GEISELMED.DARTMOUTH.E DU Medical Education Committee (MEC) Catherine Florio Pipas, MD, MPH Craig R. Westling, MS, MPH “Creating a Community of Leaders” Geisel Leadership Development “Knowing yourself is the beginning of all wisdom.” ~Aristotle July 15, 2014

GEISELMED.DARTMOUTH.E DU Objectives: At the end of this session, participants will be able to : 1.Discuss the Framework for the Competency of Geisel 2.Describe the Geisel Leadership Course 3.Demonstrate a select Session of the curriculum

GEISELMED.DARTMOUTH.E DU 1.Systems – ineffective, inefficient, unsustainable costs 1.Teams – under functioning 2.Individuals – high rates of burnout AAMC Why a Competency in Leadership? Personal Awareness: Independent Learning and Personal Discovery and Growth Communication &Team Effectiveness: Learning community / Longitudinal Mentors System Performance: Knowledge / Skills/ Experiences in Leading Change

GEISELMED.DARTMOUTH.E DU VISION: A Community of Leaders that Promotes and Fosters Effective Leadership in Themselves & Others

GEISELMED.DARTMOUTH.E DU Educating physicians, scientists, and teachers to be leaders of change in creating a healthier, better world Geisel Office of Leadership Development (GOLD) STRATEGIES AND TIMELINE 4 4 year Leadership Course July 2015 Deans Leadership AWARD 2013 & 2014 Leadership Workshops Alumni CBF Nursing SPLY Leadership Summer Course 2013 & 2014 Leadership Elective 2013 & 2014 LIG/LDC 2012 and Theme 2013 Leadership Assessment and Research Team Sept 2012 Train the Trainers Educ Working Group July 2012

GEISELMED.DARTMOUTH.E DU

Who Should Design & Teach Medical Students Leadership? Dartmouth Community Geisel, DH, DC, TDI, Tuck, Thayer) Interdisciplinary Team RN, LPN, MA, ARNP MD/ PhD MS, MEd, MPH, MBA Student Peers Residents

Leadership Pilots The Science & Practice of Leading Yourself Leadership Interest Group ‘12-’13 Student Leadership Council ’13-‘14 Workshops on Leadership, Resilience and Ethics ‘13 Leadership Elective ‘13-’14 Pilot s Learning Tools, Self < Team < Org < Community Speakers, Topics, Dirigo, Experiential Students as educational Co-Leaders, Tools Integration and Alignment for faculty Real Student Leadership Challenges (Cases)

GEISELMED.DARTMOUTH.E DU Leadership Course Objectives “Knowing yourself is the beginning of all wisdom.” ~Aristotle

GEISELMED.DARTMOUTH.E DU Methods (80 hour - 4 year long course) Large Group lecture-discussions (14 hrs.) (17%) Leadership Learning Community (LLC) (66 hrs.) – Independent and Active Learning – Inter-professional Small Group/Peer-to-Peer Learning – Faculty Mentoring – Leadership Development Portfolio Experiential Learning (Real Time Cases and Projects ) – Personal Leadership Project (PLP) – Team Leadership Project (TLP) – Organization/ Community Leadership Project (OLP/CLP)

GEISELMED.DARTMOUTH.E DU Leadership Sessions hours each) SELF – Who am I as a Leader? TEAM – Development & Effectiveness ORGANIZATION/COMMUNITY – Systems Performance ORGANIZATION/COMMUNITY – Leadership Speaker Series (24hrs)(F, P1) (14hrs)(F, P1) (10hrs)(P1) (6hrs)(P2) (26 hours)(P-3) Foundations: 4 hours, Phase I: 44 hours, Phase II: 6 hours, Phase III: 26 hours

GEISELMED.DARTMOUTH.E DU Assessment NEW Validated TOOLS: Leadership Questionnaire ; BELS, 9-Step Heuristic - Revised 2014; PLP- 2013

PROPOSED LEADERSHIP PILOTS 1.Leadership Learning Community (LLC)- PLP & TLP, with Elective Grads 2.GME with LPMR 3.IPE- Leadership Elective/LDC Sessions and Workshops with Nursing 4.Online Modules – SLDC

GEISELMED.DARTMOUTH.E DU Proposed Leadership Integration Across Courses and Themes? CLC - Communication & Team Performance CBC - Communication & Team Performance – CMBD - Leadership Theories & Models; Genetic versus Environmental – BB&I - Normal and Pathologic Effects of Stress on Personal Effectiveness – Homeostasis - Case Discussion- Self Leadership and Improvement – CC&R - Cognitive Decision Making, Behavior And Personal Choices – Nourishing the Body - Case Discussion - TEAM Leadership and Improvement – Where We Began - TBD

GEISELMED.DARTMOUTH.E DU Proposed Leadership Integration THEMES – Anatomy- Leadership in the Lab Group – Resilience - Leadership Wellness and Performance – Ethics - Case Development on Ethical Leadership – Communication - Negotiation, Conflict Resolution, Styles, and Listening – IPE / Team development - Elective/LDC Sessions with Nursing ELCS – Systems – Team Roles and Performance, Leading change at the Systems level – MACA - Building Urgency/Leverage and Leadership outcomes all assessed via Literature and Evidence – Medicine in Context – Social Determinants of Health, Financing Strategic Priorities

GEISELMED.DARTMOUTH.E DU Proposed Leadership Integration PHASE 2 – Practice Based Experiential Learning – Partners with LPMR PHASE 3 – Students Co-Lead Leadership Speaker Series Leadership In Industry – The Impact of Failed Leadership at the FDA; A Case Study in Pharmaceutical Decision Making – Dave Nierenberg Leadership in Health Administration- Joseph Pepe, MD, President and Chief Executive Officer of CMC Healthcare System and Catholic Medical Center, A Case Study on Leadership from Catholic Medical Center.

GEISELMED.DARTMOUTH.E DU Prioritizing Anticipated Obsta cles Level of Impact High Low Likelihood of Occurring Likely to occur, and major impact – prioritize actions plans to address these obstacles Unlikely to occur and impact would be low impact – do not waste scarce resources to address these Unlikely, but would have a major impact if they occur – so invest some resources to develop contingency plans for addressing these if necessary Likely to occur, but only minimal impact – not a priority to address these - Recruit / Retain LLC Mentors - Continuity & Experiential Learning in Phase 2 - Support for a Leadership Development Portfolio ( Geisel versus TDI) - Dedicated Curriculum Assessment/Evaluation Resources

QUESTIONS ? IDEAS ? SUGGESTIONS ? Session Demo ( time permitting)?

Leadership Development and Experiential Training is: A Core Competency for all Medical Students Critical to the Future of Medicine Built upon IP & ID Evidence-Based Frameworks Soon to be LCME required by AAMC Feasible Geisel Valued by Students, Faculty & Residency Directors Summary

Leadership Sample Session: LEADERSHIP WELLNESS IN THE FACE OF CHANGE A Model Based on Awareness, Authenticity and Action

GEISELMED.DARTMOUTH.E DU Session 1 LEADERSHIP WELLNESS IN THE FACE OF CHANGE At the end of this session, participants will be able to : Objectives: Demonstrate: Awareness thru observation, mindfulness and self assessment; Authenticity by aligning vision and resilience, and Action by constructing a personal leadership plan (PLP)

GEISELMED.DARTMOUTH.E DU Session 2 LEADERSHIP WELLNESS IN THE FACE OF CHANGE At the end of this session, participants will be able to : Objectives: Demonstrate: Awareness thru observation, mindfulness and self assessment; Authenticity by aligning vision and resilience, and Action by constructing a personal leadership plan (PLP)

GEISELMED.DARTMOUTH.E DU Demonstrate: Awareness thru observation, mindfulness and self assessment; Authenticity by aligning vision and resilience, and Action by constructing a personal leadership plan (PLP) Objectives:

GEISELMED.DARTMOUTH.E DU Leading Personal Change Awareness – Know thyself Authenticity – Be True to thyself Action – Improve thyself

GEISELMED.DARTMOUTH.E DU Self-Awareness “”It seems our culture does not fully appreciate the value of quiet reflection time. Valuable insights rarely come to us in the flurry of s and task mastering.” - Paul Batalden ECS 117, The Dartmouth Institute (TDI) Observation & Reflection – Mindfulness – Appreciative inquiry Formal Self-Assessment – Global – Situational

GEISELMED.DARTMOUTH.E DU Mindfulness Pay attention in the present moment Observe thoughts, feelings, actions and body sensations even when these are unpleasant Focus on experience without judging Act out of awareness: Not on autopilot Appreciate the present Kabat-Zinn 1994; Krasner 2009

GEISELMED.DARTMOUTH.E DU The RAISIN EXERCISE (HERSHEY KISS) When you eat, eat! ZEN Based on Kabat-Zinn. From Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-Based Cognitive Therapy for Depression. NY: Guilford.

GEISELMED.DARTMOUTH.E DU Formal, Global (360) and Situational – SWOT Analysis – BELS, 9 Step Heuristic, PLP – Thomas Kilman Conflict Mode Instrument – Inventory of Leadership Styles HAYGROUP – Burnout Questionnaire – Social Network Index – Connor Davidson Resilience Scale – Myers Briggs Personality Instrument – Emotional & Social Competency Inventory (Smithfield) – Life Orientation Test (LOT) Scheier et al., 1994 – Purpose in Life Test (Crumbaugh & Maholik, ‘64)

GEISELMED.DARTMOUTH.E DU EXERCISE: SELF SWOT MY StrengthsMY Weakness MY OpportunitiesMY Threats Adapted from SWOT analysis template – a free resource from Template © Alan Chapman MY VALUES_________________________ MISSION___________________________ VISION ____________________________

GEISELMED.DARTMOUTH.E DU EXERCISE: SELF SWOT MY Strengths What do I do well ? What knowledge, skills,styles, attitudes, capabilities, USP's (unique selling points), values and commitments do I hold? MY Weakness What gaps or areas for improvement do I have in knowledge, skills, capabilities, vulnerabilities, reliability? Do I fall short in accountability, integrity, performance or commitment to myself or others? MY Opportunities What new niches, trends, partnerships, collaborative projects, initiatives or skills might I take advantage of to be more effective? Are these aligned with my values, mission, vision and priorities? MY Threats What Intrinsic factors limit my effectiveness? - -belief system, biases, prejudices, recurrent thoughts or actions, past experiences? What Extrinsic threats - political, policy, environmental, or organizational cultures limit my effectiveness? Adapted from SWOT analysis template – a free resource from Template © Alan Chapman

GEISELMED.DARTMOUTH.E DU Authenticity “People do best what comes naturally.” John F. Kennedy “Be yourself. Everyone else is taken.” Oscar Wilde “If I am not myself, who else will be?” Henry David Thoreau “The chief happiness for a man is to be what he is.” Erasmus Who am I? What is Important to me (Values) ? What gives me Meaning (Mission)? What are my Commitments (Vision)? How Adaptable am I? (Resilience)? Souba, W. W. (2001). "Leadership and strategic alignment--getting people on board and engaged." J Surg Res 96(2):

GEISELMED.DARTMOUTH.E DU Resilience “the process of adapting well in the face of adversity, trauma, threats, and even significant sources of stress” The American Psychology Association “the ability to bend but not break, to bounce back and sometimes even to grow when faced with adversity.” Coutu, D. L. (2002). "How resilience works.” Harvard Bus Rev 80(5): 46-50, 52, 55 passim.

GEISELMED.DARTMOUTH.E DU Importance of Resilience “More than education, more than experience, more than training, a person’s resilience will determine who succeeds and who fails. That’s true in the cancer ward, its true in the Olympics, its true in the boardroom.” Diane Coutu: Harvard Business Review 2002

GEISELMED.DARTMOUTH.E DU 10 Factors Contributing to Resilience 1.Optimism 2.Facing Fear 3.Moral Compass 4.Religion & Spirituality 5.Social Support 6. Role Models 7. Physical exercise 8. Mental exercise 9. Flexibility & Acceptance 10. Meaning & Purpose Southwick, S. M. and D. S. Charney (2012) “Resilience, The Science of Mastering Life’s Greatest Challenge” Cambridge University Press

GEISELMED.DARTMOUTH.E DU Analyze: SELF SWOT MY StrengthsMY Weakness MY OpportunitiesMY Threats Adapted from SWOT analysis template – a free resource from Template © Alan Chapman MY VALUES_________________________ MISSION___________________________ VISION ____________________________

GEISELMED.DARTMOUTH.E DU Personal Leadership Plan (PLP)

GEISELMED.DARTMOUTH.E DU GOAL: Enhance Positivity using Appreciative Inquiry (AI) SMART OBJECTIVE: Specific – begin a daily AI journal Measurable – list one item that I did well, or identify the good that can come from an adverse experience Achievable – confident 9/10 Relevant – important 10/10 to my goal of improving my effectiveness as a leader Timely – begin today & complete daily for 1 month Personal Leadership Plan (PLP)

GEISELMED.DARTMOUTH.E DU GOAL: Increase Physical Exercise SMART OBJECTIVE: Specific – begin walking Measurable – walk daily for 30 minutes Achievable – confident 9/10 Relevant – important 10/10 to my goal of improving my health Timely – beginning today and daily for 1 month Personal Leadership Plan (PLP)

Leadership Development and Experiential Training is: A Core Competency for all Medical Students Critical to the Future of Medicine Built upon IP & ID Evidence-Based Frameworks Soon to be LCME required by AAMC Feasible Geisel Valued by Students, Faculty & Residency Directors Summary

Join Us The Science and Practice of Leading Yourself JULY , 2014 HANOVER, NH