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The purpose of this paper is to discuss a unique leadership curriculum developed at the University of Florida and its impact on the leadership skills and values of the anesthesiology residents since its conception. The authors instituted a voluntary anesthesiology residency leadership development program at their institution to fill a perceived gap in leadership training. Mounting evidence reveals that strong clinical leadership skills improve outcomes for patients and health-care institutions. Additionally, this growing body of literature indicates that optimal outcomes result from effective team behaviors and skills, which are directed through the requisite clinical leadership. Unfortunately, adding leadership training into the existing medical education curriculum is a formidable challenge regardless of the level of learner.

To evaluate learners, the authors used the Aspiring leaders in Healthcare-Empowering individuals, Achieving excellence, Developing talents instrument, which is a validated and reliable assessment of leadership competency in health-care professionals. In 2017, the authors surveyed the past five graduating classes from the department (classes of 2012-2016), using the two graduating classes before the program’s implementation as a historical control group.

The survey was sent to 96 people, of whom 70 responded (73 per cent). Those participants who usually or always participated in the program responded with higher leadership-readiness skills scores than those who occasionally, rarely or never participated in the program. Notably, those who had participated in another leadership development course at any time had higher skills scores than those who had never participated.

The study’s data provide evidence that residents who either, often or always participated in the leadership development program perceived themselves to be better equipped to become effective health-care leaders as opposed to residents who never, rarely or occasionally participated.

Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity.

Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime.

Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon.

Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability.

Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved.

Simulation modeling can be an effective tool to show practice change effects at a system-wide level.

Job competency frameworks are based on the listing skills required for a job. The assumption is that if a candidate is presumed to have the skills, then the candidate should be able to do the job. Thus, employers hope to identify prospective employees having the required skills. However, this may differ from knowing whether the employee is ready to be trusted to do the job activities with minimal or no supervision. The authors pose the question how employers might know about the capability of prospective employees to perform the job activities for which the employees are being hired.

In health professions education, a job activity-based framework has been developed called “entrustable professional activities” (EPAs, activities to be entrusted). This paper reviews the job activity framework and EPAs used in medical education, considering how this might support preparation for work in other sectors of the labor market.

The authors describe the EPA framework, some implementation issues and how EPAs lead to a type of microcredential being awarded to individuals as the individuals demonstrate that the individuals can be entrusted with specific job activities.

The focus of this paper is to demonstrate that a medical education model could potentially be adopted by other industries to provide employers with information regarding the ability of a prospective employee in performing the job activities required. Such an approach would address employer's concerns about the job readiness of potential employees.

The purpose of this paper is to investigate the effect of ethical leadership on the burnout process among resident physicians, and the mediating roles of general self-efficacy and perceived supervisor support (PSS) in the relationship between ethical leadership behavior and various aspects of burnout.

A total of 203 residents of three teaching hospitals in the South Atlantic Division of the USA completed the Maslach Burnout Inventory-Human Services Survey, the General Self-Efficacy Scale, and Survey of Perceived Supervisor Support and rated the ethical leadership of their supervising attending physicians on the Ethical Leadership Scale. Confirmatory factor analysis and path analysis were conducted to test the measurement and hypothesized structural models.

The results showed that ethical leadership had a negative indirect effect on emotional exhaustion through PSS and a positive indirect effect on personal accomplishment through general self-efficacy. However, PSS and general self-efficacy did not mediate the relationship between ethical leadership and depersonalization.

This study adds to the body of knowledge on the impact of ethical leadership on three aspects of burnout syndrome, i.e., emotional exhaustion, depersonalization and personal accomplishment. Moreover, this is the first study to consider PSS and general self-efficacy as intervening variables to the ethical leadership-burnout relationship.

This paper aims to propose an integrative and result-driven health-care knowledge management (HKM) model and discuss the findings of a research that examines how the KM initiatives of a major private Brazilian hospital system are linked to its health-care performance outcomes.

Data were collected from a top-level Brazilian private hospital system (Mater Dei Healthcare System – MDHS), which is composed of three large hospitals internationally accredited by ISO 9001/2000, NIAHO and JCI. Multiple qualitative approaches were used to collect data such as 16 in-depth interviews with health professionals and managers, document analysis, participatory observation and benchmarking interviews with two reference hospital networks in Brazil.

The proposed health-oriented KM model is an expansion of the organizational knowing cycle model (Choo, 1996), adding absorptive capacity (ACAP) as a new construct. The paper discusses how ACAP integrates with sense-making, knowledge creation and decision-making processes within the health-care context. Information technology and clinical governance were identified as support factors to the HKM processes.

The paper presents a pragmatic and result-driven knowledge management (KM) model using health-care-welfare key performance indicators, as well as the emergence of KM as an integrative and strategic approach to hospital management.

The present study presents a knowledge-based perspective to clinical staff management, demonstrating the tangible results of KM initiatives that contribute to health and management performance outcomes.

Leadership decisions occur frequently throughout the day, yet as clinicians, who balance multiple roles and responsibilities, the authors seldom label them explicitly. This translates to missed opportunities to foster the requisite skill sets junior trainees to require in their current and future contexts. While there is clear evidence for a purposeful leadership curriculum, developing, implementing and assessing these competencies remains challenging. The purpose of this paper is to provide educators with a curricular approach to incorporate leadership opportunities in their own teaching and supervisory practices.

A dyadic “teaching and assessment” strategy may overcome leadership curricular challenges. The authors propose a new framework that breaks down leadership opportunities into their requisite learning settings. Like fine wine and cheese, these learning experiences are paired with assessment strategies to provide further formative and summative feedback, all in the context of educational theories and frameworks.

In this paper, the authors recommend six unique learning environments for educators to consider, captured in the abbreviation ABC’S3 for administrative, bedside, classroom, simulation, self-awareness and summarization, all of which lend themselves to leadership development opportunities for resident physicians. The authors provide tested examples and pair these teaching options with a variety of assessment strategies to choose from.

Three practical implications are put forth in this paper, namely, leadership competencies are needed for everyone, not just for those with leadership titles or positions; multiple learning settings (and all aspects of work) can be harnessed to provide diverse leadership opportunities; and advancement beyond Miller’s knows is needed to create opportunities to hone practical leadership competencies in the shows how and does levels.

This paper uniquely pairs learning opportunities with assessment strategies across diverse practical settings and environments. These techniques and opportunities will serve to stimulate ideas and kick-start dialogue about incorporating a practical leadership curriculum within clinical training programs.

This paper aims to determine the characteristics of board certification among US physicians and to test whether accounting for the expected gains to certification alters the pattern of the determinants of board certification.

Splitting the sample into sub‐samples by characteristics associated with certification/non‐certification identified in a probit, the incremental gain to certification from log‐earnings equations is identified. Realizing that these methods are susceptible to sample selection, correction is made for it using the Heckman approach. Using the sample selection corrected equations, the expected gain to certification among those who certify is then predicted and those who do not certify is then predicted and this difference is included as a proxy for the expected gain in the original probit to ascertain whether including the expected gain alters the determinants of certification.

Accounting for the expected gain alters the pattern of the determinants of certification. Although some groups such as blacks appear less likely to certify, after accounting for their expected return to certification, they are not as less likely. This is explained in terms of the expected marginal return to certification, market structure and practice setting.

The data used in the analysis apply only to young physicians in the USA. Also, these results may be applicable only to the particular cohort used in this analysis.

The findings help to explain the absence of minority board certified physicians within the USA.

This paper is the first to simultaneously estimate the returns to physician board certification and the decision to obtain certification.

The purpose of this paper is to develop an automatic control system for mechanical ventilation therapy based on the open lung concept (OLC) using artificial intelligence. In addition, mean arterial blood pressure (MAP) is stabilized by means of a decoupling controller with automated noradrenaline (NA) dosage to ensure adequate systemic perfusion during ventilation therapy for patients with acute respiratory distress syndrome (ARDS).

The aim is to develop an automatic control system for mechanical ventilation therapy based on the OLC using artificial intelligence. In addition, MAP is stabilized by means of a decoupling controller with automated NA dosage to ensure adequate systemic perfusion during ventilation therapy for patients with ARDS.

This innovative closed-loop mechanical ventilation system leads to a significant improvement in oxygenation, regulates end-tidal carbon dioxide for appropriate gas exchange and stabilizes MAP to guarantee proper systemic perfusion during the ventilation therapy.

Currently, this automatic ventilation system based on the OLC can only be applied in animal trials; for clinical use, such a system generally requires a mechanical ventilator and sensors with medical approval for humans.

For implementation of a closed-loop ventilation system, reliable signals from the sensors are a prerequisite for successful application.

The experiment with porcine dynamics demonstrates the feasibility and usefulness of this automatic closed-loop ventilation therapy, with hemodynamic control for severe ARDS. Moreover, this pilot study validated a new algorithm for implementation of the OLC, whereby all control objectives are fulfilled during the ventilation therapy with adequate hemodynamic control of patients with ARDS.

The use of hospitalists in the care of in‐patients is a relatively new phenomenon in the USA – hospitalists are delivering medical care to patients in private practice, public hospitals, and academic medical centers. Several obstacles hinder understanding of the characteristics of academic medical center‐based hospitalists. These include differences in definitions and nomenclature, differences in job descriptions, roles and administration across hospitalist programs, and in qualifications and credentialing of hospitalists versus other physicians. These differences derive from the heterogeneity of AMCs by bed size, level of local and regional competition, and cultural, utilization and referral patterns. The field needs an agreed definition of the term “hospitalist”. Assuming a good definition, one could take advantage of already good descriptive data on AMCs to quantify hospitalists within AMCs and to study how hospitalist programs vary by AMC characteristics.

Clinician engagement in research has positive impacts for healthcare, but is often difficult for healthcare organisations to support in light of limited resources. This scoping review aimed to describe the literature on health service-administered strategies for increasing research engagement by medical practitioners.

Medline, EMBASE and Web of Science databases were searched from 2000 to 2021 and two independent reviewers screened each record for inclusion. Inclusion criteria were that studies sampled medically qualified clinicians; reported empirical data; investigated effectiveness of an intervention in improving research engagement and addressed interventions implemented by an individual health service/hospital.

Of the 11,084 unique records, 257 studies were included. Most (78.2%) studies were conducted in the USA, and were targeted at residents (63.0%). Outcomes were measured in a variety of ways, most commonly publication-related outcomes (77.4%), though many studies used more than one outcome measure (70.4%). Pre-post (38.8%) and post-only (28.7%) study designs were the most common, while those using a contemporaneous control group were uncommon (11.5%). The most commonly reported interventions included Resident Research Programs (RRPs), protected time, mentorship and education programs. Many articles did not report key information needed for data extraction (e.g. sample size).

This scoping review demonstrated that, despite a large volume of research, issues like poor reporting, infrequent use of robust study designs and heterogeneous outcome measures limited application. The most compelling available evidence pointed to RRPs, protected time and mentorship as effective interventions. Further high-quality evidence is needed to guide healthcare organisations on increasing medical research engagement.