BMJ Leader最新文献

Background: Effective clinical leadership is required at every level, including in Foundation doctors. Most leadership programmes neglect self-awareness and personal growth aspects of leadership training. We modified the Basildon Leadership Hub to focus on these aspects and evaluated the new programme.

Methods: Large group sessions were led by speakers with varied leadership roles, interspersed by breakout sessions incorporating experiential and reflective learning. Attendees answered anonymous surveys before, immediately after, and 2 months after the workshop, with 5-point Likert-scale responses (1=strongly disagree to 5=strongly agree) designed around reaction, knowledge and behaviour levels of evaluation. We assessed differences in median responses using the Mann-Whitney U test with Bonferroni-Holm correction.

Results: The full-day workshop was attended by 27 trainees, 93% of whom considered it enjoyable and relevant. Attendees agreed more strongly to the statements 'I am a leader' and 'I know how I can demonstrate and develop my own leadership knowledge, skills and behaviours' in postcourse versus precourse surveys (p<0.001). The follow-up survey had a poor response rate of 26% with non-significant differences.

Conclusion: A full-day leadership workshop for Foundation doctors focusing on personal growth resulted in improvement in self-assessed precourse and postcourse knowledge and attitudes; however, poor follow-up response rate limited demonstration of sustained outcomes or changes in behaviour.

Background: Paediatric professional scarcity and uneven distribution is acute in underdeveloped regions, exacerbated by COVID-19's workload surge and burnout, highlighting the need for strengthened prevention and response measures.

Aim: Propose an effective talent management model to address the challenge of paediatric medical personnel shortage and lack of management experience in Underdeveloped cities of developing countries.

Methods: A crisis management plan has been implemented in a paediatric hospital in Henan, China, with a talent framework to ensure a skilled, stable workforce.

Results: An advanced talent management system is vital to address paediatric talent scarcity. Leveraging the national Children's Regional Medical Center, fostering international cooperation, sharing knowledge and harnessing regional policies are key to effective paediatric talent management through leveraging, promotion, and driving initiatives.

Conclusions: Efficient talent management methods have a significant positive impact on addressing the paediatric talent crisis, enabling departments and institutions to effectively manage medical talent through scientific strategies, ultimately contributing to the alleviation of medical resource deficiencies.

Background: Radical cystectomy has the potential to be a curative strategy for patients with aggressive bladder cancer. Emerging evidence over the last 20 years has shown that minimally invasive surgical approaches using robotics in performing this highly complex and morbid operation can achieve the same oncological outcomes while reducing complications for the patient.

Objective: This paper aims to present a managerial and leadership roadmap for change to robotic cystectomy for patients with advanced bladder cancer to achieve improved patient outcomes while embracing technological developments in the delivery of cancer care.

Methods: Using the Irish Health Service Executive guide for change, we propose and detail a three-stage plan (define, design and deliver) to guide the organisation from the concept of the transition to performing the first operative case.

Results: A walkthrough from identifying a vision for change for robotic cystectomy to designing a step-by-step process is discussed. By providing a template for success, this approach can be applied to any health jurisdiction worldwide and can be adapted as needed.

Conclusion: Although challenging, major change within the healthcare setting through a structured approach provides a valuable opportunity for a department to grow, develop and become a champion of patient care.

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.