Team leadership training for medical residents: results of a pilot study
Jones, Kelsey Erin
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BACKGROUND: Leadership in medicine is a pertinent topic in the modern healthcare system, yet many hospitals and post-graduate programs provide little to no leadership development for resident physicians. Good clinical leadership provides improved patient outcomes and a better work environment for medical staff. OBJECTIVE: The purpose of this study was to pilot a leadership training program for residents and assess it efficacy amongst three different resident groups. METHODS: The pilot curriculum contained three main elements: 360 feedback utilizing the LOFT instrument created by Dr. Eva Aagaard, four 30-minute didactic sessions, and a personal-assessment. In preparation for the curriculum, all residents were required to take an MBTI assessment and subsequent debrief. Residents were randomized into one of four groups to receive either 360 Feedback, didactic sessions, both, or none. The LOFT instrument was designed to assess leadership skills in the clinical setting. Residents selected a minimum of two and maximum of five reviewers to fill out the evaluation before and after their rotation block. Feedback was provided by a professional consulting firm and didactic sessions were lead by University of Colorado faculty. Group size for both feedback and didactic sessions ranged from 1-6 residents. The primary outcome measured was change in LOFT score before and after rotation blocks. Secondary outcomes included change in leadership tactics assessed by the personal survey, and qualitative assessment of residents’ evaluations of feedback and didactic sessions. Cross sectional comparisons of baseline characteristics between randomization groups were made with ANOVA or chi-square. Mixed effects modeling, statistical methodology accounting for clustering by reviewer within resident groups was utilized for evaluating differences in change in evaluation score between treatment groups. RESULTS: 40 residents agreed to participate by filling out an informed consent document, and 29 completed the pilot program in its entirety. We saw an improvement in total LOFT score as well as an improvement in each domain over the course of the intervention (Total: 4.86, p<0.001, Coaching: 1.62, p=0.002, Project Management: 1.81, p<0.001, Self Control: 1.41, p<0.001). However, we saw no significant change in these scores amongst randomization group. In regards to the Self-Control domain, we saw improvement in the lowest scoring group (Q1) for those that received 360 LOFT Feedback. There was no change in the self-assessments before and after rotation block. Overall, the residents rated the curriculum favorably and found it pertinent to their clinical work. CONCLUSION: 360 Feedback on the LOFT assessment was proven to be an effective means of intervention for the lowest scoring participants. While participants found them helpful, the didactic sessions did not show any significant effect on leadership behavior. This study demonstrated overall potential for 360 Feedback using the LOFT assessment as an intervention for leadership improvement in the clinical setting.
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