Education Columns

Neha Sachdev, MD; Deborah L. Edberg, MD; Santina Wheat, MD, MPH; Mary R. Talen, PhD, Northwestern McGaw Family Medicine Residency Program, Chicago

The new US health care reform laws include provisions for increasing the primary care workforce, improving access to care, and developing coordinated systems of care. Family physicians are poised to become leaders in these changes. However, family medicine residency programs have not traditionally included leadership training to prepare new physicians for these roles. From our inception in 2009, the Northwestern McGaw Residency Program has met this challenge and included a longitudinal curriculum in leadership skills.

This curriculum is designed to build residents’ knowledge, skills, and professionalism in political advocacy, health care delivery, and reform through learning activities and direct, hands-on experiences. Our workshops address topics including modes of communication, managing organizational change, personal leadership style, and resolving conflict. Third-year residents work as rotating chiefs, spending 3 months as acting “junior medical director” of the clinic site. Residents participate in clinic leadership, board of director, and residency team meetings and are involved in quality and process improvement initiatives. They also create and maintain resident call and clinic schedules.

Throughout residency, residents are required to maintain roles on residency, hospital and clinic committees, and community or state organizations. Participation in the state academy is encouraged, and all residents attend the biannual advocacy trip to the state capital.

Our culture of leadership is an inspiring force that encourages our residents to “lean in” to leadership positions. We have attracted outstanding students who have demonstrated interest and aptitude in leadership prior to residency and aspire to take on leadership roles. During recruitment, applicant files are reviewed for prior leadership experiences and given a weighted scored based on demonstrated interest in and aptitude for leadership. Our interview process evaluates stated interest in developing leadership skills and future career goals. These scores are factored into our interview and ranking criteria.

Many applicants seek out our program for its leadership focus. In a survey, 60% of current residents reported that the leadership curriculum was “very important” or “extremely important” in their decision to match with us. “I chose our residency program specifically for its emphasis on leadership development. I believe we have a responsibility to become leaders in our health care system, whether it's running patient care team, hospitals, or large ACOs [accountable care organizations]. Our program recognizes this future and equips us to succeed in any leadership role,” states Benjamin Preyss, current third-year resident. As many of our residents have had past experience balancing leadership obligations with work responsibilities, we are able to support a culture where residents can continue these activities. For example, residents are often asked to represent the residency at various forums and panels and are encouraged to submit presentations to conferences. Residents cover for each other when activities conflict with clinical obligations, allowing each other to pursue and develop interests without compromising patient care, much as physician leaders must do throughout their careers.

Over the past 5 years, our residents have had 50 presentations at local, national, and international conferences. Our residents have won the Illinois state research webinar, as well as AAFP advocacy and RHEDI grant scholarships. Alumni have gone on to become associate program directors, WHO consultants, and state academy leaders. We plan to formally survey alumni every few years and evaluate our curriculum outcomes to identify their leadership roles, track their leadership career opportunities, and assess how our curriculum prepared them for these roles.

Incorporating a leadership curriculum is critical in providing physicians with tools to be advocates for change in family medicine and the health care landscape. We hope that other programs will also begin to prioritize leadership and develop curricular activities to support resident development for these valuable skills.