Residency Leadership Training

The UHFMR champions the mission to educate and prepare physicians to provide full-spectrum family medicine to graduate compassionate, competent, and ethical clinicians who are stewards of their community.

Created in 1976, and continuously accredited by the ACGME, the residency has grown from four to 21 residents in training and has graduated 185 family medicine physicians to date, many of whom practice in rural areas. The Lugar Center partners with the residency in preparing family medicine residents for successful rural practice in underserved communities.

According to a 2005 Resolution by the National Advisory Committee on Rural Health and Human Service, the challenge for rural health is to identify “emerging leaders from and for rural communities and provide them with the training and resources to play a lead role in ensuring access to quality health care in their states and communities. “ (The 2005 Report to the Secretary: Rural Health and Human Service Issues) Further, Steven Crane, M.D., writes that “physician leadership is a critical factor in developing community programs.” (Rural physicians and community leadership: Skills for building health infrastructure in rural communities, NC Med J, 67, 63-65. 2006) Rural family physicians who are effective leaders can advocate for patients’ interests in the community at-large, provide specific expertise to community agencies, and serve as an arbitrator between agencies. In addition, evidence shows that community leadership preparation and a “sense of belonging” often determine whether a young rural physician remains in a community.

Unfortunately, most residency programs do not prepare trainees in leadership and provide limited opportunities for exposure to physicians who are community leaders. To address this need, curricular experiences were designed and implemented to provide formal didactic leadership training and structure clinical training experiences with physician leaders. Residents were also administered the USDA Natural Resources Conservation Services Leadership Assessment Instrument to determine their leadership competencies among five categories: Focused Drive, Emotional Intelligence, Building Trust/Enabling Others, Conceptual Thinking, and Systems Thinking. By increasing residents’ understanding of their leadership strengths and weaknesses, they are better able to meet the needs of, and effectively engage with, the rural communities they serve.

In order for family physicians to remain effective as community leaders, they must also avoid professional burnout, a syndrome characterized by depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Research by Chopra and Sotile (Physician Burnout, JAMA, 291(5), 633, 2004) reveals that anywhere from 46% to 80% of practicing physicians experience moderate to high levels of emotional exhaustion associated with their work. In order for family medicine residents to become safe and trusted medical providers, as well as engaged and committed community leaders, they must be able to recognize risk factors for, and symptoms of, professional burnout. As part of the Leadership Curriculum, residents are administered the Maslach Burnout Inventory on an annual basis throughout their training. Individual scores are shared with each resident in order to develop an individualized burnout prevention plan. Aggregate scores are used to develop burnout prevention presentations which are incorporated into the residency curriculum.

In the words of Jesse Clark (2013 Residency Graduate): “I’m humbled to say that I’ve personally benefitted from this initiative. I grew up in Terre Haute, and my own family doctor and mentor was one of the original graduates from our residency program in 1976. He was one of several leaders and educators who contributed to develop to teach us better skills. I’ve been able to truly become involved in hospital leadership. I serve as a non-voting member on our hospital’s Quality Committee, the Ethics Committee, and Sepsis Committee. Through my experience in these groups, I’ve been able to literally earn a seat at the table with our hospital’s physician leaders and to be part of the growth of Union Hospital as a whole. Because of this, I’ve grown exponentially as a leader throughout my residency training. I’ve built a strong leadership CV to complement my medical experiences. These opportunities helped me secure my next position after graduation as a junior faculty member at the Family Medicine Residency Program at Community East Hospital in Indianapolis, allowing me to pursue my personal goal of becoming a medical education within my home state of Indiana.”

Components include: integrated longitudinal curriculum, targeted didactic presentations, Academic Leadership Majors, Competency Based Assessments of Residents capabilities, Chief Residents formal training, residents led community projects, mentorship, committee and coalition service.

Dissemination: This curriculum was the focus of several presentations at the National Rural Health Association, Family Medicine Midwest Conference, and American Academy of Family Physicians RPS conferences.