A Resident-as-Leader Curriculum for Managing Inpatient Teams

Abstract

Problem

Leading inpatient teams is a foundational clinical responsibility of resident physicians and leadership is a core competency for inpatient physicians, yet few training programs have formal leadership curricula to realize this clinical skill.

Intervention

We implemented a 4-module curriculum for PGY1 internal medicine residents. The program focused on the managerial skills necessary for daily clinical leadership, followed by clinical coaching. Interns were first introduced to foundational concepts and then given the opportunity to apply those concepts to real-world practice followed by clinical coaching.

Context

Using direct-observations and a previously published checklist for rounds leadership, this study sought to evaluate the workplace behavior change for novice residents leading inpatient teams for the first time. We conducted a prospective cohort study (March 2016 and August 2018) of internal medicine residents at a large tertiary academic medical center in Boston, MA. Trained faculty raters performed direct observations of clinical rounding experiences using the checklist and compared the findings to historical and internal controls. Questionnaires were distributed pre- and post- curriculum to assess satisfaction and readiness to lead a team.

Impact

We trained 65 PGY1 residents and raters conducted 140 direct observations − 36 in the intervention group and 104 among historical controls. The unadjusted mean score in rounds leadership skills for the intervention group was 19.0 (SD = 5.1) compared to 16.2 (SD = 6.2) for historical controls. Adjusting for repeated measures, we found significant improvement in mean scores for behaviors linked to the curricular objectives (p = 0.008) but not for general behaviors not covered by the curriculum (p = 0.2).

Lessons Learned

A formal curriculum to train residents as leaders led to behavior change in the workplace in domains essential to rounds leadership. We also found that the curriculum was highly regarded in that all interns indicated they would recommend the curriculum to a peer. Moreover, the program may have assuaged some anxiety during the transition to junior year as 90% of interns surveyed felt more ready to start PGY2 year than historical trainings. We learned that while a robust, multi-faceted modular curriculum and clinical coaching successfully resulted in behavior change, the resources required to manage this program are significant and difficult to sustain. Future iterations could include asynchronous material and potentially peer-observation of rounds leadership to reduce the burden on faculty and program curricular time.

Keywords:

• Graduate medical education
• work-place assessment
• clinical coaching
• clinical leadership
• curriculum

Acknowledgments

The authors greatly appreciate the work of Amy Sullivan EdD, and Amy Cohen EdM for their assistance in data analysis as well as Brittany L. Ranchoff MPH, and Christine Beltran for their help with data collection.

Declaration of interests

All authors report no conflicts of interest.

Ethical approval

Ethical approval has been granted by the BIDMC institutional review board protocol number 2016P00041/1

All authors had access to the data, and a role in both writing and critical appraisal of this manuscript.

Funding

The author(s) reported there is no funding associated with the work featured in this article.