Approaches for Curriculum and Assessment in Leader and Leadership Education and Development Programs in American Medical Schools

This article was migrated. The article was marked as recommended. Problem: There is a growing call to add leader and leadership education to undergraduate medical education (UME). Yet, there currently are no established standards, competencies, curricula, or requirements for UME leader and leadership education and development (LEAD) programs. The Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine LEAD program hosts annual Summit and Working Group meetings to address issues and to share experiences about LEAD programs. Approach: Based on survey results following the 2017 USU LEAD Summit, working group participants reported that the meeting was valuable, should be repeated, and should address the specific topics of curriculum and assessment. Therefore, the 2018 Summit’s goal was for participants to share experiences, ideas, and ways forward regarding leader and leadership curricula and assessment measures for UME. Themes from working groups were compiled and reported. Outcomes: Themes within LEAD curriculum include: (1) what to teach: relevant knowledge, skills, and abilities/attitudes (KSA) for specific topics; (2) when to teach: a life-cycle program woven through UME into graduate medical education and beyond; and (3) how to teach: near peers, development of mentors, and near-term, practical applications of skills. Themes within LEAD assessment include: (1) what to assess: alignment with program goals and curriculum within a positive culture of assessment and trust; (2) when to assess: occur at times that are consistent with the learning objectives and curriculum to provide information on incremental “growth” of students and the program; (3) how to assess: use formative and summative, qualitative and quantitative measures that are reliable and valid. Next steps: Based on feedback from working group participants at the 2018 Summit, the USU LEAD team will host a third Summit in April 2019 focusing on leader and leadership education and development across the healthcare work force life cycle.


Problem
Undergraduate medical education (UME) requirements already are extensive and the continuous introduction of new procedures, instruments, medications, and record systems keep adding more to learn.In addition, there is a growing clarion call to add leadership education to UME (Webb et al., 2014;Frich et al., 2015;Neeley, Clyne and Resnick-Ault, 2017;Grunberg et al., 2018).According to the AAMC, leadership is "the most critical component for success (Association of American Medical Colleges)."Yet, there currently are no established standards, competencies, curricula, or requirements for UME leader and leadership education and development (LEAD) programs (where leader refers to human capital and leadership refers to social capital (Day, 2001)).An increasing number of medical schools are offering LEAD programs (Hargett et al., 2017;Barry et al., 2018;Hopkins et al., 2018) and many are sharing information relevant to their LEAD curriculum and assessment instruments.Among these efforts, the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine LEAD program -that trains healthcare professionals, officers, and leaders for the United States Air Force, Army, Navy, and Public Health Service -hosts annual Summit and Working Group meetings (beginning in 2017) to address issues and to share experiences about LEAD programs.

Approach
The annual USU LEAD Summit and Working Group meetings are convened for faculty and staff from U.S. Schools of Medicine, service academies, and related professional organizations to address issues relevant to health workforce leader and leadership education and development.At the 2017 Summit, participants shared opinions, experiences, and best practices regarding medical school leadership programs (Grunberg et al., 2018).Based on survey results following the 2017 Summit, participants reported that the meeting was valuable, should be repeated, and should address the specific topics of curriculum and assessment.Therefore, the 2018 Summit's goal was for working group participants to share experiences, ideas, and ways forward regarding leader and leadership curricula and assessment measures for undergraduate medical education (UME).
The Summit began with an overview of the schedule, purpose, and introductions of participants.The morning session focused on small working group discussions of curriculum followed by a networking opportunity and then a plenary discussion of major points raised in the small group discussions.The afternoon session focused on small working group discussions of assessment followed by further networking and then a plenary discussion of major points raised in the working groups.The meeting concluded with a large group discussion of next steps.
Similar to the 2017 Summit, (Grunberg et al., 2018) working group participants included individuals from public and private U.S. medical schools engaged in leader and leadership education and development.Working group participants also included individuals from: United States Military Academy (USMA), United States Naval Academy (USNA), United States Naval War College, and Marine Corps University.In addition, representatives from the Association of American Medical Colleges (AAMC) and Veterans Administration (VA) participated (see Table 1).
There were six working groups composed of six to seven participants representing different organizations, demographics, and perspectives (e.g., physicians, nurses, psychologists, health profession educators, researchers, administrators).Each group had a facilitator who was given a list of questions to help guide the discussions (see Tables 2 and 3).Both morning and afternoon small group sessions lasted 60 minutes; networking sessions were 30 minutes; large group discussions were 30 minutes.
Facilitators recorded the main points from each discussion and submitted these notes to the Summit organizers.Three coders (who were small group facilitators -a senior faculty member, a junior faculty member, and an education specialist) independently analyzed the submitted notes from all six working groups.Coders were instructed to identify three to five themes into which the individual points regarding curriculum could be categorized and three to five themes into which the individual points regarding assessment could be categorized.The three coders met to compare and discuss their initial classification results.There was complete agreement among the three coders that the points raised in all working groups could be classified into what, when, and how for curriculum and for assessment.There was substantial agreement among the three coders with regard to the classification of the many individual points recorded by facilitators; differences were resolved by discussion and majority consensus among the three coders.The outcomes (see below) reflect these findings.

Outcomes
Curriculum What to teach.All working group discussions indicated that LEAD curriculum should teach knowledge, skills, and abilities/attitudes (KSA) relevant to effective and successful performance as a leader.KSA topics most frequently mentioned were: professional identity as healthcare leaders, medical ethics, emotional intelligence, and teamwork.
Table 1.List of working group participants and their affiliations.

Working Group Participants Institution
Gene Andersen, MA This review has been migrated.The reviewer awarded 4 stars out of 5 This work offers an excellent example of cross-institutional collaborations on key important issues relevant to medical education, which could be adopted by other health disciplines.I think there will be still a substantial body of work to be done to identify/manage the expectations and develop a program that will address the learning needs of the delegates at the Summit.An evaluation of the LEAD program could be developed to articulate how the program impacts on learning.I would be great to discuss how these themes identified may or may not be similar to those reported in the medical education literature on leadership.
Competing Interests: No conflicts of interest were disclosed.

Richard Hays James Cook University
This review has been migrated.The reviewer awarded 4 stars out of 5 This paper addresses a topical issue that should be of interest to many readers.We are in an era when leadership is spoken of often as a need to lead health care through challenging times.A common response is to teach and assess leadership, often from the beginning of medical education.While this is sound, in principle, it opens big questions, such as 'how much more can we fit into the curriculum', 'how does this integrate with learning clinical medicine', and 'how do we assess something that is so hard to measure?'.Some useful resources are available, such as the Leadership Development Framework in the UK, and this document will be another useful resource.However, many approaches and frameworks assume that medical doctors will be the leaders and in fact can be from a young age with little or no preparation.At risk of sounding like an 'over the hill' red wine, my experience has shown that leadership develops with experience, based on reflection, self-awareness, humility, values, respectful communication and learning from mistakes.I am not sure how this journey can be shortened, but to me that is the main purpose of leadership frameworks.Start slow, with awareness and discussing examples of strong, sound and perhaps just different leadership styles.The best time to expand may be the late undergraduate/early GME periods, when individuals often feel least empowered, with leadership experience, reflection, feedback and assessment in-context.I worry that we may be asked to deliver another linear, milestone-assessed curriculum theme, with teaching and assessment methods that are not well suited to this task.This may be too important a topic to risk engendering in early career doctors This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.