BMJ Leader最新文献

Background: Residents need and want practical leadership training, yet leadership curricula are lacking in graduate medical education (GME). We describe our process of curriculum mapping, a method for auditing a curriculum, and its role in iterative leadership curriculum development.

Aims: To show how to create a curriculum map for auditing a curriculum using examples from our leadership curriculum and to demonstrate its value through case examples of leadership education integration into existing resident experiences.

Methods: We selected our recent systematic review on current leadership curricula to prioritise leadership content given it was the basis for our initial curriculum. We identified existing resident experiences where training can occur. We use the selected content and training environments, layered with a modified Miller's pyramid, to construct a curriculum map.

Results: Our curriculum map provides an example of curriculum auditing that reveals opportunities for leadership training that could be integrated into current residency experiences. We provide case examples of application.

Discussion: Effective leadership training should address critical topics and capitalise on experiential learning opportunities that exist within residency training programmes. The training must be seamlessly integrated into the demanding obligations of GME trainees, a process that can be achieved using curriculum mapping. Curriculum mapping can provide insight into a residency programme's leadership curriculum and create a direction for future leadership curriculum development.

Background/aim: Overweight and obesity (OAO) is a major and growing public health crisis in the world. There is convincing medical evidence that caloric overconsumption, rather than lack of exercise, is the primary driver of OAO.

Methods: In this translation piece, we summarise our programme of research on laypeople's beliefs about the primary cause of OAO, the origins of these beliefs and implications for clinicians and leadership in healthcare organisations.

Results: In contrast to the medical consensus, our research conducted in several countries has found that approximately half of the population mistakenly believes that lack of exercise is the primary cause of obesity. These misbeliefs have consequences: people who mistakenly believe that exercise is the most important factor are more likely to be overweight or obese than people who correctly believe that diet is the primary cause of obesity. We argue that these misbeliefs are caused in part by systematic and multipronged communications efforts by the food and beverage industry-a phenomenon we term 'leanwashing'.

Conclusions: Not only does leanwashing require public policy intervention by the government, healthcare professionals also need to respond appropriately. In this article, we focus on the implications of leanwashing for leaders of public health organisations, health delivery organisations and clinicians.

Objectives: To understand the impact of public discourse and reaction around the COVID-19 pandemic on healthcare worker (HCW) experiences and well-being caring for patients with COVID-19.

Methods: We conducted 60 min in-depth interviews with 11 physicians and 12 nurses who were providing care to patients with COVID-19 in acute care settings at two health systems in the Western USA. Interviews were conducted in Spring-Summer 2022 using a semi-structured interview protocol that guided respondents through different stages of the pandemic.

Results: Three themes emerged from the data around providing care in the unique social context of the COVID-19 pandemic including: (1) public polarisation and disagreement with science; (2) feelings of hope and optimism during the pandemic and (3) the compounded strain of providing care within this unique social context of the pandemic.

Conclusions: To prepare for future pandemics, improved public health communications and social-emotional supports for HCWs are critical to ameliorate the physical and emotional impacts related to the social context of modern US pandemic response.

Introduction: There is a notable gap in studies examining the impact of gender within sociocultural norms in non-western professional settings, especially concerning the well-being of women physicians.

Methods: Using purposive sampling and thematic data analysis, we recorded interviews with 30 physicians in India during May-July 2023. Participants were aged 34 to 65 years, with experience ranging from five to 35 years, in various clinical (37%), surgical (30%), paraclinical (23%) and hospital administration (10%) roles, 97% were postgraduates and 53% were women. The research questions explored how leadership roles happened, managing key challenges, barriers and enablers, and practical interventions to support women into medical leadership positions.

Results: Findings revealed that the majority of interviewees believed gender-related barriers were obstructing women's progress and success in medical leadership roles in India. These barriers were identified within three overarching domains: (1) specialty, (2) organisational and (3) sociocultural. Interviewees commonly acknowledged the male-dominated landscape of medical leadership although some women stated that they did not perceive any barriers for women's advancement into leadership roles. Interestingly, some men surgeons held the perception that women might not be as effective in certain surgical disciplines, such as orthopaedics and neurosurgery. Some men physicians, however, considered women physicians in India to be highly effective multitaskers.

Conclusion: We recommend structural reforms in medical education, leadership development, workplace systems and cultures, and improved implementation of equality, diversity and inclusion policies in the Indian context.

Background: The complexity of US healthcare has been increasing for many years, requiring clinicians and learners to understand care delivery systems in addition to clinical sciences. Thus, there has been a major push to educate faculty and trainees on healthcare functionality. This comes as hospitals expand into health systems requiring the help of more sophisticated expertise of departments such as operations excellence when problem-solving. As a medical student with a background in operations excellence, medical education leader and clinical administration leader all currently facilitating this transition, we wanted to reflect on the barriers we have experienced in clinical implementation of quality improvement projects and educating learners on the impact of operations excellence principles in their clinical education.

Methods: The ideas presented in this article were the result of a several collaborative discussion between the authors, on the key challenges to adopting operations excellence principles into health system science education. In an effort to add context to this reflection through the current body of research present, they supplemented a literature review on the topic which included 86 studies published between 2013 and 2021 regarding health systems science and healthcare leadership engagement in the USA. The themes that intersected between the literature review and the discussions were then expanded on in this paper.

Results: Through this process, we identified four challenges: (1) the difference in thinking styles, which we term, 'mental model differences'; (2) the strategic nature of process improvement projects and how that collides with physician priorities, or 'the chess game of stakeholder engagement'; (3) the language and precise methodology, or 'consistency of language and need for administrative resilience' and (4) the issue of teaching these concepts or bridging the learning gap.'

Conclusion: In an increasingly complex healthcare landscape, physicians and trainee's need to bridge gaps between the mental models of administrative and clinical workflow.

Objective: This scoping review seeks to understand how kindness, compassion and empathy are defined and conceptualised within existing healthcare services literature.

Introduction: Little consensus exists on how healthcare literature defines and conceptualises kindness. Kindness is often conflated with the terms compassion and empathy, which both have more prominence in the literature. However, evidence would suggest that all three terms are indeed different. To advance kindness as a key tenet of quality improvement and human experience outcomes in healthcare, a consensual definition must be established in the evidence base.

Methods: We reviewed published research identified using search queries across five databases and one search engine. Studies were included in this review if the definition, measurement and/or conceptualisation of kindness, empathy and/or compassion were stated objectives of the work and the research was directly relevant to healthcare settings.

Results: 1348 results were screened, and with additional snowballing of some articles for relevant references, 107 progressed to full-text screening. Forty-two articles were subsequently included in this scoping review. By synthesising this evidence, we establish key commonalities and differences for kindness, compassion and empathy. We present a model for understanding how empathy, compassion and kindness can be viewed on a stimulus-response-action continuum. We also explore the definitional challenges expressed by many authors who call for these terms to be treated as separate concepts.

Conclusions: This review evidence demonstrates that kindness, compassion and empathy have clear themes that stand them apart, and they occupy different places on the stimulus-response-action continuum. Importantly, kindness deserves its own place in literature as a primary concept, not as a second tier to compassion or empathy. By comparing each term, these positions are now highlighted. They can help us to more articulately define, conceptualise and value kindness, compassion and empathy for their unique contributions to the humanity of healthcare.