Leadership in Anesthesiology – Skills Development at the Resident Level

At the most recent ASA ADVANCE business meeting, then-AMA President Jesse Ehrenfeld, MD, MPH, FASA, cited the article “Why Healthcare Workers are Quitting in Droves,” noting that the gap between the noble ideals of medicine and the reality of its business is widening, often contributing to physician burnout (asamonitor.pub/4ccdy3V). One solution to bridge this gap is encouraging anesthesiologists to assume leadership-oriented roles in the perioperative space. Anesthesiologists are well-positioned for these roles through their work in interdisciplinary teams that require effective communication, collaboration, and real-time data analysis for patient care (Anesth Analg 2022;134:235-40). However, taking on leadership roles, especially in health care, cannot be done on a whim. Serving as an effective leader requires training in interpersonal literacy, systems literacy, and a basic knowledge of management principles – aspects that are often overlooked in traditional clinical training (asamonitor.pub/3yS8JOR).

Along with Rob Whittington, MD, Senior Associate Dean for Faculty Development at UCLA School of Medicine, and Dane Saksa, MD, MBA, Director of Non-Operating Room Anesthesia, we identified a gap in leadership development among anesthesiology residents at large. Based on our past experiences and training, we proposed an innovative leadership track, which was supported by our chair and residency leadership, through which residents could learn about management principles to supplement their clinical training and prepare them for future leadership roles. Despite initial concerns about resident interest, approximately one-third of the intern class and one-fourth of the CA-1 class applied for two available positions per class, demonstrating a strong demand for such training.

Drawing inspiration from the Social Change Model of Leadership Development, UCLA Anesthesia Resident Leadership Track participants will be exposed to individual, team, and systems level management principles to gain basic skills and knowledge to help prepare them for leadership roles (Figure) (A social change model of leadership development: Guidebook version III. 1996). The track consists of activities that foster self-awareness and assessment, educational activities, including case studies, journal and book clubs, longitudinal management projects, attendance at national meetings (such as ASA ADVANCE), and lectures from established leaders in the field. Participants are also expected to involve themselves in oversight committees at the local, state, and/or national levels to observe and engage in advocacy efforts.

Systematic reviews indicate that few studies examine outcomes of such leadership initiatives at the systems level (J Gen Intern Med 2015;30:656-74; BMC Med Educ 2020;20:175; J Grad Med Educ 2018;10:134-48). The quality of evidence assessing leadership curricula remains limited, highlighting the need for further evaluation on teaching leadership principles and management science in health care settings, as well as measuring the efficacy of interventions. While ongoing discussion surrounds the measurement of success of leadership development for trainees, we hope to move away from the traditional metrics of publications and grants commonly found in academia and instead identify innovative ways of measuring contributions through attempts at quantifying change and advocacy efforts. An example of such a measure might be to quantify the amount of additional revenue captured after an educational intervention that increased timeliness and accuracy of documentation used for billing.

In a recent Anesthesia & Analgesia article, a vision of the future of anesthesiology is presented as an infinite game to preserve the clinical underpinnings and longevity of our practice (Anesth Analg 2023;137:1179-85). The authors propose that anesthesia care teams should have knowledge of mechanical systems, human factors engineering, crisis and resource management, situational awareness, and business implications to target their unique expertise across the health care landscape. This vision is consistent with a need for anesthesiology trainees to become well-versed in leadership principles and strategies that are inextricably woven into their daily activities and interactions. Through the above, we present an example of our evolving resident-driven efforts at UCLA in hopes that other programs may consider implementing similar programs or opportunities for their trainees. These leadership development opportunities will not only allow residents to become leaders in the perioperative space and in health care systems at large, but also empower them to engage in advocacy, decrease levels of burnout, and ultimately increase their personal agency and fulfillment.