report of a conference: envisioning leadership in health ...amsny.org/file-archive/2010...

October17th&18th,2010

ColumbiaUniversityFacultyHouse

Sponsoredby

TheJosiahMacy,Jr.Foundationand

TheADEAGiesFoundation

ReportofaConference:EnvisioningLeadershipin

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EnvisioningLeadershipinHealthProfessionsEducationforthe21sCentury

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Acknowledgements

______________________________________________

The Conference was made possible through grants from the Josiah Macy, Jr. Foundation and

the ADEAGies Foundation. Both foundations have taken leadership roles in fostering linkages

among educators from all health professions. Such linkages will be particularly important as

the education and delivery of healthcare becomes increasingly interprofessional.

AMSNY and NYSADC would like to thank George E. Thibault, MD, President of the Josiah

Macy, Jr. Foundation, and Richard Valachovic, DMD, MPH, President of the American Dental

Education Association and President of the ADEAGies Foundation for their support of and

participation in this project.

We would also like to thank the members of the External Advisory Committee for their

generous contributions and assistance, which were vital to the development and structure of

the program.

Jo Wiederhorn

President and CEO

Associated Medical Schools of New York (AMSNY)

New York State Academic Dental Centers (NYSADC)

Envisioning Leadership in Health Professions Education for the 21st C

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About AMSNY and NYSADC

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The Associated Medical Schools of New York

(AMSNY) is a consortium of the 16 public

and private medical schools in New York

State. Incorporated in 1967, AMSNY works to

support quality healthcare in New York State through the continual strengthening of medical

education, medical care, and medical research - connecting the people, knowledge and

resources of the NYS medical schools. AMSNY works in partnership with its members to

improve healthcare through education, advocacy, and collaboration. AMSNY’s focus areas

include, but are not limited to: advocacy on issues of importance to academic medical

centers, faculty development, diversity/inclusion of medical students and medical school

faculty, and the development of core competencies in educational areas such as clinical skills,

educational informatics, and global health. In addition, AMSNY works with its members to

promote research initiatives that aim to improve healthcare outcomes.

The New York State Academic Dental

Centers (NYSADC) is a consortium of New

York State’s 5 public and private academic

dental centers. Established in 1996, NYSADC’s mission is to improve the oral health of all

New Yorkers through the development of improved dental health policy, faculty development

programs, oral health research and clinical care. NYSADC’s focus areas include, but are not

limited to: diversity/inclusion of dental students and dental school faculty, the development

of shared educational resources and global health, and the development of best practices

around dental education, research and patient care.

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AMSNY Members:

Albany Medical College

Albert Einstein College of Medicine of Yeshiva University

Columbia University College of Physicians & Surgeons

Hofstra North Shore-LIJ School of Medicine

Mount Sinai School of Medicine

New York College of Osteopathic Medicine

New York Medical College

New York University School of Medicine

Sophie Davis School of Biomedical Education at The City College of New York

SUNY Downstate Medical Center

SUNY Upstate Medical University

Stony Brook University Medical Center

Touro College of Osteopathic Medicine

University at Buffalo, State University of New York, School of Medicine and Biomedical Sciences

University of Rochester School of Medicine and Dentistry

Weill Cornell Medical College

NYSADC Members:

Columbia University College of Dental Medicine

New York University College of Dentistry

Stony Brook University School of Dental Medicine

University at Buffalo School of Dental Medicine

Eastman Institute for Oral Health, University of Rochester School of Medicine & Dentistry


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Envisioning Leadership in Health Professions Education for the 21s Century

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Envisioning Leadership for Health

Professions Education in the 21st Century

Table of Contents

I. Executive Summary………………………………………………………...6

II. Summary of Conference Discussions………………………………......9

III. Vision for the Mid-21st

Century Health Delivery System...……....12

IV. Change Management Recommendations…………………………….17

V. Leadership Competencies………………………………………………..22

VI. Conclusion……………………………………………………………………27

VII. Immediate Outcomes and Next Steps…………………………..……29

VIII. Appendix…………………………………………………………………….33

- Conference Agenda………………………………………………..34

- Participants………………………………………………………….38

- Presentations………………………………………………………..41

- Summary of External Advisory Board Interviews………….93

- Bibliography……………………………………………………..….100

- Conference Evaluation………………….…………………......118

- Budget………………………………………………………………..124

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I. Executive Summary


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Executive Summary

___________________________________________

On October 17-18, 2010, the Associated Medical Schools of New York

(AMSNY) and the New York State Academic Dental Centers (NYSADC),

with support from the Josiah Macy, Jr. Foundation and the ADEAGies

Foundation, convened an interprofessional conference of more than 60

state and national leaders from academic health centers to envision the

future healthcare delivery environment and leadership competencies

that will be critical in the continually evolving health system of the mid-

21st Century.

Representatives from medicine, dentistry, nursing, public health, social

work, psychology, hospital systems, health policy and management,

including recent inductees into the Institute of Medicine, discussed the

future direction of health professions education and delivery and how to

work collectively across the professions to bridge the widening gap

between the current training and practice of healthcare professionals

and society's needs.

The conference was based on the following premises:

1. Health professions' education must evolve beyond 20th century

models; as such educational content and learning experiences must be

pertinent to practice in the 21st century;

2. The development of interprofessional teams offers the potential to

significantly improve the quality, efficiency and effectiveness of

healthcare delivery; structural changes to the educational system need

to be implemented in order to foster collaborative models of

interprofessional training.

During opening remarks at the conference, George E. Thibault, MD,

President of the Josiah Macy Jr. Foundation, and Richard W. Valachovic,

DMD, MPH, President of ADEAGies Foundation, stressed the importance

of interprofessional collaboration across the continuum of education and

practice, and the leadership that will be necessary for facilitating the

changes that will bring current health systems into better alignment with

society’s needs.

Dr. Thibault also noted the importance of a multi-institutional approach

for implementing widespread innovation and change: “New York is an

incredible reservoir of education and teaching. This is a moment in time

for New York to take leadership…so as to become a hotbed of

innovation and leadership directed towards meeting the needs of the

society we serve”. C

ReportofaConference:EnvisioningLeadershipin

HealthProfessionsEducationforthe21stCenturyReport of a Conference: Envisioning Leadership inHealth Professions Education for the 21st Century

Executive Summary

On October 17-18, 2010, the Associated Medical Schools of New York (AMSNY) and the New York State Academic Dental Centers (NYSADC), with support from the Josiah Macy, Jr. Foundation and the ADEAGies Foundation, convened an interprofessional conference of more than 60 state and national leaders from academic health centers to envision the future healthcare delivery environment and leadership competencies that will be critical in the continually evolving health system of the mid-21st Century.

Representatives from medicine, dentistry, nursing, public health, social work, psychology, hospital systems, health policy and management, including recent inductees into the Institute of Medicine, discussed the future direction of health professions education and delivery and how to work collectively across the professions to bridge the widening gap between the current training and practice of healthcare professionals and society’s needs.

The conference was based on the following premises:

1. Health professions’ education must evolve beyond 20th century models; as such educational content and learning experiences must be pertinent to practice in the 21st century;

2. The development of interprofessional teams offers the potential to significantly improve the quality, efficiency and effectiveness of healthcare delivery; structural changes to the educational system need to be implemented in order to foster collaborative models of interprofessional training.

During opening remarks at the conference, George E. Thibault, MD, President of the Josiah Macy Jr. Foundation, and Richard W. Valachovic, DMD, MPH, President of ADEAGies Foundation, stressed the importance of interprofessional collaboration across the continuum of education and practice, and the leadership that will be necessary for facilitating the changes that will bring current health systems into better alignment with society’s needs.

Dr. Thibault also noted the importance of a multi-institutional approach for implementing widespread innovation and change: “New York is an incredible reservoir of education and teaching. This is a moment in time for New York to take leadership…so as to become a hotbed of innovation and leadership directed towards meeting the needs of the society we serve”.

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Conference Outcomes

An overarching theme from the open forum and small group discussions was

that, in order to meet society’s needs, now and into the mid-21st Century,

the education and delivery of healthcare should meet outward looking

standards across traditional professional divisions in educational and practice

settings. In order to achieve far-reaching change, participants noted that

there would need to be better systemic and educational integration:

1. Across the health professions;

2. Across the continuum of education and practice;

3. Across healthcare providers throughout a patient’s lifetime;

4. Across practice settings.

The conference yielded a set of recommendations for health professionals

leading health education and delivery systems an era of uncertainty and

continuous change. Conference participants identified educational challenges

and areas for curricular reform, and determined organizational change

strategies for transitioning outdated models of education into models that

are better aligned with contemporary healthcare delivery.

Participants also developed a leadership curriculum for health professions

educators to facilitate the implementation of change and adequately prepare

them to train future healthcare teams practicing in the mid-21st century.

D C

Conference Outcomes

An overarching theme from the open forum and small group discussions was that, in order to meet society’s needs, now and into the mid-21st Century, the education and delivery of healthcare should meet outward looking standards across traditional professional divisions in educational and practice settings. In order to achieve far-reaching change, participants noted that there would need to be better systemic and educational integration:

1. Across the health professions; 2. Across the continuum of education and practice; 3. Across healthcare providers throughout a patient’s lifetime; 4. Across practice settings.

The conference yielded a set of recommendations for health professionals leading health education and delivery systems an era of uncertainty and continuous change. Conference participants identified educational challenges and areas for curricular reform, and determined organizational change strategies for transitioning outdated models of education into models that are better aligned with contemporary healthcare delivery.

Participants also developed a leadership curriculum for health professions educators to facilitate the implementation of change and adequately prepare them to train future healthcare teams practicing in the mid-21st century.


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II. Summary of Conference Discussions

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Introduction

______________________________________________________

The early 20th Century brought widespread changes in the education and delivery of

healthcare as a result of four landmark reports, published first in medicine with the Flexner

Report (1910)1, followed by the Welch-Rose Report (1915)2 in public health, the Goldmark

Report (1923)3 in nursing, and the Gies Report (1926)4 in dentistry. A century later, there is a

convergence among the health professions that reform is again needed to bring the education

of health professionals into better alignment with the continually evolving needs of society.

As the 21st Century progresses, the U.S. health system is becoming increasingly complex, with

an expanding scientific and clinical evidence base, advances in information technology, and

the healthcare needs of the population evolving at an unprecedented rate. One consequence

of this rapid development and increase in complexity is fragmentation in the education and

delivery of healthcare. The lack of integration and the outdated organizational structures of

the current health system have resulted in inefficient and less effective quality of care at a

higher cost, the consequences of which are preventable errors, translating into approximately

44,000-98,000 patient deaths annually in the U.S. alone.5

The strength of any complex adaptive system is in the connections between its diverse, inter-

dependent agents. Over 70% of preventable errors reported to the Joint Commission between

1995 and 2005 were attributed to communication failure, which prompted the Joint

Commission in 2008 to adopt Patient Safety Standards to improve the structure and

communication between healthcare professionals.6

In order for academic health centers to respond to and evolve with changes in the delivery

environment:

1. Health professions' education must evolve beyond 20th century models so that educational

content and learning experiences are pertinent to contemporary practice;

2. Increased systemic and educational integration needs to occur, including structural

changes to the educational system to foster collaborative models of interprofessional

training.

Most importantly, visionary, dedicated and effective leadership will be required to collectively

“create this new future” by developing an “action agenda of coordinated change.” 7

These were the premises of the conference Envisioning Health Professions Leadership for the

21st Century.

1 Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the

Advancement of Teaching. Bulletin No. 4. Boston: Updike; 1910. 2 Welch WH, Rose W. Institute of Hygiene: a report to the General Education Board of Rockefeller Foundation. New

York: The Rockefeller Foundation, 1915. 3 Goldmark J. Nursing and Nursing Education in the United States. Committee for the Study of Nursing Education. New York, NY: The Macmillan Company, 1923. 4 Gies, WJ. Dental Education in the United States and Canada. New York, NY: Carnegie Foundation for the

Advancement of Teaching, 1926. 5 Kohn LT, Corrigan JM, Donaldson MD, eds, Committee on Quality of Health Care in America, Institute of Medicine. To Err is Human: Building a safer health system. Washington, D.C.: National Academy Press, 1999. 6 Ladden M. Learning to Work Together to Improve the Quality of Healthcare. In: Hager M, Russel S and Fletcher S,

Editors. Continuing Education in the Health Professions, Proceedings from the Conference. New York: Josiah Macy, Jr. Foundation, 2008. 7 Kirch D. A Future That Inspires: AAMC President’s Address. Annual Meeting: Washington, D.C., 2010.


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Conference Objectives and Discussion

On October 17-18, 2010, the Associated Medical Schools of New York (AMSNY) and the New

York State Academic Dental Centers (NYSADC), with support from the Josiah Macy, Jr.

Foundation and the ADEAGies Foundation, convened an interprofessional conference of more

than 60 state and national leaders from academic health centers to envision the future

healthcare delivery environment and leadership competencies that will be critical in the

continually evolving healthcare system of the mid-21st Century.

The objectives of the conference were to:

1. Identify future drivers of health professions education and delivery, and develop a shared

vision for the healthcare delivery environment of the mid-21st Century;

2. Determine changes that are needed to bring health education into better alignment with

practice settings now and in the immediate future, and develop strategies for facilitating

these changes in academic health centers, including barriers/challenges, and necessary

resources, and;

3. Develop the draft of a competency-based, leadership curriculum for health professions

educators, to prepare them with the skills and abilities needed to train future healthcare

teams practicing in the mid-21st century.

Participants agreed that one of the most formidable challenges is the fragmentation of the

health system across education and practice settings, which results in inefficient and less

effective quality of care at a higher cost. They agreed that, as the pace of change in the

education and delivery of healthcare continues to accelerate and become increasingly

complex, better integrated, more high-functioning health systems would be critical, as would

the leadership of these complex systems.

The conference yielded a set of recommendations for health professionals leading these

complex systems of health education and delivery in an era of uncertainty and continuous

change. A common overarching theme from the discussions was that, in order to meet

society’s needs, now and in the environment of the mid-21st century, the education and

delivery of healthcare should focus on outward looking standards across traditional

professional divisions in educational and practice settings.

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III. Vision for the Mid-21st Century

Health Delivery System


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Vision for the Mid-21st Century Health Delivery System: Systems Integration of Health Education and Practice

______________________________________________________

In order to affect the far-reaching changes needed to achieve high-performing health

systems, now and in the mid-21st Century, conference participants noted that there would

need to be better systemic and educational integration:

1. Across the health professions;

2. Across the continuum of education and practice;

3. Across healthcare providers throughout a patient’s lifetime;

4. Across practice settings.

The leadership skills that were identified as essential for facilitating these changes and

leading in an era of uncertainty and continuous change were: visioning, risk management,

systems-based quality improvement, change management, curriculum reform, evidence-

based leadership, outcomes assessment, interpersonal relations, consensus building, the

training and leadership of interprofessional teams across the continuum of education and

practice, and health information technology.

Integration would also need to be informed by a shared set of standards aligned with the

social mission of medicine and informed by public health.

_________________________________________________________________

Better Integration Across the Health Professions

One of the most promising solutions to the fragmentation and distribution of the health

workforce can be found in interprofessional collaboration and team-based practice.8, 9, 10

In an address to students in 1905, William Osler spoke about the fragmentary nature of

scientific truth, “No human being is constituted to know the truth, the whole truth, and

nothing but the truth; and even the best of [people] must be content with fragments, with

partial glimpses, never the full fruition.” 11 A corollary of this suggests that with increased

specialization within and across the health professions, effective healthcare delivery is

becoming increasingly dependent on successful collaboration, and the extent to which

healthcare teams are able to build on the strengths, knowledge and skill-sets that each

member of the team brings to the patient’s bedside.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !8 Greiner A, Knebel E (Eds). Health Professionals Education: Bridge to Quality. Washington, DC: U.S. Institute of Medicine, May 2003. Available at: http://www.nap.edu/catalog/10681.html

9 World Health Organization. Framework for Action on Interprofessional Education & Collaborative Practice (WHO/HRH/HPN/10.3). Geneva, Switzerland: WHO Press, World Health Organization, 2010. Available at: http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf 10 Frenk J, Chen L, Bhutta Z et al. Health Professionals for a New Century: Transforming education to strengthen health systems in an interdependent world. The Lancet Commission. 2010; 375: 1923-58. 11 Osler W. Aequanimitas and With Other Addresses to Medical Students, Nurses, and Practitioners of Medicine. P. New York: Blakiston's Sons & Co., 1904.

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An integrated, systems-based perspective on the provision of healthcare and effective

interprofessional collaboration optimizes health-services, strengthens health systems and improves:

- Health outcomes;

- Access to and coordination of healthcare;

- Patient care and safety;

- Appropriate use of specialist clinical resources;

- Workplace practices and productivity.9

Perspectives from Public Health also assist practitioners to address broader determinants of health.

However, educational and practice structures do not currently foster interprofessional collaboration.

To achieve better integration across the professions, the following were identified:

Policy

- Promote shared outward looking standards and better alignment of professional accreditation,

certification and licensure agencies, including a shared set of core competencies (e.g.

competencies related to interprofessional, patient-centered, and team-based care);

- Cultivate a common vision and language to better align the cultures of the health professions;

- Support legislative actions that are aligned with interprofessional support;

- Shift the focus from hierarchical to patient-centered organizational structures so practitioners

with the most appropriate skill-sets deliver care to the full extent of their education;

- Encourage increased interprofessional focus on preparatory and clinics;

- Advance new healthcare delivery models that are informed by innovative “best practices”, in

the U.S. and internationally (integrated, community-based primary care);

- Promote the accountability of healthcare teams (balance between individual and team

accountability).

Education

- Foster increased alignment of the missions, cultures and organizational structures across

health professional schools;

- Work to create a shared language, curricula and core competencies; (e.g. interprofessional/

interdisciplinary teams, systems-based quality improvement, patient-centered care, evidence-

based practice and informatics);8

- Provide opportunities for students to learn about, from and with students of other professions,

such as orientations, seminars, grand rounds, and clinical rotations; interprofessional training

needs to be longitudinal and experiential across the continuum of educational development;

- Implement interprofessional, patient-centered and team-based horizontal models of education

(e.g. case-based simulations) that are informed by social psychology and organizational theory

to be mindful of issues that may impact successful team functioning;

- Develop interprofessional faculty committees to coordinate interprofessional curricula across

schools, and interprofessional networking and faculty development opportunities to encourage

collegiality across the professions;

- Create incentives to encourage interprofessional education.

Leadership Competencies

- Understanding and respect for the educational models and cultures of all health professions;

- Consensus building, facilitation, and the ability to develop and lead interprofessional teams

based on best-evidence organizational theory; the ability to “lead from the middle”;

- Communication and interpersonal skills;

- Systems-based quality improvement;

- Conflict resolution, mediation and negotiation;

- Interprofessional faculty development and mentoring;

- Change management;

- Curriculum reform to incorporate additional interprofessional curricula and training.


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Better Integration Across the Continuum of Education and Practice

To facilitate the integration of health education and delivery, including increasing the rate at

which scientific advances are introduced into practice, the following changes were identified:

Policy

- Foster better integration of oversight agencies across the continuum of education and practice, including agencies of accreditation, certification and licensure;

- Develop policies in support of translational medicine to ensure that practice is informed by the rapidly expanding evidence base in the biomedical and clinical sciences.

Education

- Develop educational models that better integrate pre-clinical and clinical education, and link the biomedical sciences to clinical practice;

- Implement competency-based curriculum and assessment of standardized outcomes; - Educate students in translational medicine and evidence-based practice;

- Promote the alignment of education and practice settings (e.g. longitudinal clinical training in school-based, ambulatory care centers and community health centers);

- Incorporate innovative and transformative pedagogies into the curriculum to foster critical enquiry, quality improvement and self-directed, lifelong learning;

- Promote the effective use of health information technology and educational informatics at

point of care (e.g. personal digital assistants (PDAs)).


- Visioning, scenario planning, leading in an era of continuous change and uncertainty; - Risk management; - Systems-based quality improvement;

- Change management; - Industry knowledge; - Informatics; - Curriculum reform to incorporate innovate pedagogies and curricular content.

___________________________________________________________________________

Better Integration of Patient Care

Participants agreed that a shift would need to occur from provider, to patient-centered models of

care, which would require the following:

Policy

- Develop systems for better coordination of care across providers, longitudinally, across a patient’s lifetime (e.g. healthcare innovation zones);

- Promote health information technology, including a national Electronic Health Record; - Develop public health campaigns to promote healthy behaviors and prevention.

Education

- Implement community, patient-centered models of education and care; the education of practitioners needs to move out of the hospitals and to the side of the patient;

- Shift the focus of education from acute to chronic disease and prevention; - Require education in health information technology (e.g. EHR competencies).


- Change management and curriculum reform; - Industry knowledge;

- Informatics and health information technology.

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Better Integration Across Healthcare Settings

In order to provide more equitable access to care to meet the needs of underserved

populations (urban and rural, in the United States and internationally), the following needs to

occur to facilitate better integration across healthcare settings:

Policy

- Develop policies to address disparities by ensuring affordable and equitable healthcare; - Address workforce distribution and physician shortages;

- Workforce functioning to the extent of their training to meet primary care needs; - Policies to address disparities in reimbursement for primary and specialty care; - Incentives to encourage practitioners to go into primary care in underserved areas.

- Develop programs to increase the diversity of the healthcare workforce; - Address challenges of state by state variability; - Ensure effective use of health information technology, including a national Electronic

Health Record; - Develop organized and interconnected regional and national micro and macro systems

of care (e.g. healthcare innovation zones).

Education

- Promote global health curricula and training;

- Require curricula in diversity training/cultural sensitivity and language skills; - Broaden admission policies to increase the diversity of the healthcare workforce; - Provide incentives to encourage practitioners to go into primary care in underserved

areas; - Require education in health information technology (e.g. EHR competencies).


- Change management and curriculum reform; - Industry knowledge; - Informatics and health information technology; - Cultural sensitivity and language skills.

___________________________________________________________________________

Standards for Integration

Effective systems integration requires a common set of outward looking standards informed

by public health and inspired by the social mission of healthcare:

Social Mission

- Professionalism and the reinstatement of the social mission of healthcare; - Patient-centered models of training and delivery; - Social accountability so that healthcare is better aligned with needs of the community; - Better alignment of financial incentives (e.g. accountable care systems where insurance

reimbursement is based on quality and efficiency, rather than fee for service).

Public Health

- Health education and delivery should be committed to the health of patients as well as the health of patient populations;

- Healthcare professionals should understand the social determinants of health and the unique needs of the communities they serve;

- The curriculum should include preventive medicine and the education of patient populations (e.g. to address disparities in how information is transmitted to the public).


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IV. Change Management Recommendations:

Leading Innovation and Change

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Leading Innovation and Change ______________________________________________________

Based on the preferred vision for the mid-21st Century health delivery system identified in

session one, participants in break-out groups were then asked to: 1) identify and discuss

systems or institutional factors that may play a significant role in the implementation of

educational program change, and 2) select one aspect of educational reform and develop a

strategy for implementing this change within their institutions, keeping in mind

internal/external forces, potential barriers, structural issues, and the resources that will be

required to effectively implement change at each phase of the process.

The following is a list of the recommendations and strategies for successful change

management within academic health centers.12, 13

General Recommendations

- Change needs to be planned in advance;

- Change needs to start at the beginning and be systemic and comprehensive;

- Change needs to be real and meaningful;

- Change requires good outcomes assessment and measures for evaluating change based

on continuous quality improvement, and;

- Perhaps, most importantly, change requires a commitment from visionary, effective and

action-oriented leadership in the organization.

Selected topics

The following aspects of reform were selected by the groups:

Policy Change:

- Increased interprofessional integration across accrediting agencies

Organizational Change in Academic Institutions:

- Increased collegiality across the professions

- Alignment of educational and healthcare models to promote the shift from provider to

patient-centered models of care

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !12 Kotter JP. Leading Change. Boston: Harvard Business School Press, 2008.

13 Bland C, Starnaman S, Wersal L et al. Curricular Change in Medical Schools: How to Succeed. Academic Medicine. 2000; 76: 575-594.


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Guidelines for Change Management!

1. Assess the Need Based on Current and Future Trends in Healthcare

The needs assessment should be based on a rigorous review of the literature and an

analysis of the institution. A comprehensive literature review creates the rational to move.

The needs assessment also helps to diagnose the situation and assess the strengths and

shortcomings of existing models, which creates an awareness of opportunities and the risk

of the status quo.

2. Develop a Team to Lead the Change

After determining the need, the next step in the process is to create a Steering Committee

and develop alliances, coalitions, and structures needed to implement the change.

The Steering Committee Team - The team should consist of organizational leaders who are open to new ideas and who

are willing to challenge the “status quo”, in addition to those who are proponents of the

“status quo” but are comfortable with change;

- The team should possess discipline, persistence, and a commitment to the vision;

- The team should have expertise in the change to be implemented, including an

awareness of the literature and educational scholarship;

- The team should be neutral and represent the perspectives of the various professions;

other professions outside of the health professions should also be at the table (including

individuals with an understanding of educational, business, and organizational models);

- The team should be developed using a common language and vision;

- Team leaders should facilitate collaboration and active problem solving; open dialogue

should be encouraged, but communication should remain respectful and “safe”.

The team should include key stakeholders:

- Internal Stakeholders

- Top-down administrative support (e.g. deans, associate deans for education, chairs,

curriculum committees, and course, clerkship, and residency program directors);

- Junior education, research, clinical and administrative faculty;

- Grassroots (e.g. students and residents);

- External stakeholders:

- Patients/community;

- Leaders from other community health centers and organizations.

Leadership Visionary leadership is necessary in order to keep a view on the future while addressing the

present. Leaders should be facilitators of the process and change agents who are chosen for

their leadership and consensus building skills, but not necessarily content expertise.

Leaders should be adaptable, committed to the change process, and well versed in:

- Scenario planning, environmental analysis, risk management, and the ability to lead

effectively through periods of uncertainty;

- Change management and curriculum reform;

- Consensus and team-building to inspire a shared vision and a positive respectful culture;

- Ability to motivate, develop, and enable others to achieve common goals;

- Conflict resolution, negotiation and mediation;

- Systems-based quality improvement, outcomes assessment and feedback;

- Strategic planning and the development/communication of clear goals and expectations.

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3. Create a Vision and Develop a Strategy for Implementation

Vision To create a vision, change agents must: - First start by examining the current mission of the institution; - Understand and if necessary, reconcile the values and culture of the institution with the

proposed change;

- Communicate clear goals and expectations regarding the change; - Inspire a shared vision among stakeholders. Resources The resources needed for implementation include:

- Clear leadership support from the top; - Communication about goals and expected outcomes; - Functioning micro and macro systems; - Alignment of incentives with positive outcomes;

4. Communicate Vision The team must then develop a strategy to communicate the vision, including:

- When and how to communicate the vision; - Clarity of goals and expectations. Communication should occur along multiple avenues: - Websites; - Newsletters;

- Reports; - Orientations; - Meetings; - Press releases.

5. Empower Others to Act on the Vision and Build Consensus In order to implement change, buy-in needs to occur across the institution; to encourage buy-in, there should be an alignment of incentives with positive outcomes for change.

Leaders should recognize that change is often emotional, so that they may need to assist in transitioning people into new ways of thinking and empower them to act on the vision.

In order to address resistance to change, the team must seek a common ground across stakeholders by developing a common language and a shared vision. Leadership may need

to employ conflict resolution and negotiation. Change should be reinforced with repetition.


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6. Plan for and Create Short-term Wins Leaders should keep the momentum going through the creation and communication of short-

term benchmarks and visible performance evaluations: - Annual goals/indicators; - Demonstration of examples where the change has worked; - Identification of “champions for the change”; - Discussion of groundwork;

- Development of position papers; The strategy should anticipate and plan for an initial performance dip so as to be wary of the efficiency trap. Change needs to aim for successful longer-term outcomes, at the expense of satisfactory short-term outcomes.

Change should start small and grow increasingly larger (“diffusion of innovation”). 7. Consolidate Improvements and Produce More Change

In order to assess the effectiveness of the change, there should be a clear commitment to rigorous outcomes assessment, using continuous quality improvement and various qualitative and quantitative assessment methods. Implementation of the change should be adjusted accordingly. The strategy should incorporate plans for sustainability.

The change should be reinforced through repetition. 8. Institutionalize Change

Change needs to be systemic and start at the beginning so that it is incorporated into the culture of the institution. Change should be reflected in the language, policies and leadership of the institution. It is important that leaders model the way.

Change should be based on continuous quality improvement.

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V. Leadership Competencies for 21st Century

Health Professions Education and Practice


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Leadership Competencies and Curriculum Grids ______________________________________________________

A set of leadership competencies were identified as essential for facilitating change, systems

integration and leading in an era of uncertainty and continuous change. These include:

- Visioning

Identifying challenges and opportunities

Inspiring a common vision

Scenario planning and environmental analysis

- Leading in an era of uncertainty

Risk management

Change management

Systems analysis

Organizational theory

- Systems-based quality improvement

Development of clear goals and objectives

Evaluation and assessment

- Change management and curriculum reform

Consensus-building among diverse groups

Conflict resolution and negotiation

- Emotional Intelligence

Self-knowledge

Professionalism

Modeling the way

- Communication and interpersonal skills

Cultural awareness/competence

Interprofessional team facilitation and consensus building

- Evidence-based Management

Economics

Assessment/evaluation

Statistics

Budgeting

- Faculty Development

Mentoring and Feedback

Skills to facilitate change and curriculum reform

Tools for program construction

Management of human capital and identification of faculty skill-sets

Incentives aligned to curriculum

- Educational informatics and health information technology

The elements comprising an individual competency or sub-competency can be described

using an educational rubric14

structure. The expansion of the full set of competencies into

such rubric formats will serve as a preliminary blueprint for a full educational leadership

curriculum. Examples are as follows:

14

A rubric is a tool that educators can use to define learning experiences. It should include a description of the

content, context and process for the learning experience, and a plan for evaluation including performance criteria.

24Envisioning Leadership in Health Professions Education for the 21st Century

EnvisioningLeadershipinHealthProfessionsEducationforthe

21sCentury

24

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Envisioning Leadership in Health Professions Education for the 21st Century


21sCentury

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26Envisioning Leadership in Health Professions Education for the 21st Century


21sCentury

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Conclusion

___________________________________________________

On October 17-18, 2010, the Associated Medical Schools of New York (AMSNY) and the

New York State Academic Dental Centers (NYSADC), with support from the Josiah Macy,

Jr. Foundation and the ADEAGies Foundation, convened an interprofessional conference

of more than 60 state and national leaders from academic health centers to envision the

future healthcare delivery environment and the leadership competencies that will be

critical in the continually evolving healthcare system of the mid-21st Century.

An overarching theme from the discussions was that, in order to meet society’s needs,

now and into the mid-21st century, the education and delivery of healthcare should focus

on outward looking standards across traditional professional divisions. Participants

agreed that one of the most formidable challenges is the fragmentation of the health

system across education and practice settings, which results in inefficient and less

effective quality of care at a higher cost. They noted that, as the pace of change in the

education and delivery of healthcare continues to accelerate and become increasingly

complex, better integrated, more high functioning health systems would be critical, as

would the leadership of these complex systems.

Conference participants identified future drivers of health professions education and

delivery, and developed a shared vision for the healthcare system of the mid-21st

Century. Participants also identified educational challenges and areas for curricular

reform, and determined organizational change strategies for transitioning outdated

models of education into models that are better aligned with contemporary healthcare

delivery.

The conference yielded a draft competency-based, leadership curriculum for health

professions educators to prepare them to train future health care teams practicing in the

mid-21st century. The competencies centered around leading in an era of uncertainty and

continuous change, specifically related to visioning, risk management, systems-based

quality improvement, change management, curriculum reform, evidence-based

leadership, outcomes assessment, interpersonal relations, consensus building, the

training and leadership of interprofessional teams across the continuum of education and

practice, and health information technology.

________________________________________________________________________


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VII. Immediate Outcomes and Next Steps

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Immediate Outcomes and Next Steps ______________________________________________________

The following have been immediate outcomes from the conference in addition to next steps

and areas for further exploration:

1. Leaders of nursing education in academic medical centers have begun to meet and discuss the formation of a caucus of New York State academic nursing schools;

2. AMSNY/NYSADC will convene an Interprofessional Workgroup for program planning in Spring 2011;

3. A Symposium to implement training in Leadership Competencies will be developed for academic year 2011-12.


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Meetings of the New York State Academic Nursing Schools _________________________________________________________

An immediate outcome of the Leadership Conference has been the beginnings of a caucus of New

York State academic nursing schools. In light of the fact that medicine and dentistry were more

heavily represented at the Leadership Conference, Kristine Gebbie, DrPh, RN, then Dean at the

Hunter-Bellevue School of Nursing and Terry Fulmer, PhD, RN, FAAN, Dean of the NYU College of

Nursing began to realize the need to enhance the presence of academic nursing schools – starting

within New York State. Drs. Gebbie and Fulmer began to initiate calls to other nursing school

deans to determine if there was interest in the idea. The initial purpose for the caucus is to begin

sharing information, perhaps around curricula or other projects, and to address the challenges

that are facing all healthcare leaders, such as: interprofessional collaboration to develop and

implement education and leadership curricula; and the development across New York State’s

academic health centers of “best-practice models” of interprofessional education (IPE) and team-

based care.

On November 30, 2010, the Associated Medical Schools of New York and the Hunter-Bellevue

School of Nursing co-hosted the NYS regional meeting of the Robert Wood Johnson Foundation

and the Institute of Medicine National Summit on Advancing Health through Nursing. The NYS

meeting was one of many regional meetings that were organized across the country, in

coordination with the national summit in Washington D.C., to create awareness and discuss

implementation of key recommendations from the Institute of Medicine report “The Future of

Nursing: Leading Change, Advancing Health”.

Following the National Summit on Advancing Health through Nursing meeting in November, the

nascent Caucus had its first phone call on December 1, 2010, during which the 9 Deans of

academic nursing schools agreed to its initially stated purpose.

On January 25, 2011, the Deans/Deans’ Proxies of the academic nursing schools then met at Pace

University and unanimously agreed that there was a need for a caucus of nursing schools in NYS

as all of the schools seem to be struggling with similar issues related to the implementation of

interprofessional education. They agreed that the caucus was an important opportunity to learn

from one another and promote dialogue and collaboration with the other health professional

schools in New York State.

They discussed the following mission and goals of the caucus:

Mission

To facilitate and coordinate the interprofessional educational mission of academic nursing schools

through relationships with New York State’s medical and dental schools and implement the

Institute of Medicine recommendation to double the number of nurses with a doctorate by 2020.

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Goals

- Define and promote the value of interprofessional education and training for improving patient care based on evidence-based practice;

- Develop and enhance collaborative relationships and partnerships between the schools of nursing, medicine and dentistry in New York State;

- Develop specific educational projects with New York State’s medical and dental schools; - Develop and implement “best practice” models of interprofessional education, utilizing

patient-centered, clinical and team-based pedagogies, innovations in information technology, quality improvement, and systems-based thinking;

- Implement the Institute of Medicine recommendation to double the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers, with attention to

increasing diversity.

As an initial step toward these goals, the caucus discussed collaborating with AMSNY and NYSADC member schools to hold a small symposium on case-based IPE in 2011.

New York State Caucus of Academic Nursing Schools Members: Columbia University, School of Nursing

City University of New York (CUNY), Hunter-Bellevue School of Nursing

New York University College of Nursing

Pace University, Lienhard School of Nursing

Stony Brook University School of Nursing

State University of New York (SUNY) Downstate School of Nursing

State University of New York (SUNY) Upstate School of Nursing

University at Buffalo, School of Nursing

University of Rochester School of Nursing


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VIII. Appendix

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Envision

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ership in Health Profession

s Ed

ucation for the 21

s Ce

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Conference Agenda


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Envision

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s Ed

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s Ce

ntury

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October 17-18, 2010

Columbia University Faculty House

Agenda

Conference Goals:

1. Identify future drivers of health professions education and the healthcare delivery environment of the mid-21st century, including essential leadership competencies;

2. Determine strategies for implementing change in institutions, including barriers/challenges, and necessary resources, and;

3. Develop the draft of a competency-based, leadership curriculum for health professions educators, to prepare them with the skills and abilities needed to educate future healthcare teams practicing in the mid-21st century.

Basic Premises:

1. There is an imperative for change: Health professions’ education must evolve beyond 20th century models. Educational content and learning experiences must be pertinent to practice in the mid-21st century.

2. An integrative curriculum is required: The development of interprofessional teams offers the potential to significantly improve the quality and efficiency of healthcare. Structural changes to the educational system need to be implemented in order to foster collaborative models of interprofessional training.

Conference Sponsorship:

This conference has been organized as a joint project of the Associated Medical Schools of New York (AMSNY) and of the New York State Academic Dental Centers (NYSADC). We acknowledge the generous support of the Josiah Macy Jr. Foundation and of the ADEAGies Foundation for the organization and presentation of this conference.


34



October 17-18, 2010


Agenda

Conference Goals:

1. Identify future drivers of health professions education and the healthcare delivery environment of the mid-21st century, including essential leadership competencies;


3. Develop the draft of a competency-based, leadership curriculum for health professions educators, to prepare them with the skills and abilities needed to educate future healthcare teams practicing in the mid-21st century.

Basic Premises:

1. There is an imperative for change: Health professions’ education must evolve beyond 20th century models. Educational content and learning experiences must be pertinent to practice in the mid-21st century.





34


Professions Education in the 21st

Century

October 17-18, 2010


Agenda

Conference Goals:

1. Identify future drivers of health professions education and the healthcare delivery environment of the mid-21

st century, including essential leadership

competencies;


3. Develop the draft of a competency-based, leadership curriculum for health professions educators, to prepare them with the skills and abilities needed to educate future healthcare teams practicing in the mid-21

st century.

Basic Premises:

1. There is an imperative for change: Health professions’ education must evolve beyond 20

th century models. Educational content and learning experiences must be

pertinent to practice in the mid-21st century.





34



Century

October 17-18, 2010


Agenda

Conference Goals:



competencies;



st century.

Basic Premises:







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Conference Agenda – Day 1

3:00 PM - 4:00 PM Break-Out Session 1: Envisioning the Healthcare Delivery Environment of the Mid-21st Century

In groups, consider the questions emerging from the open forum (or others identified during the open forum) and project: • Anticipated healthcare trends • What educational program changes must be accomplished to align healthcare

education and delivery with projected environment of the mid-21st century?

4:00 PM - 5:00 PM Report backs and discussion in larger group

5:00 PM End of day one

Sunday, October 17, 2010

11:00 AM - 12:00 PM Registration and Lunch

12:00 PM - 2:00 PM Introduction and Welcome • Jo Wiederhorn, President and CEO, AMSNY/NYSADC

Opening Remarks • George E. Thibault, MD, President, Josiah Macy, Jr. Foundation • Richard W. Valachovic, DMD, MPH, President, ADEAGies Foundation

Plenary Presentations on the Vision for the 21st Century • Beyond Flexner and Gies: Education leadership for the 21st Century

Michael Reichgott, MD, PhD, Professor of Internal Medicine, Albert Einstein College of Medicine; Chair, AMSNY Medical Education Committee

• Leadership Issues in Dental Education and Dental Practice Ira Lamster, DDS, MMSc, Dean, Columbia University College of Dental Medicine

• Effective Leadership for the 21st Century Tom D’Aunno, PhD, Director, Executive MPH Program, Health Policy and Management, Columbia University, Mailman School of Public Health

2:00 PM - 2:15 PM Break

2:15 PM - 2:45 PM Open forum: Drivers of Health Professions Education

What are the key issues that health professions education must address to prepare students for the practice environment of the mid-21st century?

Participants are invited to add to or revise the following questions: 1. What must we do to prepare faculty to be health education leaders? 2. How do we prepare current and future leaders to adapt education to the changing

environment? 3. How do we prepare education leaders to incorporate knowledge and technology for

the mid-21st century? 4. How do we prepare education leaders to respond to the sociopolitical environment

of the mid-21st century? 5. How do we prepare education leaders for workforce distribution and scope of

practice issues of the mid-21st century?

2:30 PM - 3:00 PM Break


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3:00 PM - 4:00 PM Break-Out Session 1: Envisioning the Healthcare Delivery Environment of the Mid-21

st Century









Plenary Presentations on the Vision for the 21st

Century • Beyond Flexner and Gies: Education leadership for the 21

st Century



• Effective Leadership for the 21st Century

Tom D’Aunno, PhD, Director, Executive MPH Program, Health Policy and Management, Columbia University, Mailman School of Public Health

2:00 PM - 2:15 PM Break


What are the key issues that health professions education must address to prepare students for the practice environment of the mid-21

st century?



the mid-21st century?

4. How do we prepare education leaders to respond to the sociopolitical environment of the mid-21

st century?

5. How do we prepare education leaders for workforce distribution and scope of practice issues of the mid-21

st century?

2:30 PM - 3:00 PM Break


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3:00 PM - 4:00 PM Break-Out Session 1: Envisioning the Healthcare Delivery Environment of the Mid-21

st Century









Plenary Presentations on the Vision for the 21st

Century • Beyond Flexner and Gies: Education leadership for the 21

st Century



• Effective Leadership for the 21st Century

Tom D’Aunno, PhD, Director, Executive MPH Program, Health Policy and Management, Columbia University, Mailman School of Public Health

2:00 PM - 2:15 PM Break


What are the key issues that health professions education must address to prepare students for the practice environment of the mid-21

st century?



the mid-21st century?

4. How do we prepare education leaders to respond to the sociopolitical environment of the mid-21

st century?

5. How do we prepare education leaders for workforce distribution and scope of practice issues of the mid-21

st century?

2:30 PM - 3:00 PM Break


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October 17-18, 2010


Agenda

Conference Goals:



competencies;



st century.

Basic Premises:








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Monday, October 18, 2010

8:00 AM - 9:00 AM Breakfast and charge for the day

9:00 AM - 10:15 AM Leading for Change: Presentation of Cases • Case 1: Leadership in Healthcare Systems

Kristine Gebbie, DrPH, RN, Interim Dean, Hunter-Bellevue School of Nursing

• Case 2: Institutional Leadership and Healthcare Delivery

Gary Kalkut, MD, MPH, Senior Vice President and Chief Medical Officer, Montefiore Medical Center

10:15 AM -11:30 AM Break-Out Session 2:

Strategies for Implementing Organizational Change

11:30 AM –12:30 PM Lunch and report backs and discussion in larger group

12:30 PM - 1:30PM Leading for Change: Presentation of Cases • Case 3: Interprofessional Team-Based Training and Educational Informatics:

NYU 3T:Teaching, Technology, Teamwork Marc Triola, MD, PhD, Chief, Section of Medical Informatics, Department of Medicine; Director, Division of Educational Informatics, NYU School of Medicine; and Chair, AMSNY Educational Informatics Committee, and;

Terry Fulmer, PhD, RN, FAAN, Erline Perkins McGriff Professor and Dean, NYU School of Nursing

• Case 4: Leadership Considerations from Other Professions

Jody Gandy, PT, PhD, Director, Academic/Clinical Education Affairs at American Physical Therapy Association

1:30 PM - 3:30 PM Break-Out Session 3:

Leadership Competencies for 21st Century Health Professions Education Each group will complete a curriculum outline grid for one or more proposed education leadership competencies

3:30 PM - 4:30 PM

Report back and discussion in larger group

4:30 PM Closing Remarks and Conclusion to Conference


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Leadership Competencies for 21st Century Health Professions Education Each group will complete a curriculum outline grid for one or more proposed education leadership competencies

3:30 PM - 4:30 PM




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Leadership Competencies for 21st

Century Health Professions Education Each group will complete a curriculum outline grid for one or more proposed education leadership competencies

3:30 PM - 4:30 PM




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Leadership Competencies for 21st

Century Health Professions Education Each group will complete a curriculum outline grid for one or more proposed education leadership competencies

3:30 PM - 4:30 PM



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Conference Participants _________________________________________________________ David Albert, DDS, MPH Columbia University School of Dental and Oral Surgery Kukuwa Adofo-Mensah

Associated Medical Schools of New York / New York State Academic Dental Centers

Donald Antonson, DDS, Med University of Buffalo School of Dental Medicine Mike Azark Associated Medical Schools of New York / New York State Academic Dental Centers

Melissa Begg, ScD Columbia University - Mailman School of Public Health Jo Ivey Boufford, MD New York Academy of Medicine Lisa Coplit, MD Mount Sinai School of Medicine Arlene Curry, MD New York University, College of Dentistry Robert D’Alessandri, MD The Commonwealth Medical College Tom D’Aunno, PhD Columbia University, Mailman School of Public Health Sherry Downie, PhD Albert Einstein School of Medicine Ronald Drusin, MD Columbia University College of Physicians and Surgeons Alice Fornari, EdD, RD


Walter Franck, MD Bassett Healthcare Terry Fulmer, PhD, RN, FAAN New York University, College of Nursing

Jody Gandy, PT, DPT, PhD American Physical Therapy Association

Patrick Gannon, PhD


Kristine Gebbie, DrPH, RN Hunter – Bellevue School of Nursing

Marti Grayson, MD Albert Einstein College of Medicine


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Joyce Griffin-Sobel, PhD, RN, AOCN, CNE, ANEF Hunter – Bellevue School of Nursing

Karl Haden, PhD Academy for Academic Leadership

Anna Horton Mount Sinai School of Medicine

Diane Indyk, DO Albert Einstein College of Medicine

Leila Jahangiri, DMD, MMSc New York University, College of Dentistry

Gary Kalkut, MD, MPH Montefiore Medical Center

Kenneth Kalkwarf, DDS, MS The University of Texas Health Science Center at San Antonio

Victoria Kaprielian, MD, FAAFP Duke University Medical Center

Mark Kelley, MD Henry Ford Health Systems

Nancy Kheck, PhD Mount Sinai School of Medicine

Jennifer Koestler, MD, FAAP New York Medical College

Don Kollisch, MD Sophie Davis School of Biomedical Education Anthony Kovner, PhD Robert F. Wagner Graduate School of Public Service Ira Lamster, DDS, MMSc Columbia University School of Dental and Oral Surgery Mary Lee, MD, MS Tufts University Maureen McAndrew, DDS, MSEd New York University, College of Dentistry Dani McBeth, PhD Sophie Davis School of Biomedical Education Laura McCreedy, MS Associated Medical Schools of New York / New York State Academic Dental Centers

Felise Milan, MD Albert Einstein College of Medicine

Letty Moss-Salentijn, DDS, PhD Columbia University School of Dental and Oral Surgery

Cathryn Nation, MD University of California

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Donna Nickitus, PhD, CNAA, BC, RN Hunter - Bellevue School of Nursing

Natalya Niewdach, MS


Kathleen Nokes, PhD, RN, FAAN Hunter - Bellevue School of Nursing

Lois Nora, MD Northeastern Ohio Universities Colleges of Medicine and Pharmacy

David Paquette, DMD, MPH, DMSc Stony Brook University Medical Center

Michael Reichgott, MD, PhD Albert Einstein College of Medicine

Boyd Richards, PhD Columbia University College of Physicians and Surgeons

Piera Robson Hunter – Bellevue School of Nursing

Lisa Rucker, MD

Albert Einstein College of Medicine

Larry Smith, MD


Nilda Soto, MS Ed Albert Einstein College of Medicine

Carol Story-Johnson, MD

Weill Cornell Medical College

George Thibault, MD

Josiah Macy, Jr. Foundation

Paula Trief, PhD

Upstate Medical University

Marc Triola, MD

New York University School of Medicine

Richard Valachovic, DMD, MPH

ADEAGies Foundation

Lynn Videka, BSN, AM, PhD

New York University, Silver School of Social Work

Steven Wartman, MD, PhD

The Association of Academic Health Centers

Jo Wiederhorn


Ray Williams, DMD

Stony Brook University School of Dental Medicine


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Presentation Slides

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Beyond Flexner and Gies:

Education leadership for the 21st Century

Michael Reichgott, MD, PhD


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Envisioning Leadership for Health Professions Education in the 21st

Century

 AMSNY

 NYSADC

Beyond Flexner and Gies

Health Professions Leadership

for the 21st Century

Michael J. Reichgott, MD, PhD Professor of Medicine

Albert Einstein College of Medicine

Chair, Education Committee

AMSNY

At the start of the 20th Century

TAN-TA-RA…

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2

WHEN THE SHIPS WERE MADE OF

WOOD:

And…THE MEN WERE MADE

OF IRON…

THERE WERE GIANTS IN THE EARTH!

Abraham Flexner (1866-1959) William J. Gies (1872-1956)


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Flexner:

[In the ideal medical school]”…the training of physicians and the healing

of the sick harmoniously combine to the infinite advantage of both.”

Medical Education in the United States and Canada:

A Report to the Carnegie Foundation. Bulletin #4 1910

The Ideal Medical School (Flexner)

  Bachelor’s degree for admission

  Laboratory-based science

  Rigorous clinical clerkships

  School/Teaching-hospital partners

  Faculty engaged in research and education

  Adequate endowment

Johns Hopkins Medical School (1893)

Gies:

Dentistry…[is] a very important division of health service…. Its

practitioners should be trained to give the service not only of dental surgeons

…but of oral physicians as well.

Dental Education in the United States and Canada:

A Report to the Carnegie Foundation. Bulletin #19 1926

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The Ideal Dental School (Gies)

  Preprofessional academic work

  Intensive training in:

  Medical science

  Dental technology

  Clinical dentistry

  Oral medicine

  Dental internships

  Training for advanced specialties

  Active promotion of research

Standardization of UME

 By the 1930’s, proprietary medical colleges were eradicated and there was standardization of the laboratory- and hospital-based research medical university model.*

* Beck, A.H., The Flexner Report and the Standardization of American Medical Education, JAMA 2004; 291:2139-40

THE “UNDIFFERENTIATED GRADUATE”

  The goal of Medical Education is to give the student a comprehensive concept of patients and disease, and to enable him (or her) to enter without handicap any one of the fields of medical practice.

Adapted from Trans. Am. Surg. Assn. 1950;68:523-554


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The “Altruism Triangle”

Patients

Attendings

EDUCATION

CA

RE

PAY

MEN

T $

Students/ Residents

x

Transitions in the ’80s

 Managed Care

  “Sicker and Quicker”

  Educational Theory

  PBL/case-based

  Integration…horizontal/vertical

  SP/simulation

  “Three Function” model

The Predominence of Science

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Family Medicine Match Statistics

2005 2004 2003 2002 2001 2000 1999 Δ

Positions

Offered2,782 2,884 2,940 2,983 3,096 3,206 3,265 -483

Positions

Filled2,292 2,273 2,239 2,357 2,363 2,603 2,697 -405

Filled US

Seniors1,132 1,198 1,234 1,413 1,516 1,833 2,024 -892

% Filled

US Seniors40.7%41.5%42.0%47.4%49.0%57.2%62.0% -21.3

Dawn of the New Millennium

AAMC

 Medical Schools Objectives Project

  Physicians must be ALTRUISTIC

  Physicians must be KNOWLEDGABLE

  Physicians must be SKILLFUL

  Physicians must be DUTIFUL

AAMC, Learning Objective for Medical Education, 1998


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ACGME

  COMPETENCIES

  Patient Care

  Medical Knowledge

  Practice-based Learning and Improvement

  Interpersonal and Communications Skills

  Professionalism

  Systems-based practice

ACGME Outcomes Project, 2000

The New Paradigm

Education … not just

Resources and Curriculum...

You must define and evaluate

Competence!

Institute of Medicine

 QUALITY   Medical Care Errors…

  Inadequate information systems

  Lapses in recommended care   Prevention

  Acute episodes

  Chronic conditions

  Medication-related errors   Abbreviations

  Legibility

Institute of Medicine: 1999 “To Err is Human”; 2001 “Crossing the Quality Chasm.”

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USMLE

  "GATEWAY" decision points: 1) Entry into supervised postgraduate training

2)  Initial licensure for unsupervised practice

  Minimum competency relevant to the level:

1) Scientific foundation of medical practice

2) Application of medical knowledge to patient care

3) Clinical skills relevant to practice level

Scoles, P.V. Adv Physiol Educ 2008; 32:109-110

  Genomics

  Proteomics

  Molecular Pharmacology

  Catheters

  Images

  Lasers

  Robotics

What the modern doctor must know:

WHAT ABOUT THE PHYSICAL EXAM???

  Altruism

  Duty

  Professionalism

  Quality

  Rapport

  Safety

  Systems

New Words in the lexicon:


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So…where do we go from here?

Expanded expectations

  Integrated/longitudinal experiences

  Explicit experiential requirements

  Simulation before participation

  Observed competence evaluation

  Students

  Faculty

  Sociology in Medicine

  EBM…Safety and Quality

  Multi-disciplinary/team skills

Difficult challenges

  Teaching patient shortages

  Teacher shortages

 Clinical site shortages

 Conflicting priorities

 Conflicting systems

  Financial stresses

Albanese, M, Mejicano, G, Gruppen, L., Competency-

Based Medical Education: A Defense Against the Four Horsemen of the Apocalypse. Academic Med. 2008; 83

(#12 December): 1132-1139

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The resistance myth…

Wooden ships Iron Men (and Women)

And Speaking of Giants…

Sir William Osler (1849-1919)

What would Osler have said?

“TO COVER THE VAST FIELD OF [HEALTH CARE] IN FOUR YEARS IS AN IMPOSSIBLE TASK. WE CAN ONLY INSTILL PRINCIPLES, PUT STUDENTS ON THE RIGHT PATH, GIVE THEM METHODS, TEACH THEM HOW TO STUDY, AND EARLY TO DISCERN BETWEEN ESSENTIALS AND NON ESSENTIALS.”

After Twenty-Five Years, in AEQUANIMITAS, 3rd Ed. 1932 pp. 201-2


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Health Professions Leaders …(mid 21st century)

Content Context Process

Knowledge

Skills

Attitude

Leaders serve to facilitate change….

Your job Mr. Phelps….

If you choose to accept it!!!

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Leadership Issues in Dental Education

and Dental Practice

Ira Lamster, DDS, MMSc


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IRA B. LAMSTER, DDS, MMSc

DEAN

COLUMBIA UNIVERSITY

COLLEGE OF DENTAL MEDICINE

  Institute of Medicine: Dental

Education at the Crossroads (1995)

  American Dental Association: The

Future of Dentistry (2001)

  ADEA: Beyond the Crossroads (2009)

(Commission on Change and

Innovation)

Education: Goal

“Leadership is a systemic, collaborative and

continuous process of innovative change in the education of general dentists so that they

enter the profession competent to meet the

oral health needs of the public… and to function as important members of an efficient

and effective health care team.” “Beyond the Crossroads”

ADEA, 2009

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2

1.  Financial environment of higher education

(high tuition, dental schools are very expensive to operate)

2.  Profession demonstrates loss of vision in regard to caring for all

components of society, leading to marginalization of the

profession, caring only for the affluent

4.  The nature of dental education

itself

  Convoluted

  Dissatisfying

1.  Critical thinking and life-long-learning

2.  Humanistic thinking

3.  Evidence-based dentistry

4.  Producing new educators, retaining existing educators, improving faculty

life

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Challenges:

1. Access to care for the underserved:

Poor/uninsured, disabled, elderly

2. Discussion of mid-level providers and other solutions. This is not being driven

by the profession

3.  Role in general health care/health care

reform

4.  Electronic oral health record – how

connected to the EPR?

5.  Technology/affordability

6.  “Geriatric dentistry”/dentistry for

older adults: no dental coverage in

Medicare

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13 Weeks Post-op


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  Oral infection is a risk factor for diseases and disorders at

distant sites

  The population is aging, with

increased prevalence of chronic disease; general issue of access to care

  Dentists are considered primary health care providers

  Blurring of the defined borders separating the health

professions

Ex: Pediatricians are able to

provide and receive compensation for preventive

oral health care services

Ex: Shortage of dentists in certain rural areas is leading to emergency room physicians providing emergency dental services

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“In this view of an enlarged dentistry,

its practitioners would be trained to give the service not only of dental surgeons…

as at present, but of oral physicians as well. Instead of examining only the teeth

and mouth of a patient… they would also

suitably enquire into and keep careful records of the state of the patient’s

health, particularly as it affects or is modified by conditions of the teeth and

mouth. Dentists would…

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recognize and note the significance of

outstanding symptoms of systemic disease, and warn or advise the patient

accordingly… The frequency with which dentists are… consulted for oral health-

service gives them special opportunity

and occasion to note not only the occurrence of oral and systemic diseases,

but also the existence of correlations between them, and to help or guide

patients accordingly.” W.J. Gies, 1926

Dental Education in the United

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Effective Leadership for the 21st Century

Tom D’Aunno, PhD

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Leadership

D’Aunno

October 2010

“We must become the change we want to see.” Mahatma Ghandi

The Knowing-Doing Gap in Leading People:

Rhetoric vs. Reality

• Best practice: take time to customize approaches for

individuals and their tasks; develop subordinates

• Reality: Identity and time management problems

• What is my comfort level with being a professional

(technical expert) vs. manager (using authority to

build systems) vs. Leader (getting results through

others without authority)?

• How much time do I invest in developing others?


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Knowing-Doing Gap

• Best practice: vary approach with task and individuals

• Reality: we rely on stereotypes; we are rigid under pressure and use top-down (authoritarian) approaches

• Best practice: be objective and fair in assessing others’ work and in rewarding others

• Reality: we engage in selective perception, snap judgements, and make attribution errors that we are unaware of

Conclusions: Closing the Knowing-Doing Gap

• Commit to developing self-knowledge (strengths,

weaknesses, preferences)

• Coaches; feedback; assessment tools

• Develop oneself in response to self-knowledge

• Know and accept one’s limits

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Closing the Gap…

• Know when not to accept an assignment or job and

know when to exit…

•  the key is fit!

Conclusions: Questions

• Am I managing up effectively (your boss)?

• Do I have a plan to build self-knowledge?…even self-development?

• Is there a good fit between me and my job?

• Is my identity tied more to being a technical expert or a leader?

•  How much do I spend on coaching and developing others?

• What factors are in my control vs. organizational systems and culture?

Questions (2)

• Do my subordinates know and understand my

leadership style?

• Do they feel comfortable managing me?

• Am I maximizing subordinates’ autonomy?

• Am I recruiting as effectively as possible?

• What is my level of “emotional intelligence” in

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Why is Leadership So Critical Now?

• Complexity and change (from globalization, technology,

demography) put a high priority on leadership

What Makes An Effective Leader?

•  Leadership: the process by which an individual

attempts to influence another individual or group

to reach a goal

•  Two critical features:

•  reaching for vision-inspired goals

•  influencing followers without authority

Effective Leaders: From Traits to

Behaviors

• From traits to behaviors: individual

characteristics matter (e.g., charisma), but not as

much as behaviors…but which ones?

• Behaviors that focus on tasks and people

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Effective Leaders: Summary

•  Effective leadership is goal-oriented; goals stem from a

vision of where the organization needs to go

•  Effective leadership is people-oriented; realizes that a

vision without followers is not much good; takes into

account key features of followers and how to influence

them

Effective Leaders: Summary (2)

“Leadership is not magnetic personality—that can just as

well be a glib tongue. It is not "making friends and

influencing people"—that is flattery. Leadership is lifting

a person's vision to higher sights, the raising of a person's

performance to a higher standard…”

Peter F. Drucker

What is the Source of Vision?

“Where there is no vision, the people perish.”

- Proverbs 29:18


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What is the source of vision?

• Extra-industry leaders

• Industry benchmarks

• History

• Managing close to operations

Barriers to Vision

•  Organizational barriers: culture, politics, reward and

incentive systems

•  Self-psychology: comfort taking risks and initiative?

Ability to learn from failures and adversity

•  Management situation: attention drawn to urgent matters

that leave little time or energy for thinking (tyranny of the

urgent)

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Leadership in Healthcare Systems

Kristine Gebbie, DrPH, RN


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Case1:LeadershipinHealthCareSystems

KristineM.Gebbie,DrPH,RN

Hunter‐BellevueSchoolofNursing,HunterCollege‐CUNY

EnvisioningLeadershipforHealthProfessionsEducationinthe21stCentury

18October2010

• WhatdoImeanby‘healthcaresystems’

o Classicunderstanding:thoseplaceswhereindividualswhobecomeillaretreated&

healthyindividualsareprovidedthesupportstheyneedtostaywell

o Abroaderdefinitionofhealth‐relatedsystemswillincludethepopulation‐focused

publichealthsystem

• Thepracticeofanyofthehealthprofessionsisacollaborativeevent

o Allprofessionalsareinterdependentwithatleastoneotherprofession

o Focusontasksisconfusing,becausesomanyofthemaredonebymultipleprofessions

o Noprofessionhastaughtcollaborationreallywell

• Leadershipatthesystemlevelrequires

o Abilitytospeakmultiplelanguages

o Abilitytodescribepreferredfuturesinsharedlanguage

o Abilitytokeeponeeyeonthefuturewhilecopingwiththepresent

• Examplesfrommyexperience

o Buildingastate‐wideapproachtoHIV/AIDSinOregon

o BuildinganewstatedepartmentofhealthinWashington

o BuildinganewoutpatientstructureatSt.LouisUniversity

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Interprofessional Training and Educational Informatics:

NYU 3T: Teaching, Technology, Teamwork

Terry Fulmer, PhD, RN, FAAN, and

Marc Triola, MD, PhD


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NYU3T: Teaching, Technology,

Teamwork Envisioning Leadership for Health

Professions Education for the 21st Century

Terry Fulmer, Ph.D., R.N., F.A.A.N.

Erline Perkins McGriff Professor

Dean, NYU College of Nursing

Marc M. Triola, M.D. Director, Division of Educational Informatics

NYU School of Medicine

Background: NYU3T

•  Students have few opportunities learn and practice the

fundamental skills of patient-provider interactions and team-

based care.

•  Despite the recognized need, systematic inter-professional

education (IPE) is not the standard.

•  New York University School of Medicine and New York University

College of Nursing received a four-year grant from the Josiah

Macy, Jr. Foundation to develop NYU 3T: Teaching,

Technology, Teamwork, which will provide NYU medical and nursing students with longitudinal exposure to a diverse patient

population and inter-professional education in the competencies

of team-based care.

Background: Our Strengths

•  Strong program of innovation in technology-

enhanced educational initiatives

•  Faculty expertise and experience in Inter-

professional Education

•  Curricular reform at NYU has created new

opportunities and new educational settings

•  Strong commitment of the Dean’s of both schools

that this is important and needs faculty time

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NYU3T: Overview

•  Developing a well-tested curriculum for IPE of

health professionals.

•  Enhancing nursing and medical students’ cultural

competencies and skills for managing health

disparities in order to prepare them to care for

diverse and underserved populations.

•  Creating a large cadre of well-trained professionals

competent in inter-professional team skills.

NYU3T: Clinical Education

•  All students will be exposed to a longitudinal

curriculum in parallel with caring for virtual,

simulated, and real patients

•  Simulation sessions allow students to practice

skills together in a safe environment

•  “Clinical Cross-over” gives students exposure to

the roles of all team members

NYU3T: Novel Instruction •  New technologies being developed for NYU3T to optimize

educational effectiveness through collaborative online

learning

•  New evidence-based Virtual Patient application: students

can asynchronously care for simulated patients together

•  All components will be made freely available on the web:

–  Simulation Cases

–  Learning Modules

–  Virtual patient application will be made available as

open-source and will be compliant with the emerging VP

technical standard


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NYU3T: Anticipated Benefits •  Continuity of learning across years of education,

including simulated disease progression

•  Unique opportunities for inter-professional team

building including working collaboratively on virtual

interdisciplinary notes and formulating problem and care

plan lists

•  Mastery in taking care of diverse patients with varied and

continually changing needs

•  By the completion of the grant period, over 1,000

students will participate in some aspect of the program.

NYU3T: Curricular Components •  Two Semester Curriculum

•  Rigorous assessment and evaluation with each intervention and

overall for NYU3T

NYU3T: Video

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NYU3T: Progress to date

•  11 nursing and 10 medical students participated in pilot mannequin-

based simulation sessions in November.

“I enjoyed spending time explaining nursing school to the medical

students and vice-versa. I hope that with experiences like this,

the communication and collaboration of future doctors and nurses will become one of teamwork and respect.”

-Nursing Student

“In terms of medical education, I actually learned a lot from sitting on

the side and asking questions [of] the nursing students, and the

nurse practitioner educating and answering questions. To me, it

makes a lot more sense to have first-hand experience of what you're learning, rather simply learning about something in the

textbook, and then trying to apply it to real-life settings a year or two later.”

-Medical Student

NYU3T: Progress to date •  Three of the five core online modules have been developed

•  We piloted the Health Care Team Members online module

with 9 medical students and 8 nursing students:

“I had no idea what sort of education and training nurses, PA's

and others have. This was very helpful in allowing me to

understand their responsibilities and how to best work as a

team to provide care for patients.”

-Medical Student

“I liked the use of a game to learn the material. The varied methods of presenting the information was very helpful for

understanding the content of the module.”

-Nursing Student

NYU3T: Challenges

•  Differing academic schedules and structures are

barriers to live synchronous learning

•  Preceptor overload: Faculty preceptors are under

increasing pressure to be more clinically

productive and devote less time to teaching

•  Health clearance and other regulatory

requirements for students to have patient access

in clinical areas

•  Inter-professional and team competencies are

only now being routinely included in curricula or

national consensus reviews of important topics


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NYU3T: What’s Next?

•  Spring 2011:

–  Kick-off "social" to introduce NYU3T curriculum to ~300

medical and nursing students

–  Implementation of 5 online modules for ~300 students as part

of "regular" course work in Professional Nursing and PLACE

courses

–  Implementation of "clinical cross-over" as part of Adult & Elder I nursing and PLACE courses

–  Continued development and pilot testing of VP21 and joint

simulation

•  Summer 2011

–  Continued development and pilot testing of VP21 and joint

simulation

NYU3T: What’s Next?

•  Fall 2011:

–  Second "social" to summarize success of semester 1 and

introduce semester 2

•  “Joint simulation day” on two weekends in the fall. All students

invited to participate in 1 hour joint simulation sessions

•  Continued implementation of VP21 as part of Adult & Elder III and PLACE

Thank You [email protected]

[email protected]

http://dei.med.nyu.edu/research/nyu3t

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American Physical Therapy Association's

Education Leadership Institute

Jody Gandy, PT, PhD

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Jody Gandy, PT, DPT, PhD

American Physical Therapy Association

10/18/10

Building a health profession’s education leadership institute requires a dedicated and committed team.

Beth Domholdt, PT, EdD, FAPTA

Michael Emery, PT, EdD

Martha Ferretti, PT, MPh, FAPTA

Susan Nelson, PT, MS

Lois Nora, MD, JD, MBA

Michael Pagliarulo, PT, PhD

Margaret Plack, PT, EdD

10/18/10

Question 1

•  Is there a need for an education leadership program for physical therapist (PT) and physical therapist assistant (PTA) faculty?

Question 2

•  Is the development of an education leadership program feasible (i.e., costs, level of interest)?

Question 3

•  If a program were developed, how should it be designed and configured (i.e., learning outcomes, content, delivery)?

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  2007  Researched existing education leadership programs

such as AACP, AAMC, ELAM, ACE, etc.

 APTA staff visited several health profession associations and interviewed leadership development coordinators

  AAMC, ADEA, AACP, ASHA

 Created a matrix that described similarities as well as unique features of these programs

10/18/10

  2008 - Consultant Group on Education Leadership Development  Conducted comprehensive literature review   Trend analysis in higher education and healthcare

  Leadership issues in higher education and health care

  Interprofessional education and practice

  Workforce data and demands for physical therapy

  Aging population and needs for healthcare services

  Increasing physical therapy vacancy and turnover rates related to practice settings and geographic location

  Current and anticipated faculty shortages

  Length of time required to fill program director and faculty vacancy

10/18/10

  Assessed demographic trends  Current program directors

  2008: PT = mean 53.8 years; PTA = mean 48.8 years

  2008: 45% PT and 41% PTA program directors in their current position < 5 yrs

  2010: 31% PT program directors > 60 years

 Developing physical therapy programs

  2008: 33 PTA and 2 DPT

  2010: 55 PTA and 14 DPT

  Planned program class size for PT programs increasing since 2004

  Identified need for leadership succession planning

10/18/10

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2008 National Survey

• Surveyed PT and PTA academic faculty, program directors, clinical and fellowship directors, and non-physical therapy members of Commission on Accreditation of Physical Therapy Education (CAPTE).

• Posed questions about perceived need, curricular content, preferred delivery approaches, program costs, likelihood of participating, and respondent demographics.

10/18/10

574 survey responses representing 85% states, all regions of the United States, and all stakeholder groups surveyed.

57% reported interest in an educational leadership institute

84% indicated a desire for a

blended approach to

content delivery

83% reported the cost of an

educational leadership program should be a shared

responsibility (individual,

institution, APTA)

Identified curricular content

perceived as of highest, high, and moderate importance

10/18/10

Identified a compelling need and urgency to develop an Education Leadership Institute initially targeted toward PT and PTA program directors.

Recommended creation of a shared collaborative (Steering Committee) comprised of representatives from the Education Section, Academic Council, PTA Educator SIG, Consultant Group, External member, and APTA.

Recommended to the APTA Board of Directors to develop, implement, and evaluate an Education Leadership Institute.

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  Reconfigured a new 7-person Steering Committee to develop, implement, and evaluate an Education Leadership Institute as a shared collaborative.

  Steering Committee Members  Reflected a shared collaborative of key stakeholders   Experienced PT and PTA program directors at

various types of academic institutions  Non-physical therapy member with experience in

building health profession education leadership program

 Higher educator administrators

10/18/10

Mission

Goal

Program Description

10/18/10

• Oriented toward leadership in the broadest context,

• Designed to meet contemporary education leadership needs with an eye toward the future,

• Targeted toward higher education culture.1 2

To develop innovative and

influential leaders in

physical therapy education who can function

within a changing

politico-socio-cultural

environment.

1Searle NS, Hatem CJ, Perkowski L, Wilkerson L. Why invest in an educational fellowship program? Academic Medicine. 2006; 81(11):936-940. 2Korschum HW, Redding D, Teal GL, Johns MME. Realizing the vision of leadership development in an academic health center: The woodruff leadership academy. Academic

Medicine. 2007; 82(3):264-271. 10/18/10

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The Education Leadership Institute’s goal is to develop PT and PTA education program directors with leadership skills to facilitate change, think strategically, and engage in public discourse to advance the physical therapy profession.

10/18/10

  Provides a yearlong blended learning curriculum.

  Content addresses current and future needs of the profession and the education community.

  Connects theory with practice through action learning and reflection as applied to everyday performance.

  Mentoring provides participants with high quality, experienced academic administrators as positive role models.

  Peer networking facilitates the development of future mentors and leaders.

10/18/10

Learning project based on issue/need

within the participant’s

academic institution

Professional leadership

development plan

Integration of educational leadership concepts

Completion of formative and

summative program

assessments

Participation in longitudinal

studies

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  Length

 One year (July to July; begins 2011)

  Program size

 Targeted cohort 25-30 participants annually

  Participant Networking and Mentoring

 Periodic audio and video conferencing

 6 program mentors

 2 mentors paired with 10 participants

10/18/10

  Infrastructure

 Blended learning format

 Online orientation

 9 online modules taught by experts outside physical therapy

 3 required on-site sessions (1.5-2 days each)

 One optional alumni session

 CEUs provided for each online and onsite course

10/18/10

  Program Application Requirements  Formal participant application with the support of

the academic institution and Dean/Supervisor

  Applicant Nomination Form

  Dean/Administrative Supervisor Nominee Form

 Targeted toward novice (0-7 years) and emerging program directors

 Current APTA membership

 US licensure/registered/certified or licensure eligible

10/18/10

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  Mentor Requirements  Meet defined characteristics and attributes as

experienced program directors

  Positive role models

 Agree to roles, responsibilities and time commitment as described in the Mentor Manual

  Function as pairs assigned to cohort of10 participants

 Access to all online coursework

 Required to attend on-site sessions

10/18/10

Program Videoconference Orientation: July

#1 Onsite Session: Oct

(Modules 1-3)

#2 Onsite Session: March (Modules 4-7)

#3 Onsite Session: July

(Modules 8, 9)

#4 Onsite Alumni Session (optional): Oct

Education Leadership Conference

Education Leadership

Institute Schedule

10/18/10

  Orientation Session: Videoconference   Introductions

 Orientation to Education Leadership Institute, yearlong program schedule, and deadlines

 Review of participant expectations and learning outcomes

 Role of Education Leadership Institute Committee, faculty, mentors, moderator, and APTA staff

  Practice accessing and using various program technologies and resources

 Key contacts

 Q & A

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  Online Curricular Content 1.  Personal Leadership and Management

2.  Higher Education, Healthcare Systems, and Society

3.  Institutional Leadership and Management

4.  Resources/Financial Management

5.  Legal Issues

6.  Student Affairs

7.  Human Resource Management

8.   External/Internal Relationships, Influence, and Partnerships

9.  Program Development and Outcomes Assessment

10/18/10

1. Personal Leadership and Management

2. Higher Education, Healthcare Systems, and

Society

3. Institutional Leadership and Management

4. Resources/

Financial Management

5. Legal Issues 6. Student Affairs

7. Human Resource Management

8. External/Internal Relationships, Influence, and

Partnerships

9. Program Development and Outcomes Assessment

Curricular Modules and

Sequence

October

March

July

10/18/10

  Module Outcome Objectives   Apply the principles that guide being a change agent to

establishing new relationships and partnerships for academic programs.

  Analyze risk factors that may cause new relationships with stakeholders from being established.

  Analyze which principles associated with establishing new partnerships with your program would be challenging to employ in your environment.

  Apply the principles for creating a departmental positive public image that would be acceptable in your environment.

  Compare and contrast the concept of “leading from the middle” with two other leadership paradigms/models for creating new partnerships.

10/18/10

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  Onsite Sessions: October, March, July  Highlight key concepts from online learning and

provide for faculty question and answers

 Case studies used to translate knowledge into practice

 Application to real-life situations in educational environments

 Ongoing refinement and enhancement of Leadership Development Plan

  Participant networking, action learning, reflection, and mentored discussions

10/18/10

  Alumni Session: October  Reception for Education Leadership Institute alumni

 Networking alumni with current ELI cohort and future program applicants

  Promotion of alumni institutional leadership projects

  Introduction of alumni to other leaders in the profession and education

 Alumni attend the Education Section’s Education Leadership Conference

10/18/10

  Education Leadership Institute Website www.apta.org/eli

  Education Leadership Institute logo and branding of materials

  Distributed bookmarks at the Education Leadership Conference

  APTA communication vehicles

  Education List serve

  Education Section Website

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Academic Institution

$5,000 Program Tuition

Support for the participant through

institutional resources and

mentoring

Participant

Hotel and travel to on-site meetings

Access to required technology

APTA

Online course content in APTA Learning Center

Program faculty, mentors, moderator and APTA staff

Technology, resources

On-site meetings and logistics

~$200,000

10/18/10

  Education Leadership Institute Program  Confirm faculty to teach online modules and

provide standard template for course materials

  Select and confirm 6 program mentors and several alternates

 Develop case vignettes for the on-site courses

  Use experienced program directors not selected as

mentors to craft case vignettes

  Identify program moderator

 Determine locations for the on-site courses in 2011 and 2012

10/18/10

  Creation of an “official” Education Leadership Institute Committee (Policy and Oversight)  7-members to be appointed by the APTA Board of

Directors

  First appointments will include staggered terms for the current Steering Committee members

 Develop Committee charge and tasks

  Special criteria to serve on the committee

  Frequency of Board reports

10/18/10

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  Assessments   Participant assessments

  Individual online and on-site course assessments

  Program assessment (includes mentors and faculty)

  Profession assessment

 Creation of a database for future program research

  Marketing and Communications (Future)  Develop a brochure to include the benefits of the

program with testimonials

  Promote of ELI graduate projects

10/18/10

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Summary of External Advisory Board Interviews

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Thematic Summary of External Advisory Board Interviews

______________________________________________________ External Advisory Board Members Carol Aschenbrener, MD - Association of American Medical Colleges Robert D’Alessandri, MD - The Commonwealth Medical College Melissa Begg, ScD - Columbia University, Mailman School of Public Health Linda Fried, MD, MPH - Columbia University, Mailman School of Public Health Jody Gandy, PT, DPT, PhD - American Physical Therapy Association Kristine Gebbie, DrPH, RN - Hunter-Bellevue School of Nursing Deborah German, MD - University of Central Florida College of Medicine Karl Haden, PhD - Academy for Academic Leadership Kenneth Kalkwarf, DDS, MS - The University of Texas Health Science Center at San Antonio Dental School Mark Kelley, MD - Henry Ford Health Systems Mary Lee, MD, MS - Tufts University Cathryn Nation, MD - University of California Lois Nora, MD - Northeastern Ohio Universities Colleges of Medicine and Pharmacy Steven Wartman, MD, PhD - The Association of Academic Health Centers

______________________________________________________ As part of our research into best practices for health professions education leading up to the conference, AMSNY/NYSADC convened an external advisory board of representatives from innovative leadership programs and institutions across the country, to learn how they have responded to the changing landscape of health education and delivery.

Members of the External Advisory Board provided their insights on the development of health professions leadership during a series of interviews. External Advisory Members were asked to: 1) describe their programs/institutions, including their innovative approach to health professions education and leadership, and 2) to discuss their leadership philosophy, specifically what they thought would be requisite skills for leading in the healthcare environment of the mid-21st Century, including how to lead interprofessional teams across the continuum of education and practice, systems-based quality improvement and organizational change. Members were then asked to provide recommendations for the development and implementation of faculty development leadership programs using innovative pedagogical approaches and educational informatics related to program content, context (learning setting) and process methods.

External Advisory Board members also shared their experiences and expertise on the subject of leadership and innovation, as facilitators of roundtable discussions at the conference "Envisioning Leadership in Health Professions Education for the 21st Century".


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Interview Summary

_______________________________________________________

Definition of Leadership We need to make a distinction between management and leadership. Management is related to operations while leadership is about vision. Leaders should be open-minded, strategic thinkers. It is also important to differentiate between de facto leadership roles, and leaders who are appointed to leadership positions: “The chain of command is not the same as leadership.” There were differing opinions on how leadership is defined and whether it is innate, or can be developed. Some EAB representatives felt that leadership requires innate ability, but that certain aspects of leadership can be learned/developed. They noted that it is not possible to provide leadership training to all health sciences faculty so that institutional leadership must be selective in who is chosen for training and that it is important to identify potential leaders early on for succession planning. Other EAB representatives felt that it was important to think broadly about leadership and expand the definition, as many leadership styles and roles exist. Different types of leaders can be effective within different roles because of the complex nature of the healthcare system. Different institutions and even different departments within the same institution can require different leadership skill-sets. Program Content The content of a leadership program will very according to participants, however it should be structured so that there is asynchronous presentation of content and that the design of the curriculum should be competency-based.

LEADERSHIP SKILLS and CURRICLUM CONTENT:

1. How can we foster leadership in faculty to prepare them to work in a changing health care environment?

2. How should we develop educational content that is relevant to the changing health care system in the 21st century and beyond skills?

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Leadership Competencies (knowledge, skills, and attitudes)

Emotional intelligence

- Self-awareness and reflection (identifying one’s leadership and communication styles); - Professionalism, integrity, and modeling the way.

Visioning, scenario planning and strategic thinking

- Leaders should be proactive so as to be cognizant of what is on the horizon and anticipate change at a minimum of ten years out to identify challenges and opportunities early on;

- Ability to clearly articulate one’s vision and well defined goals; - Project management skills/action plan management.

Interpersonal skills/communications

- Facilitation and consensus building, including how to motivate people to move from thinking into doing (which is the key to sustainable change);

- Communication: • The art of effective listening and communication; • Ability to find a common ground and an understanding of diverse perspectives; • Formative and summative performance evaluations and constructive feedback;

Leadership of high performance, interprofessional teams

- Systems-based education and practice with reference to complex adaptive systems; - Development and management of human capital:

• Ability to manage up and down;

• Faculty development, mentoring, and succession planning. Conflict resolution

- Negotiation and mediation; - Consensus building and the ability to inspire a common vision.

Continuous quality improvement - Adaptive expertise and cognitive flexibility (ability to change in response to new models); - Innovation cycles in learning organizations; - Curriculum reform and program evaluation.

Change management and curriculum reform

- Managing behavioral transitions and consensus building; - Adaptive expertise; - Continuous quality improvement and curriculum renewal.

Health information technology and educational informatics

Evidence-based management

- Assessment and statistics;

- Economics and budgeting.

Social mission of the health professions

- Public health; - Longitudinal, patient-centered care models of care; - Accountability and the social mission of healthcare: “The servant leader accepts responsibility

because they want to serve and resolve issues for the common good.”


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Program Development

While educators should utilize the teaching methods that are most appropriate to specific learning

objectives, methods should be varied to accommodate different learning styles (e.g. early electives,

longitudinal research, community programs). Educators should also incorporate planned redundancy

and repetition into the program design for the presentation and evaluation of key concepts.

Learning should be experiential and focus on: - Case-based learning with clinical applications, e.g. interprofessional simulations; - Problem-based learning (PBL); - Quality improvement exercises; - Self-directed life-long learning and reflection;

- Competence and outcomes assessment; - Adaptability/responsiveness to change; - Integration across the continuum; - Educational informatics at point of care (e.g. personal digital assistants (PDAs)).

Interprofessional team building/team work

- Interprofessional training should be longitudinal across the continuum of education and practice, and occur in settings of critical incidents where teamwork is essential for patient

care; - Team-based training should identify issues in healthcare delivery and utilize problem-based

learning; - Leadership training for interprofessional teams is an important concept, but leaders must first

be cognizant of differences between the health professions; - Interprofessional quality improvement exercises;

- Peer assessments and 360 feedback; - Given the cross-cutting and interprofessional nature of public health, it should be included in

any health curriculum.

CONTEXT and PROCESS/EDUCATIONAL METHODS:

How can we prepare learners to become expert clinicians, who continually grow and refine their expertise? How can we engage learners to effectively improve their cognitive abilities, skills and attitudes?

1. Where should learning occur, for example, in the classroom, at the bedside, in outpatient and community settings, at the computer?

2. How can we foster teamwork and interprofessional collaboration?

3. How can we effectively assess the full range of learner competence?

4. How can we determine if the program goals have been accomplished?

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Determine goals/objectives first through conducting a needs assessment, then structure the

program around established needs.

Define the level of faculty or staff to participate in the program.

Emphasize principles and generic skills, e.g. managing change, innovation, adaptability; interprofessional teamwork, and systems-based continuous quality improvement.

Be mindful of constraints (e.g. any constraints that stakeholders are under).

Resources

Programs should be developed by faculty with expertise in program design and evaluation.

A focus group of leaders should be brought into the program development to discuss what they wish they knew before they took their current positions (this method also creates interest in the program).

The program should be at least 2 weeks in order to affect meaningful and long lasting change.

Projects were often cited as the most important component of the program.

The program should include professional coaching and mentorship, including first-person

assessment. Mentors should receive formal training.

Program Evaluation

In order to determine whether the program’s goals have been met:

- Programs should use a sampling of assessment methods and skills (formative and summative). - Qualitative and longitudinal evaluations are necessary to determine long-term outcomes.

Breaking down barriers: 1) between the professions, and 2) across the continuum of education.

Structural issues related to interprofessional training (incentives are needed to encourage

collaboration across the professions).

Momentum is needed behind change and the motivation of key stakeholders.

Recommendations for the Development and Implementation of a Leadership Program

Potential Obstacles for the Implementation of Institutional Change


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Quality Improvement/Innovation Cycles

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Leadership and Organizational Theory-General

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Complexity Science/Systems Theory/Complex Adaptive Systems

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Leadership/Faculty Development

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Conference Evaluation


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Conference Evaluation __________________________________________________________

n = 28; The results were based on 50% of the conference participants who completed the survey.

Other

Comments:

“The mix of people from the various professional schools was an excellent way to gain cross-professional perspectives about leadership.”

Health sciences education and training Internist in health screening and as dental faculty Physical Therapy Faculty Affairs

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Overall Format

Conference Relevance

Comments: “Leadership in a shared collaborative is a great idea and very worthwhile. The concepts raised are certainly applicable to other health professions that were present.”


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Presentations

Comments: “The speakers represented a wide range of perspectives and expertise and that provided fertile ground for discussion and some debate”.

“The presentations did a great job of setting the stage for small group discussions”.

Break-Out Sessions

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Break-Out Sessions, Cont. Comments

“The most amazing thing was how closely everyone concurred - many of the groups came up with similar if not identical criteria and best practices for leading successful innovations and institutional change. This demonstrates that the different professions are all facing similar challenges with shared goals”. “The small group discussions fueled some interesting approaches to leadership and communication. The sessions stressed the need for honest, open communication and the need to develop negotiation skills, especially when there is conflict”. “Brainstorming opportunities were great and conversations were good, despite the fact that at times we wandered a bit off of the topic; the free-flowing format did allow us to explore a variety of aspects”.

Additional Comments Strengths

“The interprofessional breadth and integration; excellent resources and mix of people. The interprofessional nature of the conference was great and could be expanded to other professions. Opportunities to engage in small group discussions about topics of relevance and importance was very beneficial”. “The conference planners did a wonderful job of conceptualizing the conference and its structure. The opportunity for medicine, dentistry, nursing and other health professions to come to the table to discuss future leadership issues and needs in health professions education was important. This is a great start, recognizing there is more work to come. Opportunities to share resources with other professions is also possible once the curriculum has been determined, so as to maximize resources”. “I had not been a part of the leadership aspect of the Institute before so it was interesting. I think introducing an interprofessional aspect was valuable. Good to see where other professions are heading and the impact of health care reform. There appears to be leadership vacuums all over the map so these kinds of conferences are needed”. Weaknesses

“Too complex; there were too many topics and areas to cover in the small groups, which made it hard to focus the discussions at times. Good ideas were presented, but a simpler, more focused set of questions might have been better”. “To maximize time further, the large group plenary could have come to agreement about the most important topics to be addressed and then assign those to small groups to help them focus, while also setting a reasonable agenda to accomplish in the time provided”.


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Next Steps “Thinking through the process of developing programs for our institution, we intend to look more closely at the possibilities for interprofessional coursework. The conference provided inspiration in leading change as well as a great environment for exchanging ideas and networking.” “This was a great opportunity for gathering and creating a "think thank". The conference described the need and I applaud you all for organizing it.” “Perfect as brainstorming. Need additional time, maybe with groups from similar institutions to discuss mechanics and gaining support within and across institutions”. “Excellent forum for brainstorming and collaboration to get a NYS dialogue underway across the professions – interinstitutional collaboration will ensure a much greater chance of success.”

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Conference Budget


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Budget __________________________________________________________

Vendor Quantity Cost Total

Columbia Faculty House 1 14,508.00 14,508.00

Videographer 1 1000 1,000.00

Journal Articles 1-2 2 82.5 165.00

Journal Articles 3-4 2 3.5 7.00

Printing - Program Materials 75 15 1,520.00

Printing – Final Report 35 2,610.00

EAB Travel 11 1000 9,689.39

Miscellaneous 2,500.00 Estimated

Personnel 20,000.00

Total 51,999.39

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