‘Wargaming with the chiefs’: A novel pre-mortem exercise to enhance communication and well-being among ‘top gun’ chief residents

Abstract

Pilots who complete the ‘TOPGUN’ program return to their squadrons as elite leaders and instructors. Physicians from all specialties who are selected to become Chief residents can also be viewed as ‘Top Guns’, as they are the ‘cream of the crop’; having been chosen to be the leaders and role-models for all the other residents in their programs. Yet, unlike Top Gun pilots, Chief residents are arguably only minimally prepared for this new role. Wargaming involves generating every possible bad outcome and brainstorming contingencies for these possible outcomes. We developed an exercise for the incoming Chiefs (ICs) and outgoing Chiefs (OCs) in four specialties: Family Medicine, Internal Medicine, Neurosurgery, and Neurology. Following this exercise, 100% of the Chiefs in all four programs indicated that this activity was beneficial and the majority agreed that wargaming improved communication and their own feelings of well-being. Based on our trainees’ feedback, it appears that wargaming is a simple, fun, and highly-interactive exercise which increases perceived control among ICs and allows OCs the chance to reflect and share their knowledge and experience with the new Chiefs. This activity also seems to enhance communication and feelings of well-being among both incoming and outgoing Chief residents.

Acknowledgements

Special thanks to Dr. Kenneth D. Stahl for sharing his vision of utilizing ‘wargaming’ to improve patient safety in the operating room and to Rob Wubbenhorst and Dave ‘Bio’ Baranek for providing us with invaluable information about wargaming, aviation and that most stellar group of pilots, TOPGUN.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Heidi Allespach

Heidi Allespach, PhD, is an Associate Professor of Clinical Family Medicine, Medicine and Surgery at the University of Miami Miller School of Medicine (UMMSM). In addition, she is the Director of Behavioral Medicine in the Family Medicine, Internal Medicine, Surgery and Neurology Residency and Fellowship Programs at UMMSM/Jackson Memorial Hospital (JMH).

Stefanie Brown

Stefanie Brown, MD, is an Assistant Professor of Pediatrics and Internal Medicine and serves as Program Director of the internal medicine residency program at UMMSM/JMH. She holds additional roles as section chief for Pediatric Hospital Medicine and Med-Peds. She has been teaching in a clinical setting for 19 years.

Kassandra M. Bosire

Kassandra M. Bosire, MD, is an Assistant Clinical Professor and the Residency Director for the Department of Family Medicine and Community Health at the University of Miami Miller School of Medicine. She has been teaching medical students and residents for the past seven years while still maintaining her private practice.

Leticia Tornes

Leticia Tornes, MD, is an Associate Professor of Clinical Neurology and serves as Program Director of the neurology residency program at UMMSM/JMH. She is also the Associate Vice Chair for graduate education in Neurology and has been teaching in medical education for seven years.

Stuart Bagatell

Stuart Bagatelle, MD, has been the Program Director of the University of Miami/JFK internal medicine residency program since 2017. Dr. Bagatell received his Bachelor of Science degree from Cornell University in 1997 and his MD from Tulane University School of Medicine in 2004.