A workshop on leadership for MD/PhD students.

Success in academic medicine requires scientific and clinical aptitude and the ability to lead a team effectively. Although combined MD/PhD training programs invest considerably in the former, they often do not provide structured educational opportunities in leadership, especially as applied to investigative medicine. To fill a critical knowledge gap in physician-scientist training, the Vanderbilt Medical Scientist Training Program (MSTP) developed a biennial two-day workshop in investigative leadership. MSTP students worked in partnership with content experts to develop a case-based curriculum and deliver the material. In its initial three offerings in 2006, 2008, and 2010, the workshop was judged by MSTP student attendees to be highly effective. The Vanderbilt MSTP Leadership Workshop offers a blueprint for collaborative student-faculty interactions in curriculum design and a new educational modality for physician-scientist training.

Success in academic medicine depends on many factors, but a hallmark of accomplishment in this discipline that receives little attention in medical school curricula is aptitude in leadership and organizational behavior. In particular, physician-scientists must learn and apply advanced skills in recruitment, retention, communication, conflict resolution, providing feedback, and strategic planning, among other competencies. Most training programs offer exposure to these skills primarily through the passive observation of peers and mentors, who may be inconsistent or even ineffective role models.

Research in organizational behavior and business administration indicates that people making the transition from individual contributors to leaders find that the experience of ‘leading’ differs significantly from what was anticipated and is substantially more challenging. In an analysis of 19 first-year managers conducted in 2003, Hill (1) describes the process as a ‘transformation – a fundamental change in identity and point of view,’ often associated with stress and intense emotion. Furthermore, she notes that lack of preparation and support often results in failed leadership transitions. The quality of leadership also varies significantly across individual leaders, even in the same organization. Importantly, leadership quality predicts critical outcomes such as productivity and turnover (2).

Formal instruction in leadership and organizational behavior is an expressed need among those preparing for careers in academic medicine. Many self-help books for assistant professors incorporate descriptions of management principles and leadership competencies (3–6). The Sigma Xi Postdoctoral Training Survey identified structured training opportunities in leadership and teamwork (including communication and management) as main areas requiring improvement in postdoctoral training (7). The National Research Council of the National Academies cites training in areas such as laboratory management, business and budgeting, communication, and team leadership as a critical opportunity for improving the postdoctoral experience (8). The Howard Hughes Medical Institute along with the Burroughs Wellcome Fund led well-attended ‘boot-camp’ workshops in 2002 and 2005 on laboratory management and have published a detailed companion guide that dedicates two chapters to leadership and mentoring skills (9). The AAMC (10), Cell (11), and Science Careers (12) have highlighted leadership resources and workshops designed for postdoctoral fellows. Importantly, efforts in leadership training have documented value in the career development of medical school faculty. At the University of California at San Diego, assistant professors who complete a leadership curriculum are significantly more likely to be promoted on the tenure track (13).

There are limitations to currently available educational modalities in leadership for physician-scientist trainees. First, leadership programs tend to exist as supplements to traditional curricula, although integration of the content into formal training programs is frequently identified as a major opportunity for improvement (7, 8). Second, available modalities are in large part designed for trainees at the postdoctoral level and beyond. There are limited resources targeted to graduate students and medical students, who have more time to reflect on key concepts and develop core skills before it becomes necessary to apply them. Third, congestion in predoctoral graduate and medical school curricula, combined with an acknowledgment that not all graduate and medical students will pursue academic careers, leaves little time for formal leadership training experiences. Combined MD/PhD training programs, which seek to train leaders in academic medicine, are ideal settings for integrating leadership training into the formal predoctoral curriculum.

The Medical Scientist Training Program (MSTP) at the Vanderbilt University School of Medicine provides integrated training in medicine and science leading to both MD and PhD degrees. Most Vanderbilt MSTP trainees complete the first two years of medical school, pursue graduate studies in a doctoral program for three to four years, and return to medical school to complete the final two years of clinical training. Core elements of the Vanderbilt MSTP developed specifically for dual-degree students include a literature-based seminar series, clinical preceptorship during research training, a data club, a career development workshop, a physician-scientist speaker series, and an annual retreat.

In 2005 we considered how our MSTP could better equip students to become effective leaders. The following describes our student-driven approach to answering this question, the leadership curriculum we implemented for our trainees, an evaluation of that curriculum, and the implications and remaining questions for further investigation. While leadership training for physician-scientists could be effective in many distinct forms, lessons learned from our experience utilizing a joint student-faculty committee to develop and execute an original curriculum may provide guidance to others seeking to meet this well-defined need.

Premises

The Vanderbilt MSTP leadership curriculum has two primary goals: to expose MSTP students to the importance of proficiency in leadership skills for success in academic medicine, and to provide instruction in a set of core competencies for both immediate and long-term practice. We began by considering how an optimal leadership curriculum for MSTP students would fit within the current MSTP educational framework. First, we were aware that MD/PhD programs exist in an environment with finite resources. Therefore, we sought to develop a quality, sustainable program on a limited budget. Second, constraints on faculty and student time demanded an efficient program. Third, accomplishment of our educational goals would require the most relevant sources of information, including academic research, expert consultants, and intra-institutional resources. We proposed that the following specific questions be addressed.

Content – What specific content should be included to address our learning objectives?

Teaching modalities – What instructional materials and learning activities would be most appropriate?

Format and delivery – What format should be adopted and how should the content be delivered?

Timing– At what point in the MSTP curriculum should students attend the leadership program?

Evaluation – How should the program be evaluated?

To address these questions, we assembled a committee that included six MSTP students representing a cross-section of experience levels within the MSTP, the MSTP director, and faculty members from the Owen School of Management and the Peabody College of Education and Human Development. The diverse perspectives among the committee members were essential in our endeavor to select and adapt instructional approaches to be maximally effective, interesting, and relevant to our target audience. Over time, the committee has rotated off graduating senior students and replaced them with rising junior students, providing fresh perspectives for the committee and new leadership opportunities for our trainees.

Content

Training experiences providing content relevant to the actual work to be done are more likely to produce learning that is usable in practice (14, 15). Committee members specializing in education and management were well versed in generic leadership competencies and the standard frameworks commonly used to categorize current research and theory involving human behavior in organizations. However, these standard constructs of the leadership discipline were not always optimally relevant nor directly translatable to the specific nuances of investigative leadership in the setting of academic medicine. The committee therefore filtered the generic competencies using the experience of other committee members about the role of scientific and medical leaders to determine the most relevant competencies for MSTP students to learn. The four competencies featured in our curriculum are motivating others, giving effective feedback, understanding conflict, and coaching. These competencies were then adapted to a standard framework of organizational theory: the self, the team, and the situation. Questions that illustrate the conceptualization of leadership in this context include the following.

What do I need to know about myself as a leader, and what do I need to know about the individuals who form my team?

What do I need to know about team dynamics and team effectiveness?

What do I need to know about situational factors that influence individual and team performance?

Teaching modalities

We used a ‘challenge cycle’ approach to deliver the workshop content (16). In this approach, students are initially challenged to solve a problem with no prior teaching about how to do so. Students are encouraged to struggle through the problem using their pre-existing ideas, which are likely to be undeveloped and perhaps inaccurate. After students arrive at their best solution, formal instruction is provided about relevant concepts and theories. Equipped with this new knowledge, students then revise their thoughts about the original challenge. This cycle is repeated with new challenge scenarios, giving students the chance to revise their understanding of the central concepts further as they consider each related problem and apply their expanding knowledge base.

Instructional formats that actively involve the participants are more likely to allow information obtained in the classroom to be applied by participants in real-world situations (14, 15). Thus we planned the workshop to be as interactive as possible. Common methods of involving participants include experiential activities and discussion of cases, and we employed both of these modalities.

Experiential activities

A number of effective experiential activities specifically designed for use across disciplines currently exist within the wealth of educational tools for leadership and organizational behavior. Thus we were able to draw on previously developed activities rather than inventing our own. Student attendees participated in several of these group challenges to illustrate specific points about leadership and organizational behavior. These activities also provided students with new shared experiences, which served as valuable reference points throughout the rest of the workshop. In the discussion that followed each activity, we focused on how the experience illustrated the leadership competencies we had already covered in the workshop, including the importance of developing a shared language among a team to be able to complete a task; the typical roles that team members adopt and which are most effective; the diversity in the types of decision-making processes groups may adopt and which are most effective in which situations; and while ideally a group will outperform its top individual, why sometimes the opposite is true.

Case studies

The core of our workshop involved analysis of cases in investigative leadership. A synthesis of the literature on case-based instruction indicates that effective teaching cases should be relevant, realistic, engaging, challenging, and instructional (17). Although thousands of cases have been published for teaching leadership in business settings, these do not fit the distinctive context of a laboratory. Therefore we wrote nine original cases (Table 1 and Appendix for full text; Boxes 1 and 2 for two sample cases), each describing a different scenario where realistic but obviously ineffective leadership behaviors in the areas of motivation, providing feedback, conflict management, and coaching were exhibited by a principle investigator, attending physician, or team member. At each workshop, three of these cases were integrated into the curriculum. For each case, students in subgroups of five or six were asked first to discuss the scenario, considering the basis of the underlying problem, how it could have been avoided, and what should happen next. The whole group then reassembled for a broader discussion in which students were challenged to apply and further develop their working understanding of leadership in the context of relevant patterns of human behavior. In describing realistic, relatable problems that unmistakably arise from a lack of leadership skills, the cases also serve to highlight the importance of acquiring the core competencies covered in the workshop to be successful in academic medicine.

Table 1

Central themes from nine original cases developed to highlight key leadership concepts in the setting of academic medicine

Case title	Critical discussion questions
‘T-shirts’	How can a Principal Investigator (PI) effectively use rewards to motivate lab members? What are the potential pitfalls?
‘A new robot, oh boy!’	What unique factors motivate graduate students? Postdoctoral fellows? How can a PI encourage productivity among lab members whose motivation is lacking?
‘Oil and water’	How can a PI handle the different types of conflict that arise in close working relationships? Can there be positive consequences of conflict within a lab team?
‘Rebel with a cause’	How might an attending physician handle objections to critical decisions in patient care? Does it matter who objects, and how and why?
‘A call to arms’	How might a PI navigate making a significant change in research direction amid concerns from lab members?
‘To collaborate or not to collaborate, that is the question’	When (and how) should decisions about patents, future research directions, and paper authorship be made?
‘There is no “I” in team’	How can a PI improve recruitment and retention of graduate students? Should a PI engineer a certain lab environment to this end? How so?
‘Who's the boss?’	How should PIs establish and evaluate their hiring (and firing) practices?
‘It's all about the vitamin D’	What potential conflicts can arise in a mentoring relationship during the trainee's transition to independence? How can these conflicts be resolved? Or avoided in the first place?

Since much of the workshop content was new to MSTP students, we concluded that it would be appropriate to include didactic lectures with the other activities in our curriculum. Although formal lectures can be limited in fostering skill-building, personal insight, and problem-solving capability, they can be used effectively for disseminating information (18). During the didactic sessions, students were taught critical language and theory underlying each of the selected competencies. Our didactic sessions were highly interactive, discussion-based lessons. This format was achieved by illustrating concepts with realistic scenarios from academic medicine while challenging students to pinpoint the origin of a problem or describe the forces at work. Students often contributed examples from their own experiences that related to each topic and practiced applying new learned techniques via interactive exercises built into each lesson. An overview of the workshop, including a sample of specific content addressed under each leadership competency, is provided in Figure 1.

Fig. 1

Overview of the Vanderbilt MSTP Leadership Workshop.

Format and delivery

In reviewing the literature on leadership, Avolio, Walumba, and Weber (19) concluded that interventions designed to enhance participant leadership tended to have positive impact on ratings of leader performance even when the length of the intervention was as little as a day or less. Accordingly, we thought that a short, intensive experience would have a positive impact on students. We considered alternative formats (such as a seminar series) and concluded that a two-day workshop would be most appropriate given the time constraints imposed by the MSTP curriculum and our overall goal of generating deep, substantive thought and discussion about investigative leadership among the student attendees.

The management and education faculty members have more than 20 years of combined experience in teaching cases and facilitating experiential exercises. Therefore, the committee decided that they would facilitate the workshop. Student committee members remained actively engaged in the workshop presentation, serving as process observers and subgroup facilitators for experiential activities. Ultimately, inclusion of leadership content experts as workshop facilitators was invaluable in achieving our goal of active participation by student attendees. These faculty members were highly proficient in teaching the content and eliciting high-quality discussion among the group participants.

Timing

We concluded that students would benefit most from the workshop after having spent sufficient time in a laboratory to acquire some fluency in lab cultural norms and exposure to the unique challenges of the research team environment. Furthermore, we wanted to address the sharp contrast between the conventional hierarchical nature of training in clinical medicine and the highly variable and less-structured environments encountered by research teams, and the attendant requirements for different leadership competencies in each. Concurrently, we sought to reach students sufficiently early in their training to provide an immediate opportunity to practice new skills in the laboratory setting before returning to medical school. Therefore, we chose students in their first and second years of graduate training (third and fourth years in the program) as the target audience for our workshop. Additionally, students are encouraged to return to the workshop as senior students; returning participants benefit from revisiting and revising their concepts of leadership, while other workshop participants benefit from discussions enriched by the experiences of senior students.

Evaluation

Students completed evaluations at the close of each workshop to assess participant reaction to the program (20). Half of the evaluation consisted of Likert-scale questions, where students were asked to rate their agreement (1, strongly disagree; 5, strongly agree) on whether each portion of the workshop was, independently, ‘well organized and executed’ and ‘relevant to leadership concepts and skills.’ The second half of the evaluation consisted of free-response questions, including: What is the most valuable skill or concept that you gained from the workshop? Were there any topics or skills you wish the workshop had covered that were not included? Was the workshop well balanced in terms of presenting didactic information versus teaching practical skills? What are the one or two greatest strengths of the workshop? What are the one or two greatest opportunities for improvement?

Conclusions

We are able to draw several conclusions from the three workshops offered thus far (in 2006, 2008, and 2010). Data from our Likert-scale evaluation questions indicate that, overall, students agree that each component of the workshop was both well organized and executed as well as relevant to leadership; the mean of all scores in both categories combined was 3.8 in 2006, 4.3 in 2008, and 4.3 in 2010 (see Table 2). The evaluations also indicate that the participants placed significant value on the interactive nature of the workshop. Each year an overwhelming majority of the responses to ‘Was the workshop well balanced in terms of presenting didactic information versus teaching practical skills?’ were affirmative, most with comments indicating that they were engaged by the interactive activities and appreciated the opportunity to apply the didactic lessons. Furthermore, most of the 2008 and 2010 responses to ‘What are the one or two greatest strengths of this workshop?’ related to the experiential learning activities and the interactive nature of the workshop and its facilitation of learning.

Table 2

Likert-scale evaluation responses following the Vanderbilt MSTP leadership workshops conducted in 2006, 2008, and 2010

Workshop component	2006 mean (n=22)	2008 mean (n=21)	2010 mean (n=16)
Framework lesson	4.1	4.2	4.2
Experiential activity #1	4.1	4.5	4.7
Case studies	3.9	4.3	4.3
Didactic sessions	3.4	4.2	4.4
Keynote speaker	4.8	3.9	3.9
Video case study	3.6	4.7	4.4
Experiential activity #2	3.3	4.4	NA

Note: Data shown reflect combined means of responses to ‘This component was well organized and executed’ and ‘This component included relevant concepts and skills’ using a 5-item scale (1, strongly disagree; 5, strongly agree).

Our success in engaging students in active learning was evident by observing students participating in the workshop. During didactic sessions, unplanned topics often arose as the discussion led to new questions and ideas, stimulating meaningful conversations that we had not anticipated. We pursued these topics while encouraging students to consider new issues in the context of the leadership competencies covered earlier in the workshop. Among these ‘extra-curricular’ discussions were: can a laboratory group be effectively divided into separate subteams? Is rewarding success by individual laboratory team members acceptable? What is the best way to do so?

There was not much consensus in the evaluations about opportunities for improvement. In 2008 the strongest theme that emerged was that while students appreciated the examples that were included to illustrate most concepts, some concepts still came across as abstract. To address this weakness for the 2010 workshop, we examined each of the main teaching points and added as many examples and illustrations as possible. Our 2010 evaluations suggest that this intervention was effective, as none of the 2010 participants thought that the concepts were too abstract, whereas ‘clarity of message’ was cited when students were asked to list the workshop's greatest strengths.

The 2010 participants indicated that the main weaknesses of the workshop were related to scheduling: inconvenient hours and too fast a pace to cover each topic in appropriate depth. To address these concerns for the next installment, we are considering narrowing the focus of the workshop to fewer topics that will allow each one to be addressed in more depth, leaving students with a short list of take-home points. Concordantly, we recognize the importance of emphasizing to students that our workshop should be considered an introduction to a vast and important field. First and foremost, we hope that our students leave the workshop with an appreciation of the necessity of acquiring leadership competencies to achieve success in investigative medicine, along with a solid understanding of a few basic concepts and the motivation to seek opportunities for future leadership development training.

We have also considered strategies to assess the long-term impact of the training obtained in the workshop on the subsequent careers of our students. While formal outcomes such as appointment to leadership positions (e.g., department chair or dean) cannot be measured for quite some time, there are several options for assessing more intermediate effects of the workshop on participants’ professional development. These include surveying former participants at designated intervals after completing the workshop (e.g., after one, three, and five years) for examples of specific occasions in which they have implemented an intervention based on a concept introduced in the workshop, along with a reflective analysis about why the intervention was or was not successful. This process could also provide an opportunity for former participants to contribute additional real-life case studies to the workshop curriculum and offer fresh insights into the application of leadership competencies as a form of peer consulting.

An alternative idea for assessing the effectiveness of the workshop is to generate a written exam to test the ability of participants to apply workshop competencies to a new set of case studies. This evaluation tool could be applied at various intervals after the workshop. However, since the goal is to provide leadership skills that students will continue to develop and apply long after the workshop is completed, we think that testing immediately after completion of the workshop may not be very meaningful.

Based on the feedback we collected during its three initial installments, we think the leadership workshop provides an effective introduction to investigative leadership for MSTP students. Our participants have helped us identify several keys to our success: involving students in curriculum design; using expert facilitators who are knowledgeable and engaging; placing emphasis on interactive learning; and employing real-world case scenarios to illustrate key concepts. We will continue to offer our workshop biennially and incorporate improvements based on student feedback. Following up with workshop participants as they progress through their careers will allow us to measure qualitative long-term outcomes and make appropriate changes to maximize the workshop's impact.