Heatherlee Bailey, MD, FCCM
Previously in medical education, independent learning was the norm. “See one, do one, teach one” served as the tradition in medicine for generations. Trainees learned quite commonly from their resident colleagues and from faculty. While procedural techniques, differential diagnosis generation, and clinical decision-making were readily shared, skills required for the transition from trainee to faculty were generally and conspicuously absent. For those of us lucky enough to find mentors, those key individuals helped ease the transition between residency completion and shouldering the responsibilities of the role of junior faculty. In every way, training led to independent practice, and clinicians were taught how to be in charge.
We were also expected to be in charge of our own academic development. Academic centers have established criteria for what is expected to merit promotion from one rank to the next, for example, as a physician or moving through the ranks of nursing or pharmacy leadership. There are many other examples, and all demand a level of personal responsibility for developing within one’s chosen field. One key challenge is that not all institutions provide support or well-defined pathways to help guide the professional development of junior and mid-level faculty. This is one of the key opportunities for coaching or mentorship—the ability to help a junior faculty member lay out goals and areas of focus to help the junior faculty member achieve his/her personal and professional potential.
Within the current training paradigm, team-based approaches predominate. Crew Resource Management in the European Union and TeamStepps in the United States are two examples of how team-based training is reinforced during postgraduate medical education and throughout clinicians’ careers. This team dynamic allows junior members time to observe how teams function and to develop leadership skills early in their careers by group participation. The many types of teams include those for cardiopulmonary arrest, trauma, rapid response, stroke, ST elevation myocardial infarction, and difficult airway response. This team approach is also emblematic of changes in medical education, where trainees work with more than one guide along their professional development pathway. That same team structure is mirrored in how the Society of Critical Care Medicine (SCCM) works in teams.
SCCM functions as part of a team within the Critical Care Societies Collaborative (CCSC), which also consists of the American Association of Critical-Care Nurses, American College of Chest Physicians, and American Thoracic Society. Together, the four societies encompass more than 200,000 members across all of the major disciplines that might be found on an ICU team. The CCSC has addressed topics both relevant and challenging to critical care medicine, including burnout syndrome and the Choosing Wisely Campaign. Each of these topics has been explored in earlier editions of Critical Connections as well as SCCM’s flagship journal, Critical Care Medicine.
In a recent perspective piece, Lerman and Jameson explored a disconnect between the presence of leadership skills in medicine and the complexity of healthcare systems.1 This important perspective implies that there are necessary leadership skills that are not only learnable but also deployable and durable. They offer a three-step basic guideline to correct the gap between current skills and needed skills. First is to recognize the need to build and support diverse leadership within the healthcare system. Second is for healthcare systems to routinely search for individuals with talent and leadership potential within as well as external to the institution. The corollary is that there should be a program to build and buttress the talent and potential that such programs develop. Third is for the institution to have a structured onboarding process for those joining the institution that also guides appropriate individuals as they develop leadership skills. The long-range goal is to make the development of leadership skills a priority for healthcare systems and institutions, which will lead to increasingly efficient and effective healthcare systems.
While developing leadership skills is a laudable goal, it does not address how to optimally utilize those who have already developed that unique skill set. These individuals may be found by searching for those who have led work groups, task forces, or professional organizations. This group can be leveraged to develop leadership ability in those who are perceived to have that potential. This same group also typically comprises individuals identified as mentors for those transitioning from trainee to junior faculty. However, without a structured approach to professional development, each mentor must devise his/ her own approach. Perhaps a more efficient approach is to provide development tools for mentors to use to help guide skill set acquisition for trainees and junior and mid-career faculty.
SCCM is exploring new ways to help support members’ professional development. An SCCM task force is being formed to address this member need. It is designed to address the management of key stressors and support specific skill set acquisition as members grow within the different phases of their careers. Table 1 shows common junior faculty stressors, and Table 2 shows stressors more prominent among mid-career faculty. These lists are not exhaustive but represent some areas of commonality and some that are unique to each career phase.
The potential domains of needed programming will vary depending on members’ specific phases of training. Programs that may be developed include skills such as ICU leadership, fellowship administration, charting the first three years, speaking to the media, financial spreadsheet interpretation, committee leadership, and interprofessional organization negotiation, as well as maintaining work-life balance, personal health, and joy. The kinds of professional development needs required across all disciplines represented within SCCM will be reflected in programming content and presentation format. In this way, SCCM continues to expand educational content and respond to member needs to support both personal and professional success.
- Lerman C, Jameson JL. Leadership development in medicine. New Engl J Med. 2018 May 17;378(20):1862-1863.