Read to Lead: Developing a Leadership Book Club Curriculum for Graduate Medical Education

Introduction

Physicians serve as leaders in diverse capacities early in residency and throughout their careers. Effective leadership benefits patient outcomes, provider satisfaction, and physician well-being.^1–7 Leadership skills must be taught and developed.^2,3,8 Despite increasing calls for leadership development among physicians,^3,9 few residency programs and health care organizations have formal curriculums to develop leadership skills and the Accreditation Council for Graduate Medical Education (ACGME) does not list leadership education as a core competency. ¹⁰ As a result, most clinicians consider themselves “accidental leaders.”^3,11 Prioritizing leadership education is an opportunity to transform accidental leaders into effective and intentional leaders.^3,9,11

Several residency programs have created curricula to develop physician leaders to close this “leadership gap”.^8,11 Lectures, small group discussions, and case-based activities dominate the current landscape of leadership curricula.^3,11 While book clubs have been utilized in a variety of specialties and settings to strengthen leadership development as well as medical education in general,^12–17 they remain an underutilized instructional format within residency programs. When used appropriately, book clubs have been shown to promote critical thinking, ¹⁸ reduce burnout,^19,20 and possibly improve leadership skills. ¹² We developed a leadership book club at Walter Reed National Military Medical Center as part of our leadership curriculum. The purpose of this article is to examine our 6 years of experience with an annual leadership book club and explore barriers and potential solutions to effective implementation.

Methods

Results

The survey had a response rate of 60% (N = 49). Overall, the evaluation of the leadership book club was positive. 53% of residents were either “satisfied” or “very satisfied” with the book club experience. Only 6% were not at all satisfied and of these residents, they reported reading “none” or “very little” of the book (Figure 1). The small group in-person discussion was well-received and strongly preferred (83.3%) over alternative formats (Figure 2). 66% of respondents would recommend book club to other residency programs as a tool for leadership development and 61% felt that the curriculum influenced their leadership thoughts and behaviors. Specifically, respondents wrote that the leadership book club:

“Caused me to reflect on the styles of my role models and see how [vulnerability in leadership] is more important than I previously thought. I have increased its priority in my own style.”

OPEN IN VIEWER

Figure 1.

Shows resident overall satisfaction with leadership book club curriculum.

OPEN IN VIEWER

Figure 2.

Shows resident preference for instructional format.

The survey results also identified opportunities for curricular improvement. Only 12% of survey responders read the entire book, while a small majority (54.5%) read at least half. Most (79.50%) cited lack of time as the most significant barrier to finishing the book. The incorporation of complementary materials (eg, blog, podcast, and video) and offering alternative book formats (eg, audiobook) may increase future participation (Figure 3). Resident involvement in the book selection may further increase participation.

OPEN IN VIEWER

Figure 3.

Depicts opportunities for increasing resident engagement in the leadership book club.

Discussions

A leadership book club serves as a potential method for transforming graduate medical education (GME) trainees from accidental to intentionally effective leaders. We successfully implemented a leadership book club that enhanced community through meaningful discussion^15,19 and likely influenced the development of leadership thoughts and behaviors, consistent with prior literature.^12,13,17 Using the books to jumpstart conversation, residents discussed a wide variety of topics including teamwork, culture, vulnerability, well-being, gender equity, feedback, accountability, and values. These discussions allowed residents to better understand and learn about each other while enhancing their leadership skills. We hypothesize that our resident-led, faculty-supported small group book club discussions promoted near-peer leadership and increased resident satisfaction. This is different from other programs that have used leadership-trained faculty members as discussion facilitators. ¹³ In our study and the literature, small group discussion formats are preferred.^11,13,16,17 More evidence is needed to determine optimal facilitation strategies.

Other studies have looked at the influence of leadership curricula in GME programs. For example, Cobb et al. compared leadership development after implementing a leadership book club curriculum in an anesthesia residency program against historic controls, finding that leadership curricular participation was associated with a non-statistically significant increase in leadership skills. ¹² Other medical specialties, ranging from Emergency Medicine to Psychiatry have found similar success, fostering professional development.^15,17 While our survey did not assess the attainment of leadership skills or improvement as a leader, the survey respondents reported that the discussions influenced their leadership thoughts and behaviors and allowed residents to intentionally discuss leadership in medicine. Future curricular interventions could directly assess the improvement in leadership skills of participants.

Our study is a rare example of book club implementation for leadership development in GME, providing information for other programs to implement successful leadership book clubs. Among our lessons learned, resident participation in our book club was variable, consistent with the anesthesia residency book club where 61% of residents participated. ¹² To maximize participation, our results suggest that residents should participate in the book selection. In addition, our study demonstrated that the most significant barrier to implementing a book club was lack of time during residency (79.50% of responses). Respondents indicated that this could be mitigated by selecting books shorter in length that have audiobook capabilities or complementary media such as podcasts. Alternatively, programs could consider using a podcast or short article alone as an option given there are many leadership podcasts available and almost a third (32%) of residents suggesting this would improve participation. Podcasts have the additional benefit of being free which could be a useful alternative for programs without the funds to purchase books. By implementing these variations, we hypothesize that resident participation will be maximized, and resident satisfaction will increase. This is evidenced by our survey that found that the residents who were “not at all satisfied” with the experience had read “none” or “very little” of the book; suggesting that the inability to read even part of the book severely limits the benefit of the book club group discussions for that resident.

Leadership book clubs serve as a tool to foster physician leaders in many ways. Setting aside dedicated academic time emphasizes the importance of leadership development and avoids residents from having to give up their free time to participate. Allowing a small group of residents to help run the leadership book club affords residents with practical leadership and teaching experience. The residents leading the process also can help make the material more applicable to resident learners. It is important to have preformulated points of discussion for the meetings. We have started using prompts that can be discussed by anyone even if they have only read part of the book. If implementing a leadership book club, we would recommend planning ahead to gather data on its effectiveness for programmatic improvement and to potentially publish results so the medical education community can continue to learn how to effectively use book clubs for leadership development.

Limitations

The book club was conducted in a residency program consisting of military officers, which may have impacted their perceptions of need and desire to learn about leadership in comparison to civilian programs. The residency program purchased and distributed the books, limiting access as a barrier. The survey was designed for purpose of evaluating our specific curriculum, and it did not directly assess for improvement in leadership skills. While efforts were made to collect evidence to support the validity of our survey, the questions were only tested on a small percentage of the target population.

Conclusion

Leadership book clubs offer 1 relatively simple method for GME programs to longitudinally teach leadership skills to trainees. Additional research is needed to determine potential alternatives to books such as podcasts or articles, optimal discussion formats, and develop additional tools for building physician leaders of today and the future.

Supplemental Material

Supplemental Material