Systematic Resident and Faculty Leadership Development STFM National Conference 2016 R. Raymond, MDNatividad Medical Center E. Romero, MDFamily Medicine Residency W. Mills, MDSalinas, CA ADDRESSING THE LEADERSHIP GAP IN FAMILY MEDICINE

Background Who are we? Natividad Family Medicine Residency: Salinas, CA Unopposed residency program with a cohort of 28 residents and 18 Core faculty Community based clinic system delivering care to the greater Monterey County Striving for Patient Centered Medical Home model and towards the standards of Center For Excellence

Outline I. Background: Literature Review II. Patient Centered Medical Home: A call to Rising Leaders III. Self-Reflection on Leadership IV. Frameworks of Leadership Training and Delivery V. Module 1: Professional development of self VI. Module 3: The Values that Guide us VII. Junior Faculty Development VIII. Senior Faculty development IX. Conclusions

Background The Association of American Medical Colleges estimates a projected shortage of 46,000 primary care physicians by 2025 Family Medicine practitioners must be prepared for novel delivery systems in order to address this deficit. New Physician leaders of tomorrow must be capable and willing to participate with our mid level partners, interdisciplinary teams, social work, various therapy modalities, as well as community health workers in a variety of clinical and cultural settings

Background: Literature review Recent Review from the Global Health Leadership Institute associated with Yale School of Public Health reviewed physician leadership training. Search from ; 600 studies identified and 45 selected 6 of those were based in Family Medicine Residencies 4 of those were exclusive to Resident training The other 2 were faculty development Most studies focused on didactic or case based training Review noted a lack of systems based outcomes Noted a lack of emphasis on personal growth and development

Background: More Literature Currently initiatives are being studied in IM, ER, Pediatrics, and Surgery Blumenthal et al (2012): Framework for delivery of leadership training (Collaborative effort from PGY-1 in Internal Medicine, Emergency Medicine, and Surgery) Blumenthal et al (2014): The results of a pilot study for delivery of this curriculum which showed significant improvement in confidence surrounding leadership and more interest in pursuing leadership roles in medicine.

Leadership training: Where Natividad stands Old paradigms of training to help facilitate team leaders. LFPC: Teamlets Establishing teaching services where possible Facilitating mentorship between residency years. Nights/Call PGY-2 PGY-3 PGY-1 Clinic PGY-2 PGY-3 PGY-1 Fam Med PGY-3 PGY-1 Internal Med PGY-2 PGY-1 Pediatrics PGY-2 PGY-1

The Change Concepts of PCMH Transformation Laying the Foundation: Engaged Leadership and Quality Improvement Strategy Building Relationships: Continuous Team Based Healing, Empanelment Changing Care Delivery: Patient Centered Interaction, Organized, Evidence-Based Medicine Reducing Barriers to Care: Care Coordination, Enhanced Access

Program evaluation ACGME Annual Program review (2014): 4 Care Coordination Enhanced Access Reducing Barriers to care EMR in hospital: 95% EMR in ambulatory setting: 100% 3 Patient Centered Interactions Organized, Evidence Based Changing Care Delivery Culture reinforces patient safety responsibility: 95% Access to reference materials: 100% 2 Continuous and Team Based Healing Empanelment Building relationships Information not lost during transfers of care 95% Saw patients across a variety of settings 95% 1 Quality Improvement Strategy Engaged Leadership Laying the Foundation Participated in QI: 80% Faculty interested in Resident education: 35%

Ah-Ha Moments in leadership The “building blocks” model promoted by the UCSF Center for Excellence in Primary Care which calls out “engaged leadership” as the most important of the Ten Building Blocks. In 2014 only 35% of our residents felt as though there was engaged leadership which lead us to question: How do we facilitate maturation into engaged leaders? What parts of residency training help leaders to grow and thrive?

Brainstorming leadership Activity 1: Today is meant to look at the paradigms we have in place for leadership training and how to make leaders of tomorrow in family medicine. How did you learn leadership?

Brainstorming leadership Activity 2: What types of teams are your residents expected to be able to lead? (ie. Clinic teams, MA, Nursing, Inpatient teams, teams of lower level residents) What do you do, if anything, formally to support leadership training? What do you see as the deficits in your program regarding leadership training in a formal setting?

Frameworks for leadership training Resident Leadership Training Junior Faculty Development Senior Faculty Development How do we train leaders for our teams? How do we enable people to deal with conflict and stress? How do we train the resilient and capable physicians of tomorrow?

Residency Leadership Curriculum Module 1: Professional development of self Module 2: Reactivity and Proactivity: Bridging the gulf Module 3: Values that Guide us Module 4: First things First Module 5: Conflicts: Why adaptation and failure teach us Module 6: At the Core of Communication Module 7: Interdependency: Resiliency in action

Module 1: Professional Development of Self Let’s explore an abbreviated version of the first of the modules we are utilizing for our residents.

Module 1: Reflections As baseline, we can start the process of inviting reflection in ourselves, for our goals, and for our basic values. Other modules center around finding our personal centers, defining our core values and motivations, establishing relationships that are conducive to learning for all members of a team, and promoting resiliency in motion.

Module 3: Values that Guide us As we progress through the leadership course, residents are asked to try to explore their own leadership principles to help them reflect on the type of leader they want to be. A part of this is to define our “center” or the values/principles/core things that help us live purposeful lives and lead with the heart.

This is my center: Guidance Wisdom Security Power I find security in taking responsibility, doing my most effective work and maintaining my integrity Integrity Effective Responsibility Challenge Precision I will trust my inner sense of integrity to guide me to make precise, responsible choices. I find wisdom through challenging old paradigms and effectively promoting change I find power through my precision, I find the power to challenge with my integrity, I am responsible for the power I embody.

Module 3: Reflections When we ourselves are clear in our purpose and in our center, we are more capable leaders.

Junior Faculty Development Fellowship On site learning Formal training on learners in difficulty How to teach and learn simultaneously

Junior Faculty Development Transforming Primary Care Fellowship through UCLA-Harbor Family Medicine Weekly seminars that cover teaching skills, team dynamics, quality improvement, new models of primary care, organizational transformation. Reviewed basic requirements for NCQA PCMH recognition, model for improvement/ PDSA, Learn techniques for QI work, and learned the basics of how to precept residents.

Junior Faculty Development Synergy Rotation/Practice Management Resident Rotation: Teach what you learn Teach residents concepts learned through transforming primary care fellowship Guide residents on panel management, PDSA cycles Prepare residents to thrive in the new models of care

Senior Faculty Development To Live, Love, Learn, Leave a legacy R36

Senior Faculty Development Activity 3: Think of a leader that you respect and admire that you have worked with. What are the words that describe him/her? VisionRelationshipTask

Senior Faculty Development LeadershipFollowershipMentorship

Conclusions Family medicine is evolving to meet the demand for primary care, and to enact novel care delivery methods PCMH models mandate strong, effective leaders Multi-level intervention is needed to train ourselves to meet this need Leadership training is necessary as well as development of the professional self

Q&A

References 1. Petterson, SM et al. Estimating the Residency Expansions Required to Avoid Projected Primary care Physician Shortages by Ann Fam Med. March/April Vol13(2); Eiff, MP et al. Faculty Development Needs in Resident Redesign for Practice in Patient-centered medical Homes: a P4 report. Fam Med. 2012; 44(6); Blumenthal, DM et al. Implementing a pilot leadership course for internal medicine residents: design considerations, participant impressions, and lessons learned. BMC Medical Education : Blumenthal, DM et al. Addressing the leadership Gap in Medicine: Residents’ Need for Systematic Leadership Development Training. 5. Covey, S. The 7 Habits of Highly Effective People. New York, NY: Simon & Schuster, Kotter, JP. Leading Change. Boston: Harvard Business School Press, Leading Change Modules: STFM Ury, WL, Fisher, R. Getting to Yes. New York, NY: Penguin, Kouzes, JM. Posner, BZ. The Leadership Challenge: How to make extraordinary things happen in organizations. San Francisco, CA. Wiley Press, Chief Leadership conference Packet and information May 2015

Care Coordination Enhanced Access Patient Centered Interactions Organized, Evidence Based Continuous and Team Based Healing Empanelment Reducing Barriers to care Changing Care Delivery Building relationships Quality Improvement Strategy Engaged Leadership Laying the Foundation