Adaptive leadership during challenging times: Effective strategies for health professions educators: AMEE Guide No. 148.

Leadership and management are becoming increasingly recognised as vital for high-performing organisations and teams in health professions education. It is often difficult for those embarking on leadership activities (as well as more experienced leaders) to find their way through the volume of literature and generic information on the topic. This guide aims to provide a framework for developing educators' understanding of leadership, management, and followership in the context of health professions education. It explains many relevant approaches to leadership and suggests various strategies through which educators can develop their practice to become more effective.

Co-creating scholarship through collaborative writing in health professions education: AMEE Guide No. 143.

This AMEE guide provides a robust framework and practical strategies for health professions educators to enhance their writing skills and engage in successful scholarship within a collaborative writing team. Whether scholarly output involves peer-reviewed articles, book chapters, blogs and online posts, online educational resources, collaborative writing requires more than the usual core writing skills, it requires teamwork, leadership and followership, negotiation, and conflict resolution, mentoring and more. Whilst educators can attend workshops or courses to enhance their writing skills, there may be fewer opportunities to join a community of scholars and engage in successful collaborative writing. There is very little guidance on how to find, join, position oneself and contribute to a writing group. Once individuals join a group, further questions arise as to how to contribute, when and whom to ask for help, whether their contribution is significant, and how to move from the periphery to the centre of the group. The most important question of all is how to translate disparate ideas into a shared key message and articulate it clearly. In this guide, we describe the value of working within a collaborative writing group; reflect on principles that anchor the concept of writing as a team and guide team behaviours; suggest explicit strategies to overcome challenges and promote successful writing that contributes to and advances the field; and review challenges to starting, maintaining, and completing writing tasks. We approach writing through three lenses: that of the individual writer, the writing team, and the scholarly product, the ultimate goal being meaningful contributions to the field of Health Professions Education.

Twelve tips for developing a global community of scholars in health professions education.

Scholarship in Health Professions Education is not just original research, it also includes study of educational processes, and application of new knowledge to practice. The pathways to successful scholarship are not always clear to novice educators. In this article, we describe strategies to establish a Community of Scholars (CoS), where more experienced and senior members guide junior members in scholarship to advance the field. Drawing on Lave and Wenger's concepts of Communities of Practice (CoP), we describe twelve practical tips, which include generation of a shared vision, formation of a global community of scholars, engagement in scholarly initiatives, and development of a professional identity, categorised under three major steps: establish, grow, and sustain the community. The tips embrace inclusivity for diverse cultural contexts which further provide opportunities for Health Professions Educators, interested in forming communities of practice, to work on scholarly outputs and add value to the professional arena.

AMEE Consensus Statement: Planetary health and education for sustainable healthcare.

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.

Rethinking health professions' education leadership: Developing 'eco-ethical' leaders for a more sustainable world and future.

In this commentary, we discuss health professions' education (HPE) leadership in relation to planetary health emergencies, suggesting that an 'eco-ethical leadership' approach is highly relevant. Building on both traditional and more contemporary leadership approaches and the need for HPE to be socially and environmentally accountable, we define the key features of eco-ethical leadership and its underpinning beliefs and values, then expand on these features in terms of leadership at intrapersonal, interpersonal, team, organisational and system levels. Eco-ethical leadership is needed to tackle a range of 'wicked' problems - a changing climate, environmental pollution, deforestation, all of which threaten global biodiversity and human civilisation. Such leadership requires passionate individuals to role model the behaviours and actions that are required to bring people along with them, not least the learners, many of whom are already concerned about their future. Eco-ethical leadership (and followership) offers an integrated approach for HPE, centred around sustainability, values, collaboration, justice, advocacy and, if need be, activism. The environment cannot not wait. Eco-ethical leaders already exist but their numbers are small. They are required in key positions in academia and healthcare to drive the agenda in partnership with learners, many of whom are already environmental advocates and activists.

Adapting to the impact of COVID-19: Sharing stories, sharing practice.

Health Professions' Educators (HPEs) and their learners have to adapt their educational provision to rapidly changing and uncertain circumstances linked to the COVID-19 pandemic. This paper reports on an AMEE-hosted webinar: Adapting to the impact of COVID-19: Sharing stories, sharing practice. Attended by over 500 colleagues from five continents, this webinar focused on the impact of the virus across the continuum of education and training. Short formal presentations on teaching and learning, assessment, selection and postgraduate training generated wide-ranging questions via the Chatbox. A thematic analysis of the Chatbox thread indicated the most pressing concerns and challenges educators were experiencing in having to adapt programmes and learning across the continuum of medical education and training. The main areas of concern were: campus-based teaching and learning; clinical teaching; selection and assessment, and educator needs. While there is clearly no one simple solution to the unprecedented issues medical education and training face currently, there were two over-arching messages. First, this is a time for colleagues across the globe to help and support each other. Second, many local responses and innovations could have the potential to change the shape of medical education and training in the future.

Education for sustainable healthcare: Leadership to get from here to there.

The current global crises, including climate, COVID-19, and environmental change, requires global collective action at all scales. These broad socio-ecological challenges require the engagement of diverse perspectives and ways of knowing and the meaningful engagement of all generations and stages of personal and professional development. The combination of systems thinking, change management, quality improvement approaches and models, appreciative/strength-based approaches, narratives, storytelling and the strengths of Indigenous knowledges, offer synergies and potential that can set the stage for transformative, strengths-based education for sustainable healthcare (ESH). The need for strong leadership to enact a vision for ESH is outlined here with the intent to enable and nurture the conditions for change, ultimately improving health and well-being across generations.

Twelve tips for organising speed mentoring events for healthcare professionals at small or large-scale venues.

Mentors play a critical role in the development of professionals, influencing their job satisfaction, career aspirations and evolving professional identity. A variety of mentoring models exist, each with distinct benefits and challenges. Speed mentoring, based on the concept of speed dating, provides mentees with opportunities to meet multiple mentors over a short time and pose focussed career development questions. At large-scale events such as the annual AMEE (Association for Medical Education in Europe) meeting, speed mentoring sessions can successfully connect aspiring, novice and mid-career educators with international educational leaders to facilitate transfer of valuable insights for professional growth. For some mentors and mentees, this might spur ongoing communications or even longitudinal relationships. In this paper, we aim to provide strategies for planning and implementing speed mentoring events, combining insights gained from the literature and our experience of organising speed mentoring at the 2019 AMEE meeting in Vienna. These tips will be useful to a variety of professionals planning to organise speed mentoring initiatives.

The Swansea 6D model: a diagnostic and conversational framework for supervisors, mentors and doctors in training.

Doctors in training are particularly vulnerable to stress and burnout, with the transition into the early parts of training being a period of acute anxiety. Supervisors and mentors have a key role to play in helping trainees make the transition from medical student to practising doctor. This often involves professional conversations, ranging from the relatively routine to difficult issues. The Swansea 6D model has been designed as a guidance tool which provides a simple, memorable framework around which conversations can be structured in terms of identifying meaningful expectations, providing explanations and reframing situations.

Sharing stories about medical education in difficult circumstances: Conceptualizing issues, strategies, and solutions.

BACKGROUND: Global economic forces, political decisions, and natural disasters are only some of the factors that affect contemporary healthcare education. Given the centrality of health in all settings, the future of healthcare education depends on how we overcome these difficult circumstances. METHODS: Through a series of collaborative activities involving healthcare educators from around the world and their attempts to overcome these difficulties, the authors have developed a conceptual model centered around the people involved, the impact of culture, and organizations and systems. RESULTS: The model can help to frame discussions and develop strategies about how best we, as a community of health professionals and educators, collaborate and share wisdom, experiences and resources to assist colleagues who might be struggling to deliver education. What has clearly emerged from this work is the centrality of leadership and management in effectively challenging and addressing difficult circumstances. CONCLUSIONS: Contemporary health professions' education leadership needs to be inclusive, mindful, compassionate and caring; echoing and role-modeling how we expect our students to be with patients and colleagues. This means being willing to confront unacceptable behaviors and speak out and challenge authority when needed. It also requires awareness and understanding of the complex systems in which healthcare education is provided.

Twelve tips for applying change models to curriculum design, development and delivery.

Drawing primarily from business and management literature and the authors' experience, these 12 tips provide guidance to organizations, teams, and individuals involved in curriculum or program development at undergraduate, postgraduate, and continuing education levels. The tips are based around change models and approaches and can help underpin successful curriculum review, development, and delivery, as well as fostering appropriate educational innovation. A range of tools exist to support systematic program development and review, but even relatively simple changes need to take account of many factors, including the complexity of the environment, stakeholder engagement, cultural and psychological aspects, and the importance of followers.

Twelve tips for integrating leadership development into undergraduate medical education.

Healthcare systems need effective leadership. All healthcare professionals can and should "learn to lead" and this requires a clear focus on leadership development from the earliest stages of a career. Within medicine, undergraduate students should be provided with opportunities to thrive and develop their skills in terms of leadership, management and followership. Drawing from the existing evidence base, the authors' expertise and the latest "thought leadership", these 12 tips provide practical guidance to universities and associated provider organizations, and to academic and clinical faculty, on how to integrate leadership development into their undergraduate medical programs. These 12 tips will help educators provide medical education that incorporates leadership as a core part of a professional's identity, and help students gain a deeper understanding of themselves and the teams, organizations and system they work within.

Interprofessional learning experiences: Exploring the perception and attitudes of Saudi Arabian medical and dental students.

OBJECTIVE: The objective of this study is to evaluate the awareness and attitudes of medical and dental students regarding interprofessional learning (IPL). METHODS: A cross-sectional study was conducted with 278 female undergraduate Medical and Dental students from Princess Nourah bint Abdulrahman University, Riyadh. These students undertook IPL in the Foundation block, in basic science teaching, clinical skills' laboratories and in professionalism and learning skills' modules. A modified, validated RIPLS questionnaire with four subscales and 29 items was used to collect data regarding their perception and attitudes towards shared learning. A five-point Likert scale was used with a value ranging from 1 (strongly disagree) to 5 (strongly agree) for each item. Factor analysis was done using Varimox rotation. Student's t test was applied to detect difference between mean scores of medical and dental student's responses Results: The mean age of respondents was 19.8 ± 1.7 years with the majority in the second year of each program. There was no difference in mean responses of the medical and dental students. The respondents favored shared learning in the areas of professional skills and patient care. They agreed that IPL helps to develop respect, trust and appreciation for other professions; however, both groups preferred to learn uni-professionally with regard to developing discrete professional identities and roles. CONCLUSIONS: There is an overall positive response towards IPL and the value of team work; however, more attention needs to be paid to enabling students to learn about the specific roles of each profession in the healthcare team.

Medical education in difficult circumstances: A global responsibility to contribute.

Medical and health professions' education is becoming increasingly standardized across the world in terms of core standards and competencies. Yet, the context in which education and training occurs is far from even. Many educators face challenges in providing health professions' education, ranging from individual challenges and organizational struggles, to working in countries experiencing major conflict or environmental disaster. This commentary sets the scene for an international discussion on might constitute "difficult circumstances" and invites educators from around the world to contribute to the discussion by sharing their stories and suggesting strategies and solutions in a themed issue of MedEdPublish, AMEE's (the Association for Medical Education in Europe) innovative online journal.

Exploring educational interventions to facilitate health professional students' professionally safe online presence.

OBJECTIVE: To establish the most effective approach and type of educational intervention for health professional students, to enable them to maintain a professionally safe online presence. METHOD: This was a qualitative, multinational, multi-institutional, multiprofessional study. Practical considerations (availability of participants) led us to use a combination of focus groups and individual interviews, strengthening our findings by triangulating our method of data collection. The study gathered data from 57 nursing, medical and paramedical students across four sites in three countries (Aotearoa/New Zealand, Australia and Wales). A content analysis was conducted to clarify how and why students used Facebook and what strategies they thought might be useful to ensure professional usage. A series of emergent codes were examined and a thematic analysis undertaken from which key themes were crystallized. RESULTS: The results illuminated the ways in which students use social networking sites (SNS). The three key themes to emerge from the data analysis were negotiating identities, distancing and risks. Students expressed the wish to have material about professional safety on SNS taught to them by authoritative figures to explain "the rules" as well as by peers to assist with practicalities. Our interactive research method demonstrated the transformative capacity of the students working in groups. CONCLUSIONS: Our study supports the need for an educational intervention to assist health professional students to navigate SNS safely and in a manner appropriate to their future roles as health professionals. Because health professional students develop their professional identity throughout their training, we suggest that the most appropriate intervention incorporate small group interactive sessions from those in authority, and from peers, combined with group work that facilitates and enhances the students' development of a professional identity.

"Doctors on the move": Exploring professionalism in the light of cultural transitions.

As the world becomes "flattened" and travel is easier, doctors and other health professionals move and live around the world in large numbers: some for short periods (such as student electives) others on a longer-term or permanent basis. Similarly, as wider migration patterns play out, all doctors need to learn to work in multi-cultural environments, whether they move countries or work in their "home country". We consider cross-cultural aspects of "professionalism" in terms of medical students' and graduates' assimilation into different cultures and some of the aspects of professional practice that may be problematic where cultural expectations and practices may differ. Specifically we explore professional socialization, identity formation, acculturation and cultural competency as related concepts that help our understanding of challenges for individuals and strategies for curriculum development or support mechanisms.

Collaborating in healthcare delivery: exploring conceptual differences at the "bedside".

Calls for greater collaboration amongst health professionals and for programmes to support this are not new, nor are they likely to diminish. While various interventions have been adopted to improve collaboration, the literature suggests that these have neither been well-informed with a strong conceptual base nor have they accounted for the context in which the health professionals work. In this study, interviews of senior doctors and nurses in two hospital-based services explored experiences of interprofessional collaboration and the processes involved. A framework based on activity theory was used to analyse the data. The data suggest a dichotomy between nurses as collectivist, protocol and systems-driven and doctors as individualist and autonomy-driven, although this played out differently in each service. Unless such complexities and contextual factors are addressed in the preparation for collaboration it will continue to fall short.

Recruitment of doctors to work in 'our hinterland': first results from the Swansea Graduate Entry Programme in Medicine.

INTRODUCTION: Recruitment and retention of doctors to rural and remote areas is a well-known problem to which very few countries are immune. Planning effective interventions to enable appropriate recruitment to rural areas requires an understanding of the specificities of each country and region, understanding 'what works' and 'why' in each specific context and then consideration of what that might mean in the context of neighbouring countries. In order to inform local policy makers and stakeholders, this study aimed to investigate 'how and why students elect to study in Wales, UK' and, more importantly, 'what influences students' choices about either staying, or leaving Wales, after graduation'. 'Our hinterland', in the title of this article, refers to the more rural parts of the country. METHODS: Two cohorts of medical graduates at different stages of their training (one cohort approaching the first year and the other approaching the third year of postgraduate training) were recruited as participants. A mixed-method, sequential study was conducted by means of an online questionnaire (phase 1) followed up by semi-structured telephone interviews (phase 2). Phase 1 results informed the interview schedule for phase 2. A thematic analysis of the interview transcripts was conducted using QSR NVivo v10. RESULTS: The results show that students elect to study in Wales (Swansea in this case) for a variety of reasons that include liking key features of the course, the attractive location and being able to pursue and maintain ties with family and others. Despite some identified challenges for long-term career prospects, early exposure to clinical placements in rural areas seems to be regarded as a rich, enjoyable learning opportunity that can constitute valuable preparation for future practice as a doctor. Participants also revealed how their choices were made as a result of balancing career aspirations, perceived opportunities and personal factors or circumstances. All seem to be determinants for medical career decision-making and reveal the complexities underlying these life choices. CONCLUSIONS: Despite the many positive aspects of studying in Wales and of having placements in rural areas emphasised by study participants, the prospect of entering postgraduate training in those regions is, for some, inhibited by feelings of social isolation and lack of opportunities. Some students still perceive rural locations as a backward step in the natural progression of their work and career. Graduates are concerned about discontinuity with family ties (for example stemming from the unpredictability of job allocation) and tend to gravitate to where family members, including life partners, reside. In line with international concerns and local efforts about these issues, the Swansea Graduate Entry Programme in Medicine will continue to monitor students' opinions and attitudes towards career pathways and training locations to maximise the likelihood of high-quality healthcare provision to rural communities.

Medical educators working abroad: a pilot study of educators' experiences in the Middle East.

Medical education is now a global enterprise, with many medical educators working internationally, either for short or longer periods or even permanently. In parallel, many medical schools are now involved in collaborations and partnerships with schools in other countries. With this in mind, we set out to explore what motivates, supports and inhibits medical educators who wish to or might work outside their "home country". This article reports on the pilot stage (in specific organizational contexts in Middle East) of a longitudinal project aimed at canvassing medical educators on a broader global scale, using reflective accounts and a questionnaire survey. The findings from this pilot study raise interesting issues about the lived experience of medical educators who have chosen to work in a different culture from their own. Respondents identify many advantages around skills, personal and professional development. Three main issues emerged in terms of educators' experiences: the academic environment, medical practice in a different cultural context and personal matters. Adapting to the local culture, gender segregation and the impact on learning and teaching was an overarching factor. We introduce an explanatory framework to explain the development of international educator identity, a cyclical process in which, through experiences and reflection, individual world views and perspectives are continually modified and developed. This pilot study tested the methodologies and developed a new conceptual model that will be used in a wider study across different cultures.