A Proposed Shared Vision for Leadership Development for all Medical Students: A Call from a Coalition of Diverse Medical Schools.

Issue: Despite clear relevance, need, descriptive literature, and student interest, few schools offer required curriculum to develop leadership skills. This paper outlines a proposed shared vision for leadership development drawn from a coalition of diverse medical schools. We advocate that leadership development is about self (looking inward), teams (not hierarchy), and change (looking outward). We propose that leadership development is for all medical students, not for a subset, and we believe that leadership curricula and programs must be experiential and applied. Evidence: This paper also draws on the current literature and the experience of medical schools participating in the American Medical Association's (AMA) Accelerating Change in Medical Education Consortium, confronts the common arguments against leadership training in medical education, and provides three cross-cutting principles that we believe must each be incorporated in all medical student-centered leadership development programs as they emerge and evolve at medical schools. Implications: By confronting common arguments against leadership training and providing a framework for such training, we give medical educators important tools and insights into developing leadership training for all students at their institutions.

Assessment challenges in competency-based education: A case study in health professions education.

There is a growing demand for health sciences faculty with formal training in education. Addressing this need, the University of Michigan Medical School created a Master in Health Professions Education (UM-MHPE). The UM-MHPE is a competency-based education (CBE) program targeting professionals. The program is individualized and adaptive to the learner's situation using personal mentoring. Critical to CBE is an assessment process that accurately and reliably determines a learner's competence in educational domains. The program's assessment method has two principal components: an independent assessment committee and a learner repository. Learners submit evidence of competence that is evaluated by three independent assessors. The assessments are presented to an Assessment Committee who determines whether the submission provides evidence of competence. The learner receives feedback on the submission and, if needed, the actions needed to reach competency. During the program's first year, six learners presented 10 submissions for review. Assessing learners in a competency-based program has created challenges; setting standards that are not readily quantifiable is difficult. However, we argue it is a more genuine form of assessment and that this process could be adapted for use within most competency-based formats. While our approach is demanding, we document practical learning outcomes that assess competence.

Beyond Better, Safer, Cheaper Health Care: What's Ultimately at Stake?

Health care reform continues to be controversial and divisive and takes its toll on physicians, patients, and national unity. An emphasis on efficiency and profit that depersonalizes human interactions hampers building physician-patient relationships grounded in compassion and trust. The authors argue that health care reform will be more effective if it is grounded in and anchored by a physician-patient relationship that is relationally transformative rather than transactionally commercial. This health care paradigm shift, from the "transactional getting" to the "relational giving," must be physician led. The authors propose 3 next steps. First, establishing discourse "ensembles" will foster conversations where new ideas can emerge and percolate and where participants can renew their collective stand for the humanitarian side of the healing relationship. Second, ensemble unity and effectiveness will be enhanced by the so-called inward journey of leadership. Without that journey, we cannot fully connect with the suffering of others, and we lack the wisdom and will to tackle our health care challenges. Third, to begin the process of solidifying this humanistic foundation, transformative leadership becomes essential. In contrast to transactional leadership, which motivates physicians by seducing their self-interests, transformative (relational) leadership connects physicians with their deeply held values that embody what it means to be a physician and what it means to be human. A shared, collective view of what's at stake if we settle for purely transactional medicine would help create the necessary physician alignment and commitment to reposition medicine as a profession that values service above reward.