Building teams across clinical settings – building collective commitment across graduate medical education | BMC Medical Education



Burnout and fatigue are key factors that play a key role in the training of postgraduate medical learners [1]. The COVID-19 pandemic has caused significant disruption to medical training for residents and fellows. To understand the needs of trainees, a survey was distributed by leaders of the Mayo Fellows Association to Mayo Clinic GME program trainees in her three regions of Arizona, Florida, and the Midwest during the summer of 2022. Survey data shows a strong desire for more vacation days to improve the health needs of graduate residents. The total number of annual vacation days at that time was 15 days. The data also showed a strong desire for salary increases. In addition to the survey, site-specific town halls were held under Mayo Clinic GME leadership in the summer of 2022 to allow trainees to voice their concerns directly. During these town halls, trainees brought forward personal stories about cost of living challenges at their current salary levels. . These personal accounts provided an opportunity for the MFA leader and her GME leader to collectively understand the personal impact of current pay and leave policies and the needs of trainees.

Following the town hall, MFA leaders and Mayo Clinic GME leaders engaged in discussions to establish top priorities and address each challenge over the next academic year through a five-step framework (Figure 1). This framework was a new approach to her GME improvement efforts at our facility. Previously, GME leaders identified areas for improvement by working with training program directors and soliciting input from trainee representatives at regularly scheduled Graduate Education Committee meetings. It was specified. Mayo Fellows Association leaders often represented them, and their opinions were frequently sought for suggestions on specific topics for improvement. Additionally, the MFA leader met regularly with site-specific graduate education committees and her GME leaders at the firm to raise concerns.

Before the COVID-19 pandemic, increasing the number of vacation days was considered, but this required extensive research, including benchmarking and determining the impact of training absences on board certification. . When the impact of the COVID-19 pandemic became clear, the Graduate Medical Education Committee made the difficult decision not to increase vacation days. Over time, the GME leader and her MFA have worked together with a focus on improving the health outcomes of trainees and expanding the reputation of Mayo Clinic’s training programs.

To better target the most important concerns, our institution’s GME culture has shifted to a collaborative approach using a five-step framework.Trainees and GME leaders named commonalities By identifying goals that enhance the attractiveness of Mayo Clinic’s training programs and support the health of our trainees. After identifying these goals, consensus built About increasing pay and vacation to improve trainee health and satisfaction. A working group was formed and frequent meetings were held between the trainee and her GME leader to ensure progress was made on these priorities. A benchmarking analysis of scholarships was performed on both geographic and national peer programs. This introduced a market-based pay adjustment of 6%. Annually, benefit increases are evaluated and adjustments to institutional rates for related care are considered. GME leaders advocated for fairness for trainees. The workgroup also benchmarked total vacation days between these same programs and evaluated the impact of the proposed vacation increases on executive certification, current travel policies, and required case logging. His core GME leadership understands the personal impact of salary and vacation increases from his one-on-one meetings with MFA leaders, Graduate Education Committee meetings, and town hall participation. , a trainee and his GME leader shared stories about the personal impact this has had on them.Changes during presentations to the broader GME stakeholder community Personalize these priorities.

The workgroup met frequently to consider the opinions and concerns of the broader GME stakeholder community.this frequent and open communication This allowed both trainees and GME leaders to not only work on creating policy changes, but also to develop proposals for implementation that addressed concerns about board eligibility across different disciplines. The workgroup process will include reviewing current vacation and travel policies and discussing and proposing new policies. The workgroup reviewed the eligibility requirements for his national GME expert committee. Trainee compensation and benefits and leave plans were evaluated. The workgroup sought further input from program directors and other key stakeholders to develop the draft policy. An initial vote on the policy took place at a site-specific graduate education meeting. Positive and constructive feedback was collected and used to generate the final version of the policy. After the official policy was finalized, the policy was proposed to the Mayo Clinic Graduate Medical Education Committee for approval.

With the introduction of market-based pay adjustments and the successful approval of a new leave policy increasing vacation days from 15 to 20 days for all trainees in Mayo Clinic’s training program, trainees feel Masu. Recognized and highly valued They contribute to the organization. Additionally, this his five-step process for GME improvement efforts strengthened the relationship between a trainee leader and her GME leader and improved the collaborative context and culture of GME.

commonality of names

The first step in our proposed framework is to name the commonalities.When learners, employees, and leaders all take responsibility for an institution’s mission, that mission can become a powerful unifying force. [14]. For example, Mayo Clinic’s primary values ​​are very clear. “Patient needs come first.” This shared value naturally creates teams across all roles as individuals work together to meet patient needs. Incorporated as a path to excellence in clinical learning environments, the concept of teaming emphasizes the importance of all individuals coming together and leveraging their different professional strengths to achieve a common vision and goal. I’m emphasizing it. [15]. This concept can be applied beyond patient care as GME and trainee leaders work together to share accountability for the facility’s clinical learning environment and trainee experience. [15]. These leaders share a commitment to promoting trainee health and achieving superior outcomes from their programs. GME may have an inherent hierarchy, but naming a common foundation or mission statement that unifies the team rather than tiering it will only improve the relationship between GME and trainee leaders. But it also builds collective efforts to balance patient care, education, and working conditions.

Build consensus on your biggest concerns

Once shared values ​​are highlighted and common ground specified, GME and trainee leaders can work together to identify concerns and build consensus on a set of priorities. Her GME leaders at educational institutions strive to identify best practices and strategic initiatives that improve the quality of their educational programs. Similarly, volunteer house staff association leaders strive to identify and understand needs and advocate on behalf of trainees. In our experience, anonymous surveys are successful in capturing the voice of trainees because they provide the opportunity to perform a comprehensive needs assessment and evaluation of current resources. However, as trainee experiences vary by specialty and region, it is important to have a survey component that allows for appropriate subgroup analysis to more accurately characterize trainee needs while maintaining anonymity. is. Trainee leaders can use survey data and the context of their own experiences to effectively advocate for these concerns. Once GME and trainee leaders have identified opportunities for improvement in the clinical learning environment and trainee experience, they can agree on a set of priorities. Open discussions provide an opportunity to learn from team members’ experiences, understand the implications of potential changes, and focus on priority areas where the trainee and her GME goals are aligned. [16].

Personalize your priorities

Leaders need to communicate effectively to increase motivation for change [14]. The next step for the framework is to personalize the priorities set when building consensus. Storytelling is an effective approach, framing the issue in a context that is familiar to the audience and attracting a sense of empathy. [14, 17, 18]. Leaders must be able to highlight the personal stories behind the needs and concerns that their priorities address so that stakeholders also want the proposed changes. These stories can be told anonymously by leaders and individuals themselves in public forums such as city halls. Additionally, leaders must build belief that the plan will be successful in promoting health by addressing existing gaps in the clinical learning environment and trainee experience.Research demonstrating effective workplace interventions that promote health is limited, so finding ways to communicate the impact of proposed changes on individuals may be more successful [2, 3, 19,20,21].

Communicate frequently and openly

Once commonalities are named and priorities are established, it is important that GME and trainee leaders communicate frequently and openly. Regular meetings with thoughtful and lively discussions help understand these priorities within the larger organizational culture, make decisions, and delegate responsibilities to advance team goals and priorities throughout the academic year. It is important to [22].Team members should expect to participate in meetings with an open mind, as engaged and engaged listeners. [15]. Meeting via email and touchpoints as needed can help maintain momentum throughout the year, address cross-disciplinary differences in board requirements, and overcome unforeseen challenges. Another aspect of this communication is that the trainee leader participates in the organization and her GME committee along with her corresponding GME leader. The more trainee leaders are aware of changes and challenges in the system, the more informed they will be as GME team members.

Frequent and transparent communication with the entire trainee community is also important. Priorities and plans for the school year should be communicated once they are established and progress made at the end of the year. This communication should incorporate the institution’s mission statement (named common ground) and originate from the GME and trainee leadership team. Trainees appreciate direct communication with GME leaders and have found emails, town halls, and Q&A sessions to be successful. [7].

Recognize and evaluate value

The final element of this framework is recognizing and valuing the value of trainees and the people who work for them. Trainees are important members of the medical school’s clinical team and educational mission. Recently, the Gold Humanism Honor Society launched “Thank You a Resident Day” in 2018 to recognize the contributions of trainees. [23]. Institutions and their GMEs should work with volunteer house staff associations to recognize the value added by trainees and take advantage of opportunities to show appreciation. Similarly, faculty who have invested in GME leadership positions should be recognized by their departments and institutions for their work on behalf of their trainees. Trainees also benefit from having highly motivated and thoughtful people in their positions. Additionally, the inclusion of trainees on hospital and her GME committees communicates the organization’s commitment to valuing the trainee’s perspective and its educational program.

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