BMJ Leader最新文献

Background: In the landscape of Indian healthcare, the role of leadership in addressing disparities and driving change is often overlooked, particularly within medical education. Through the lens of the author journeying from a volunteer to ultimately a leader of a student-led non-profit organisation, this article explores the reason, rhyme and possible resolutions to the quiet effect of lacking leadership in healthcare education.

Methods: Drawing from personal experience and reflections, the article highlights the profound impact of grassroots initiatives in reaching underserved populations and how inadequate leadership hindered their ability to scale effectively. Insights into the challenges encountered and the barriers that needed to be overcome have been elaborated to unravel the possible origins of this problem and address potential solutions throughout various levels of health education.

Results: Although there is rarely a simple solution to a complex challenge, building adequate mentorship and support can help sustain leadership efforts in leadership by providing a pillar to lean on without diminishing individualised effort for growth. Cultivating collaborative networks can further provide opportunities to kindle the flame of leadership among young doctors.

Conclusions: By fostering a culture of leadership, medical education can produce professionals who are skilled clinicians and innovative leaders capable of driving change in the community.

Objective: To identify leadership qualities associated with psychological safety among physician faculty in a large medical centre in New York City.

Patients and methods: An anonymous, institution-wide cross-sectional survey was sent to all physician faculty with clinical responsibilities between July and September 2022. Demographic and occupational characteristics were assessed. Perceived leadership effectiveness was measured with the nine-item Mayo Leadership Index and psychological safety was measured using the seven-item Fearless Organisation Questionnaire. Multivariable logistic regression analyses were conducted to determine associations between leadership, psychological safety, and demographic and occupational correlates of psychological safety.

Results: Of 3086 eligible clinical faculty members, 867 (28.1%) physicians with clinical responsibilities participated. On average, 57.6% of physicians reported that their workplace was psychologically safe and the majority agreed with items on the Mayo Leadership Index (60.0%-84.5%), the most prevalent being 'treats me with respect and dignity,' 'employs me to do my job' and 'encourages employees to suggest ideas for improvement.' In a multivariable model, higher overall leadership index scores were positively associated with psychological safety scores.

Conclusions: Greater perceived leadership effectiveness was positively associated with psychological safety among clinical physician faculty at a large, urban hospital. These results suggest that organisational investment in promoting leadership effectiveness may have positive downstream effects on healthcare delivery, burn-out and attrition rates.

Objective: Examine relationships between religiosity, workplace discrimination, religious accommodation and related professional and psychological outcomes among UK Muslim physicians.

Methods: In 2021, a national survey of British Islamic Medical Association members was conducted. Statistical analyses explored associations between participant religiosity, sociodemographic characteristics and the specified outcome measures.

Results: Out of 104 participants with a mean age of 39, the majority were male (56%), Asian (81%), adult immigrants to the UK (56%) and wore a beard or a hijāb (73%). Workplace experiences revealed that 40% experienced discrimination primarily based on religious identity, with 44% facing regular discrimination since medical school. Notably, 38% reported current workplace discrimination, 15% encountered patient refusals based on religion and 56% felt heightened scrutiny due to religious identity. Most struggled with prayer at work (69%), and 28% felt inadequately accommodated. In multivariate models, religiosity was associated with experiencing discrimination from patients and struggle with prayer accommodation at work but increased the odds of perceiving religious identity to be accommodated at work. Notably, participants wearing hijāb or a beard reported higher job satisfaction and lower odds of burn-out and depression. Increasing participant age lowered the odds of burn-out but increased the odds of religious discrimination at the current workplace and over one's career, as well as being passed over for professional advancement.

Conclusion: These findings underscore the urgent need for the National Health Service to address religious discrimination in the workplace by implementing policies that accommodate the workplace needs of Muslim physicians.

Background: Physicians are planful beings, spending much time imagining and trying to design their ideal careers. Yet, despite actuarial expectations that physicians may spend almost two decades in retirement, it is paradoxical that little attention is generally given to designing an ideal retirement.

Methods: The coauthors are physicians in the latter parts of their careers who both teach leadership to physicians and have thought deeply about physician transitions, including retirement. This perspective narrative is based on their observations, actual experience of colleagues who have retired well and their review of relevant literature.

Results: Several forces restrain physicians from imagining an ideal retirement: first, as with people in general, physicians may be averse to change, and second, thinking about retirement may be framed through a deficit-based lens (eg, "I am retiring because I want to avoid some unpleasant features of my current career.") Though physicians are predisposed to deficit-based thinking by virtue of their longstanding practice of developing differential diagnoses in clinical reasoning, appreciative or asset-based thinking about retirement (eg, "I am retiring because I am attracted to activities that have not otherwise been possible in my career.") offers richer possibilities and is encouraged. A rubric for navigating retirement regards being intentional about identity, relationships and purpose in the new state. A taxonomy for types in retirement is offered, recognising that physicians may exemplify more than one type or migrate among them. Finally, several examples of successful retirement by the authors' colleagues are offered.

Conclusions: We endorse physicians' being as planful and intentional about retirement as they are about designing their careers. Our hope is that the described issues and approach enhance physicians' likelihood to achieve the fulfilment and impact in retirement that they seek.

Background: High burnout and low retention rates among trainee doctors threaten the future viability of the UK medical workforce. This study empirically examined factors that can sustain trainee doctors.

Method: A total of 323 trainee doctors from 25 National Health Service (NHS) Trusts in England and Wales completed an online survey on their training and employment experiences. A mixed method approach was employed.

Results: Structural equation modelling revealed that perceived compassionate leadership of hospital senior leaders (CLSL) (i.e., doctors in senior clinical and management positions, and senior managers) is directly and negatively associated with trainee doctors' burnout and intention to quit. We propose the associations may be indirectly strengthened through two mediating pathways: increased psychological contract fulfilment (PCF) of training/organisational support and reduced worry about the state of the NHS; however, only the former is supported. The model can explain a substantial 37% of the variance in reported burnout and 28% of intention to quit among trainee doctors. Being a Foundation Year (FY) trainee was significantly associated with poor PCF and burnout. Rich qualitative data further elaborated on their experiences in terms of senior leaders' awareness of their training/working experiences, listening to and acting on.

Conclusions: Active and demonstrable CLSL plays a vital role in trainee doctors' retention. It has both direct (through support) and indirect effects through improving trainee doctors' PCF to reduce burnout and intention to quit. This seems particularly valuable among FY doctors. Implications for the development and management of the medical workforce are discussed.

Objective: Achieving gender equity in academic medicine is not only a matter of social justice but also necessary in promoting an innovative and productive academic community. The purpose of this study was to assess gender distribution in dual MD/PhD academic programme faculty members across North America.

Methods: Academic metrics were analysed to quantify the relative career success of academic faculty members in MD/PhD programmes. Measured parameters included academic and leadership ranks along with nominal research factors such as peer-reviewed research publications, H-index, citation number and years of active research.

Results: Χ² analysis revealed a statistically significant (p<0.0001, χ²=114.5) difference in the gender distribution of faculty and leadership across North American MD/PhD programmes. Men held 74.2% of full professor positions, 64% of associate professor positions, 59.4% of assistant professor positions and 62.8% of lecturer positions. Moreover, men occupied a larger share of faculty leadership roles with a statistically significant disparity across all ranks (p<0.001, χ²=20.4). A higher proportion of men held positions as department chairs (79.6%), vice chairs (69.1%) and programme leads (69.4%).

Conclusion: Gender disparity was prevalent in the MD/PhD programmes throughout North America with women achieving a lower degree of professional stature than men. Ultimately, steps must be taken to support women faculty to afford them better opportunities for academic and professional advancement.

Background: Despite efforts to advance equity, diversity and inclusion, women face gender-based barriers in research, including in neurology. Compared with men, women are less likely to hold leadership positions and be senior authors. Gender disparities in grant funding within neurology have yet to be investigated. We examine gender disparities in Canadian Institutes of Health Research (CIHR) funding for Canadian neurology divisions and departments.

Methods: Data on CIHR grant recipients and metrics (grant contribution, duration and quantity) within Canadian neurology divisions and departments between 2008 and 2022 were acquired from the CIHR Funding Decisions Database. Gender identity was determined by a validated application programming interface. Gender-based differences in CIHR grant contribution amount, duration and prevalence within neurology were calculated. Subgroup analysis was conducted for Canadian-licensed neurologists and Project Grant awards.

Results: 1604 grants were awarded to Canadian neurology divisions and departments between 2008 and 2022. Compared with men, women received less funding (p<0.0001), shorter grant durations (p<0.0001) and fewer grants (41.5%) annually. Women comprised the minority of recipients (45.5%) and were less likely to be awarded grants (p<0.001) annually relative to men. Differences were consistent in subgroup analyses, except for equal grant durations observed across genders in Project Grant awards.

Conclusion: We report gender disparities in CIHR grant funding to Canadian neurology divisions and departments. Women receive lower contribution amounts, shorter grant durations and fewer grants than men. Future recommendations include addressing gender differences and continuing to evaluate CIHR funding to provide equal opportunities for women in research and funding.