A workshop on leadership for senior MD-PhD students.

Leadership skills are essential for a successful career as a physician-scientist, yet many MD-PhD training programs do not offer formal training in leadership. The Vanderbilt Medical Scientist Training Program (MSTP) previously established a 2-day leadership workshop that has been held biennially since 2006 for students in the first and second years of the graduate school portion of combined MD and PhD training (G1/G2 students). Workshop attendees have consistently rated this workshop as a highly effective experience. However, opportunities for structured training in leadership competencies during the subsequent 3-5 years of MD-PhD training are limited. Given the success of the G1/G2 leadership workshop and the need for continuity in this model of leadership training, we developed a half-day workshop for MSTP students in the clinical years of medical school (M3/M4 students) to foster continued training in leadership. Our workshop curriculum, based in part on original cases drafted by Vanderbilt MSTP students, provides concrete strategies to manage conflict and navigate leadership transitions in the physician-scientist career path. The curriculum emphasizes both short-term competencies, such as effective participation as a member of a clinical team, and long-term competencies, such as leadership of a research team, division, or department. Our inaugural senior leadership workshop, held in August, 2015, was judged by student participants to be well organized and highly relevant to leadership concepts and skills. It will be offered biennially in our training curriculum for M3 and M4 MSTP students.

Institutional cultivation of strong leadership competencies has been acknowledged as a necessary element in the training of physician-scientists (1, 2). Specifically, the National Academy of Sciences has recommended the broadening of educational opportunities for postdoctoral trainees in laboratory management and mentoring to support timely and successful establishment of independent careers (1). Additionally, members of healthcare teams with strong leaders are more likely to report satisfaction and less likely to develop burnout (3). However, while the need for leadership development in physician-scientist training is widely acknowledged, the optimal mechanism and timing of leadership training remains an open question.

Several healthcare organizations and academic centers have established leadership programs in response to the need for more formal leadership development of faculty and trainees (1, 4–6). Such programs and published materials for postdoctoral fellows and junior faculty members increasingly provide opportunities to learn or refine leadership skills such as those in communication, collaboration, feedback, mentoring, and management. These efforts positively contribute to effective leadership of clinical and research teams, achievement of tenure, and scientific publications (1, 6–8). However, such programs are not yet standard practice in the predoctoral training of physician-scientists.

Completion of medical school and graduate school requirements provide important experiential learning of leadership skills. We previously hypothesized that MD–PhD training programs (Medical Scientist Training Programs, or MSTPs) provide an ideal environment for incorporation of formal leadership development, particularly given that mission statements of multiple programs nationwide explicitly describe a commitment to training leaders in investigative medicine. For the past decade, we have sought to design and implement leadership programming for MD–PhD students in the Vanderbilt MSTP to fill these critical gaps in medical and research training.

Vanderbilt MSTP Junior Leadership Workshop

In 2006, the Vanderbilt MSTP instituted a biennial 2-day leadership workshop for MD–PhD students in their first and second years of graduate school (G1/G2; Fig. 1) (9). The goal of implementing this junior leadership workshop was to provide formal training in leadership during MD–PhD training. In the first 2 years of graduate school, students learn firsthand about team dynamics and mentoring styles as they gain experience as members of investigative teams. The junior leadership workshop was designed to provide structured programming to complement student experiences at this stage of training, allowing time to apply new leadership competencies during graduate school. This workshop has been an integral part of our MSTP curriculum for 10 years and employs an original design continually modified by a joint student–faculty committee responsible for planning and execution of the workshop. The junior leadership workshop employs a case-based learning format to cover a variety of topics including leadership styles, recruitment and retention, motivation, coaching, and feedback and has been consistently rated by MSTP students as a highly effective learning experience.

Fig. 1

Schematic of MSTP leadership workshop timing within the MD–PhD training curriculum. Since 2006, the Vanderbilt Medical Scientist Training Program (MSTP) has hosted a leadership workshop biennially for MD–PhD students in their first and second years of graduate school (G1/G2; ‘Junior Leadership Workshop’). The MSTP Senior Leadership Workshop, held for the first time in August 2015, was attended by senior, clinical-phase Vanderbilt MD–PhD students enrolled in the final two years of medical school (M3/M4). M, medical school year; G, graduate school year.

Vanderbilt MSTP Senior Leadership Workshop

While a one-time workshop is useful for exposure to concrete, learnable leadership skills, true leadership development requires time. More importantly, it requires application of new skills, revisiting of previously learned leadership concepts, and experience in multiple different professional contexts as one matures (10, 11). Fortunately, the 7–8 years that each Vanderbilt MSTP student will spend in MD–PhD training provides substantial time for the student to apply and reflect on learned leadership competencies from the junior leadership workshop. However, students spend those years rotating between clinical and research-based academic endeavors, and the interpersonal dynamics and hierarchical nature of teams in research and clinical settings can vary significantly. As such, the leadership competencies required for navigating these situations are unique.

Given the success of our junior leadership workshop and the opportunity for subsequent leadership development during MD–PhD training, we hypothesized that our MD–PhD trainees would benefit from reinforcement of important leadership competencies in the form of a follow-up workshop during their final clinical years of medical school (M3/M4; Fig. 1). Therefore, we developed a workshop focused on topics relevant to senior MD–PhD students preparing to enter internship and residency and begin a career in investigative medicine.

We formed a committee that included MSTP students, the MSTP director, and a faculty member from the Owen Graduate School of Management with expertise in organizational behavior to plan and facilitate the inaugural senior leadership workshop. While we incorporated programmatic expertise gained from hosting previous junior leadership workshops in planning this new curriculum, our planning committee was a distinct entity, independent of the planning of the junior leadership workshop. Our intent for the senior workshop was to design a half-day curriculum that accomplished two goals: 1) provide content that served as a refresher and follow-up of experiences of the junior leadership workshop and 2) use real-life case scenarios relevant to senior MD–PhD (M3/M4) students. In this way, we challenged senior students to think beyond previously attained leadership competencies and consider additional leadership challenges inherent to the physician-scientist career, both from short- and long-term perspectives.

Content survey

In contrast to our junior leadership workshop, which has consistently been designed as a 1–2 day event, the limited time available for senior students required a more focused selection of content for the senior leadership workshop. To identify topics of greatest interest to senior MD–PhD students, we administered a survey to rising M3 and M4 Vanderbilt MSTP students (anticipated workshop attendees) as well as graduating M4 students. In this survey, we provided a list of leadership competencies, some of which were covered in the junior leadership workshop, and asked students to select three to four topics from this list thought to be most important. The list of competencies included conflict management, feedback, coaching, expectations, motivation, directing group meetings, communication styles, effecting change, and building a team. We also listed a few potential scenarios for case studies and asked students to select three that were thought to be most relevant. Finally, we provided additional response space in which we encouraged students to suggest potential case studies from their experiences in investigative or clinical teams.

The two leadership competencies most frequently selected by students as topics warranting further discussion were conflict management and building a team. In addition, among the potential case scenarios most frequently selected by students were 1) management of administrative, clinical, and research time by an assistant professor and 2) establishment of priorities by a department chair. Based on this feedback, we chose two main areas of focus for our senior leadership workshop. First, we designed a case study focused on conflict management within a clinical team. Conflict management was a topic of study for the junior leadership workshop, and given the responses from students about their continued interest in this topic, we concluded that it would be valuable to revisit. Furthermore, since previous case studies in the junior leadership workshop had focused primarily on conflict management within a research team (as junior leadership workshop attendees are in the early years of graduate school), we thought it would be useful to address conflict management in the clinical setting. Second, we designed a case study focused on the challenges of transitioning between leadership positions within academic medicine. This case study would jointly address building a team and managing administrative, clinical, and research priorities as a faculty member and leader.

Workshop curriculum

Pre-workshop survey

One month prior to the workshop, we distributed a survey to workshop attendees to obtain participant-level information relevant to the planned curriculum. The first section of the survey was a conflict management style self-assessment (12), which assigned relative rankings of each individual's conflict management style in the following categories: collaborating, competing, avoiding, harmonizing, and compromising. The goal of this self-assessment was to prime workshop participants for discussions about conflict management by facilitating self-reflection before the cases were considered by the group. We thought that self-reflection about conflict management would be especially important given that the workshop was confined to a half day, eliminating the opportunity to introduce initial concepts, allow for a period of reflection, and re-open the discussion the following day. In addition, the de-identified results of these conflict management style assessments were correlated with gender and medical specialty of interest, providing cohort information useful to the workshop facilitator and of interest to participants when presented during the didactic portion of the workshop.

The second section of the pre-workshop survey was designed to elicit perspectives about leadership from student attendees. Specifically, we asked students to list the top three most and least effective leadership qualities they had observed thus far in their academic careers. We then asked students to list desired leadership positions in their future careers. By asking students to record these observations and career goals in advance of the workshop, we hoped to facilitate discussion among peers and with faculty facilitators about plans to achieve stated goals, potential barriers to success, and rationale for deciding which professional endeavors to pursue when given the opportunity. We thought that this stage of training, when students were thinking most intently about post-graduation plans and further training in medicine and science, would be an ideal time for encouraging students to thoughtfully consider future leadership opportunities and how to achieve them.

Case studies

To facilitate discussion during the workshop about the selected curriculum topics, we drafted two original case studies. Content areas for the cases were identified by workshop attendees to be interesting and relevant to their career aspirations. Discussion of these cases comprised the majority of our workshop curriculum. For each case, workshop participants were assigned to groups of four to five for initial discussion. The students then re-convened as a group (total 23 students) to compare conclusions and points of interest with their peers, the workshop facilitator, and additional content experts.

The follow-up sessions after each small-group case discussion were formatted as discussion-based lecture material to expand on the students’ preexisting knowledge base, incorporate results from the pre-workshop self-assessment exercise, and apply theoretical concepts back to the case scenarios. By incorporating these didactic sessions after the initial case discussions, we used the ‘challenge cycle’ of learning, in which students had an opportunity to probe their initial understanding of the topics at hand before engaging in a didactic learning format. The challenge cycle is a well-established teaching modality that we have successfully employed in previous leadership workshops (9, 13). Overall, the goal of these case-based discussions was to encourage context-based learning relevant to MD–PhD students’ future career endeavors.

Case #1: ‘Bottom of the Heap’

Our first case, entitled ‘Bottom of the Heap’, focused on conflict management within a clinical team (Appendix, Box 1). We presented a scenario in which a new intern working in an emergency department disagrees with other members of the medical team about the appropriate plan of care for one of her patients. She is forced to navigate a hierarchical team of co-residents, attending physicians, and consulting physicians to resolve the disagreement and provide optimal care. She also struggles with how to respond to the concerns and questions of the patient's family, given that the situation is largely outside of her direct control. In the discussion questions following the case, we encouraged students to consider the conflict management styles of each case character and provide potential avenues that could be used by this intern to reach a resolution for the described scenario. Following the case discussion, our workshop facilitator led a didactic session focused on conflict management, incorporating responses collected in the pre-workshop survey and encouraging students to reflect on their own conflict management styles. In sum, the purpose of this first case discussion was to present a realistic scenario that reflects the type of situation students will navigate as new resident members of clinical teams. The goal of the discussion was to provide students with tools to approach conflict in a more confident and prepared manner early in their professional careers.

Case #2: ‘On the Road Again’

Our second case, entitled ‘On the Road Again’, focused on transitions between leadership positions in academic medicine (Appendix, Box 2). We described a mid-career physician-scientist who is recruited to a new institution to take a position directing a large clinical division. The case describes the challenges faced by this individual as she decides whether to take the position, considers strategies for retaining and recruiting members of her research team, and learns to balance administrative, clinical, and scientific aspects of her new position. Discussion questions for this case also focused on these issues, prompting students to consider strategies for making transitions between leadership positions in academic medicine. We thought that this case was especially relevant given that, according to our survey results, 83% (19/23) of our workshop participants have aspirations to become a division director or department chair at some point in their careers.

For Case #2, our follow-up discussion extended into an informal reception and dinner session of the workshop and included prominent Vanderbilt faculty members (including two current division directors and a department chair) in a panel discussion. The panelists were asked to discuss challenges faced and decisions made while serving in various leadership positions over the course of their careers. The panelists then answered questions submitted by the workshop participants. As such, the panel discussion provided an opportunity to learn from institutional leaders about a variety of topics of interest from the afternoon workshop, including real-world conflict management and leadership strategies.

Evaluation

Post-workshop evaluation

Immediately following the workshop, we elicited feedback from student participants in the form of a written evaluation (Table 1). Similar to the evaluations for our MSTP Junior Leadership Workshop (4), this evaluation included one section of Likert-scale questions, in which students were asked to indicate their opinion about the organization, execution, and relevance of each section of the workshop (1, strongly disagree; 5, strongly agree). The second portion of the evaluation consisted of free-response questions soliciting information from students about the utility of the workshop content, the most valuable aspects of the workshop curriculum, and areas for improvement. These questions included: Was the workshop well balanced in terms of presenting didactic information versus encouraging discussion? In what way, if any, did this workshop affect your personal plans for leadership development? Is there anything you heard today that will affect how you approach conflict in the future? What is the most valuable skill or concept that you gained from the workshop? Were there any issues or skills you wish the workshop had covered that it did not?

Table 1

Likert-scale evaluation responses of 2015 MSTP Senior Leadership Workshop by student participantsa

Workshop activity	Well organized and executed?	Relevant to leadership concepts and skills?
Conflict Management Styles Quiz (pre-workshop survey)	4.47	4.56
Case Study #1: ‘Bottom of the Heap’	4.64	4.59
Didactic Session on Conflict Management	4.53	4.29
Case Study #2: ‘On the Road Again’	4.41	4.53
Dinner Discussion: Leadership in Academic Medicine	4.73	4.73

Data represent mean responses using a five-item scale (1, strongly disagree; 5, strongly agree; n=17)

On our Likert-scale evaluation questions, the majority of students selected either ‘strongly agree’ or ‘agree’ when asked whether each element of the workshop was well organized, well executed, and relevant to their understanding of leadership concepts and skills (Table 1). The two most highly rated workshop activities were the case study on conflict management (Case #1: ‘Bottom of the Heap’) and the after-dinner panel discussion with Vanderbilt faculty leaders about academic leadership.

When asked whether the balance between didactic learning and opportunities for discussion was appropriate, all student participants answered in the affirmative, many repeatedly noting throughout the evaluation that the discussion portions were a strength and highlight of the workshop experience. When asked about the effect of the workshop on students’ personal plans for leadership development, students replied with such statements as: ‘It made me think of what I want my career to look like in 20 years – during a time when it's hard to think beyond residency’, ‘It provided clarity on what the tasks and expectations are for leadership positions in academic medicine. It also put leadership styles and conflict management skills into a more structured, comprehensive context’, and ‘[It] affirmed my desire for an academic leadership position’. Two of 13 respondents noted that it did not significantly change their thinking but merely affirmed their previous career plans.

When asked whether there was anything the students heard during the workshop that will affect how they approach conflict in the future, students replied with such responses as: ‘… Primarily, to gauge where I'm coming from, where the other person is coming from, and then act. And don't be afraid to ask for help and advice’, and ‘It highlighted the value of stepping back from tense conflict situations and resolving issues in a constructive, mutually beneficial way’.

One of the most frequently cited areas for improvement in future workshops was the suggestion that we minimize the small group (four to five students) discussion of each case study and maximize the large group discussion (~20 students) with our workshop facilitator. In addition, two students noted that the timing of this workshop could have been improved; specifically, an M4 student suggested that August during the fourth year of medical school was an especially busy time. While later in the fall semester would likely lead to a lower turnout of M4 students due to away rotations and residency interviews, it might be preferable to move the workshop to the spring semester in future iterations. Notably, we were able to achieve 75% (22/29) attendance of the M3 and M4 MSTP classes based on extensive consultation of medical school calendars and restriction of the workshop to a half-day Saturday experience.

Follow-up survey (6 months later)

To determine whether the workshop curriculum influenced student attitudes and behaviors about conflict resolution and leadership development beyond the workshop interval, we surveyed workshop attendees 6 months after the workshop was completed (Table 2). We asked students to reflect on personal and professional experiences during the 6 months following the workshop and assess any changes in attitudes or behaviors about the leadership competencies addressed.

Table 2

Six-month follow-up survey administered to the participants of 2015 MSTP Senior Leadership Workshop

Survey question		Frequent themes in response
Please describe in what way, if any, the following have changed as a result of your participation in the MSTP Senior Leadership Workshop:	Your attitude about conflict in personal or professional situations	Less likely to avoid conflict More thoughtful about others’ perspectives and methods of managing conflict
	Your behavior in conflict situations	More proactive in engaging in conflict resolution Seeking the underlying cause of conflict, rather than taking it personally
	Your attitude about work–life balance	Balance is important in order to be successful Balance only gets more difficult as a career progresses, start forming habits now
	Your decisions about work–life balance	More thoughtful about how to spend time professionally and personally
What additional behavioral or attitudinal changes, if any, have you made since the workshop in response to what you learned?		More proactive about seeking guidance
		More aware of each role on the team More thoughtful about gender equality in science and medicine
What are the three most critical skills, behaviors, or insights from the workshop that have affected your professional or personal life?		Skills in conflict resolution Strategies for recruitment of laboratory personnel Effective communication

In response to this survey, students consistently noted that, as a result of workshop discussions, they were more accepting of conflict as a normal occurrence in the workplace and more likely to engage, rather than to avoid, conflict in an attempt to resolve conflict as it becomes apparent (Table 2). Additional behavioral changes that students recognized and attributed to the workshop experience included being more proactive about seeking guidance, more attentive to gender equity in academic medicine, and more likely to engage in casual conversations with peers about development of leadership skills.

Discussion

The inaugural MSTP Senior Leadership Workshop was an effective addition to the Vanderbilt MSTP curriculum. Evaluations of the initial offering of the workshop indicate that the workshop was well received by students and that the workshop curriculum influenced student thinking about leadership development. Similar to our experience with the MSTP Junior Leadership Workshop (9), we found that the curriculum served not as a strict template but as a starting point for a variety of engaging, and at times impassioned, discussions about topics of interest to the group. For example, in addition to the discussion questions provided for each case, additional topics raised by the students included the importance of different types of leadership styles, appropriate communication strategies for a leader to inform team members when planning to change institutions, the role of gender in conflict and hierarchy on clinical teams, and a physician-scientist's relative obligation to his or her various scientific, clinical, and administrative responsibilities.

We can make three general conclusions from the feedback obtained from the first cohort of workshop attendees. First, our experience with this group demonstrated that discussion of conflict management was a useful aspect of the curriculum. The feedback we received from students indicated that this was an appropriate time in their training paths for a refresher discussion of this topic, which was introduced during the MSTP Junior Leadership Workshop. Second, inclusion of Vanderbilt leaders in academic medicine in the workshop curriculum was beneficial for students as they explored their own leadership development, career aspirations, and balance of personal and professional responsibilities. Third, we will reevaluate the most appropriate timing for this workshop during the academic year, given that scheduling for students in the clinical years of medical school can pose difficulties.

We have continued our successful model of involving students in curriculum design and execution of this workshop, and we intentionally included junior students who will assume leadership roles and recruit new student members to the planning committee for the next version of the workshop in academic year 2017–2018. Over the next several years, we will continue to revise the workshop curriculum based on student feedback. From a long-term perspective, we will follow the careers of the workshop participants to understand more fully the effect of our leadership workshops on the professional aspirations and achievements of MD–PhD students.