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INTRODUCTION: Physicians assume leadership roles in their health care organizations and practices often without support or training. The Physicians Leadership Academy provides integrated leadership seminars, mindfulness training, and executive coaching in a 10-month curriculum to physicians across area organizations. METHODS: Program evaluators responded to stakeholders' need for continuous program improvement by developing a continuous feedback loop evaluation design incorporating a program monitoring system and a theory-driven program evaluation. Given the size of the 2019 to 20 cohort ( n = 19), a one-group pretest/posttest design was used to assess the mechanisms of the program (mindfulness and wellbeing) along with knowledge development, emotional intelligence, and personal and professional growth. The assessments used a combination of published and administrator-developed assessments to address the unique aspects of the program. Doing such ensured continuous improvement and sustainability for the program. RESULTS: The cohort of physicians demonstrated significant engagement and learning across the curriculum, improved mindfulness, and improved capacity of the providers to affect their health care system and communities. CONCLUSIONS: The utility of the program was demonstrated through quantitative and qualitative analyses. Implications of the methodology for future evaluations of program developments are discussed.
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Liderazgo , Médicos , Humanos , Retroalimentación , Médicos/psicología , Curriculum , Evaluación de Programas y Proyectos de SaludRESUMEN
BACKGROUND: The Advanced Trauma Life Support course is the American College of Surgeons' standard of care for physicians who provide initial care to trauma victims. In addition to content updates, Advanced Trauma Life Support version 10 adopted contemporary learning theory and practice into the format and conduct of the training. METHODS: The study used a mixed-methods approach wherein a one-group post-test-only study of student and student refresher exam score differences was followed up with a faculty survey to qualitatively explore the quantitative findings. Mann-Whitney U tests were used to test the null hypotheses that student and student refresher test scores on version 9 (2018) and version 10 (2019) were the same. χ2 tests of independence were conducted to test the null hypotheses that student and student refresher initial assessment pass rates under versions 9 and 10 were the same. Faculty survey responses were analyzed descriptively. RESULTS: For the student written tests, the null hypothesis was retained. For the student refresher written tests the null hypothesis was rejected; the 2019 cohort performed worse than the 2018 cohort. Student initial assessment and student refresher initial assessment pass rates in 2018 and 2019 were statistically the same. The majority of faculty reported less motivation for teaching version 10. CONCLUSION: Although a quadrennial review of the format and conduct of Advanced Trauma Life Support courses above and beyond content updates is appropriate, it may be prudent to require strong evidence of improved student performance and value before implementing changes to the training.
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Atención de Apoyo Vital Avanzado en Trauma , Curriculum , Evaluación Educacional , Medicina de Emergencia/educación , Traumatología/educación , Actitud del Personal de Salud , HumanosRESUMEN
The outbreak of coronavirus disease (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) in 2019-2020 had a substantial impact on the healthcare resources of the world community. An organized regional response was essential to saving lives, preserving and distributing health care resources, and coordinating health care efforts. This brief report describes how a long-established regional trauma organization (RTO) provided that coordination in Central, Southeast, and Southeast Central Ohio during the COVID-19 pandemic.
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COVID-19 , Infecciones por Coronavirus , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Humanos , Pandemias , SARS-CoV-2RESUMEN
BACKGROUND: Our regional trauma organization, which comprises 7 trauma centers, 30 acute care hospitals and free-standing emergency departments, and 42 emergency medical services agencies, conducted possibly the largest mass-casualty drill to date, totaling 445 victims at 3 sites involving 11 hospitals and 25 agencies and organizations. METHODS: The drill was preceded by a tabletop exercise 4 months beforehand called Operation Continued Care Full-Scale Exercise, which consisted of simulated terrorist events at 3 sites to wound 445 moulaged patients. Four law enforcement and 5 fire and emergency medical services departments and 16 supporting organizations and agencies were involved in transporting patients to 11 different hospitals. The 7 objectives for the event addressed coordinating emergency operations, sustaining adequate communications, updating regional bed status, processing resource requests, triaging patients, tracking patients, and patient identification. RESULTS: Of the 445 transported patients, 270 (60%) were entered correctly into the state patient tracking system; 68 (25.2%) upgrades and 34 (12.6%) downgrades from scene triage categories were noted. Multiple opportunities for improvement were identified, with major weaknesses noted in communication and coordination from event sites to the regional trauma organizations and hospitals. CONCLUSION: The size and complexity of the drill provided experience and knowledge to facilitate future disaster preparedness and highlighted weaknesses in communication and coordination. Large, multijurisdictional, multiagency exercises provide opportunities to stress, evaluate, and improve regional disaster preparedness.
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Defensa Civil/organización & administración , Planificación en Desastres/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Incidentes con Víctimas en Masa/mortalidad , Transporte de Pacientes/organización & administración , Centros Traumatológicos/organización & administración , Femenino , Bomberos/estadística & datos numéricos , Humanos , Comunicación Interdisciplinaria , Masculino , Incidentes con Víctimas en Masa/prevención & control , Innovación Organizacional , Control de Calidad , Triaje , Estados UnidosRESUMEN
The vast majority of hospitals in the United States today are led by nonphysicians. This is in sharp contrast to the turn of the 20th century, when over a third of the hospitals in the United States were physician led. As the pendulum swings back from lay leader to clinician leader, there is a strong and appropriate opportunity for physicians to reinsert themselves into a leadership role. In fact, the time has perhaps never been more appropriate than today. In a health care system that is complex, troubled, and challenging, the physician CEO brings a unique set of skills to the business of medicine. The successful physician leader, however, must understand the business of medicine as well as or better than he or she understands the practice of medicine. Training, developing, and equipping our future physician leaders with the necessary skill sets will be one of medicines' many challenges as it expands into the 21st century.
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Directores de Hospitales , Ejecutivos Médicos , Humanos , Liderazgo , Estados UnidosRESUMEN
Signal transducers and activators of transcription (STATs) were identified originally as key components of cytokine signaling pathways. More recently, constitutive activation of STAT proteins has been detected in a wide variety of human tumor specimens and tumor cell lines. Here, we examined the activation of one STAT family member, Stat3, in human prostate cancer cell lines and primary prostate tumors. An analysis of 45 adenocarcinomas obtained at radical prostatectomy revealed elevated levels of constitutive Stat3 activation in 37 (82%) of 45 of the tumors compared with matched adjacent nontumor prostate tissues. A highly specific immunohistochemical assay for detection of phospho-Stat3 revealed that elevated Stat3 activity was localized primarily in the tumor cells of prostate carcinoma specimens. Furthermore, higher levels of Stat3 activation in patient specimens were correlated significantly with more malignant tumors exhibiting higher Gleason scores. In addition, all of the three human prostate cancer cell lines examined (DU145, PC3, and LNCaP) displayed constitutive activation of Stat3. Substantially lower levels of Stat3 activation were detected in LNCaP cells; however, stimulation with interleukin 6 induced a significant increase in Stat3 DNA-binding activity in these cells. Moreover, the direct inhibition of constitutive Stat3 signaling in DU145 cells using antisense Stat3 oligonucleotides induced growth inhibition and apoptosis. Our findings demonstrate that constitutive activation of Stat3 occurs frequently in primary prostate adenocarcinomas and is critical for the growth and survival of prostate cancer cells. These studies further suggest that Stat3 signaling represents a potentially novel molecular target for prostate cancer therapy.