-up questionnaire was sent. Summary of results: The pre-intervention survey showed most SAS doctors were under-confident in the specific requirements of the leadership assessment tasks. They lacked knowledge of the leadership competencies required, including presentation formats. The workshop provided details of leadership competencies, including scoring scheme and how these could be demonstrated in interview reports, presentations and group scenarios. A subsequent questionnaire revealed greatly improved confidence, greater preparedness, and a clearer awareness of the need for and ways to make explicit, in different formats, those required leadership competencies. SAS doctors also identified CPD needs and a need to extend the project to promote their career progression. Conclusions: SAS doctors have clear leadership skills and potential but need and welcome support in preparing for the explicit demonstration and assessment of those skills at consultant interview.


Building Leadership and Management Competencies Among Nurses

Jui-Chen Tsai (Taipei Medical University-Shuang Ho Hospital, Nursing Department, No.291, Zhongzheng Rd., Zhonghe District, New Taipei, 23561, Taiwan) Meei-Ling Shyu (Taipei Medical University, College of Nursing, Taipei, Taiwan)

Background: The purposes of this study are: 1) to explore the current competencies of nursing managers in leadership and management; 2) to assess nurses' needs in building leadership and management skills; 3) to design continuing education courses for nurses in developing leadership and management competencies. Summary of work: The study methods include systematic review of the literature, cross-sectional survey, and expert focus group discussion. The targeted population is nursing managers who work at medical centers or area hospitals for at least 6 months in Taiwan.

Stratified randomization is used to select study subjects. This study will employ two self-constructed questionnaires, "Nursing Manager's Self-Awareness of Leadership and Management Competencies" and "Needs Assessment of Nurses in Building Nursing Leadership and Management Skills", with adequate expert content validity, internal consistencies, and test-retest reliability. Data analyses include descriptive statistics (frequency, percentage, mean, and standard deviations), T test, univariate analysis of variance, Scheffe's posteriori comparison, and Pearson's correlation.

Summary of results: Nursing managers consider their leadership and management skills are insufficient, especially for males. They think that they need to be trained.

Conclusions: Results from the systematic review of the literature and the cross-sectional survey, as well as continuing education courses related to nursing leadership and management in Taiwan and abroad will be provided to experts before conducting focus group meeting, in order to design a set of continuing education courses that meet nurses' needs in developing leadership and management competencies.


Leadership Roles for Training Doctors in Change Implementation

Anupkumar Patel (East Kent Hospitals University NHS Foundation Trust, Medical Education Directorate, William Harvey Hospital, Kennington Road, Willesborough, Ashford TN24 0LZ, United Kingdom Prathibha Bandipalyam (East Kent Hospitals University NHS Foundation Trust, Medical Education Directorate, Ashford, Kent, United Kingdom) Susan Kennedy (East Kent Hospitals University NHS Foundation Trust, Medical Education Directorate, Ashford, Kent, United Kingdom)

Background: East Kent Hospitals University NHS Foundation Trust, using funding awarded by Health Education England under the Better Training Better Care project, have been piloting a new medical rota with an enhanced weekend team, managing the care of ward-based in-patients that is led by an additional registrar. Summary of work: The role of the registrar has been key in changing service delivery and implementing the new changes. One registrar has been a permanent member of the Project Management Team and others regularly attend meetings. The project has seen registrar involvement in designing the new rota, in designing/implementing an improved Friday handover, in leading the weekend team and in liaising with both consultant and foundation level colleagues. Summary of results: Using the Medical Leadership Competence Framework (MLCF), registrars have been able to log development in all seven domain areas. Proactive engagement in the project has involved registrars in team-working with a wide variety of stakeholders, in resource-utilisation, in financial planning, audit and in national presentations. Health


Education England have been delighted to see the active leadership demonstrated. Early results for the project over 4 months have been very encouraging and show more pro-active care, reducing mortality, improved rates of appropriate discharge and decreasing length of stay.

Conclusions: It can be easy to think that bringing about change is someone else's job. Collaborative project management that involved training doctors from the very beginning has demonstrated continuing enthusiasm, drive and initiative and real leadership in those training doctors.

Take-home messages: Involving training doctors in projects will develop their leadership competencies and will help bring about purposeful change that improves patient care and training.


Getting down to business - is there a role for the independent-sector in the undergraduate medical curriculum?

Adam M Gwozdz (UCL Medical School, Department of Medical Education, London, United Kingdom) Liana Zucco (St. George's University of London, Division of Biomedical Sciences, London, United Kingdom)

Background: The landscape in UK healthcare is such that there is increasing focus on improving patient care through management and leadership. However, the process of developing these skills at an undergraduate level appears restricted to supported experiences in non-clinical environments. This project explores the educational outcomes of the independent-sector's participation in a UCL Medical School student selected component (SSC).

Summary of work: A medical management and leadership SSC was designed for first year undergraduate medical students at UCL. It comprised a series of eight seminars and workshops with participation by KPMG, a management consultancy firm with a strong presence in healthcare, and BUPA, a multinational healthcare corporation. Summary of results: Students who completed the SSC have measurably enhanced their leadership competencies, as defined by the Medical Leadership Competency Framework. Feedback from our students revealed three recurrent themes: speakers from KPMG and BUPA were identified as the aspect of the course which most facilitated students learning; students unanimously agreed that they observed high standards of professional behaviour that they would like to emulate; and students felt well-prepared for their future profession after taking the SSC. Conclusions: The independent-sector exposes undergraduate medical students to a broader healthcare eco-system. Early exposure in the medical curriculum is key as it gives students the opportunity to develop their leadership and management skills without needing to organise self funded management-oriented internships later in their course.

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