Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
Mil Med. 2023 May 18;188(Suppl 2):87-93. doi: 10.1093/milmed/usac110.
Developing physicians as leaders has gained attention across the United States. Undergraduate medical education (UME) and graduate medical education (GME) leader development programs have increased. During postgraduate years (PGY), graduates bring their leadership education to the bedside; however, associations between leader performance in medical school and GME is largely unknown. It is important to find experiences that can assess leader performance that may be useful to predict future performance. The purpose of this study was to determine if (1) there is a correlation between leader performance during the fourth year of medical school versus leader performance in PGY1 and 3, and (2) leader performance during the fourth year of medical school is associated with military leadership performance in PGY1 and 3s while taking previous academic performance markers into account.
This study examined overall leader performance of learners (classes of 2016-2018) during the fourth year of medical school and their graduate leader performance post-medical school. Leader performance was assessed by faculty during a medical field practicum (UME leader performance) and graduate leader performance was assessed by program directors at the end of PGY1 (N = 297; 58.3%) and 3 (N = 142; 28.1%). Pearson correlation analysis examined relationships among UME leader performance and between the PGY leader performance items. In addition, stepwise multiple linear regression analyses were conducted to examine the relationship between leader performance at the end of medical school with military leadership performance in PGY1 and 3, while taking into account the academic performance markers.
Pearson correlation analyses revealed that the UME leader performance was correlated with 3 of 10 variables at PGY1, and was correlated at PGY3 with 10 out of 10 variables. Results of the stepwise multiple linear regression analysis indicated that leader performance during the fourth year of medical school explained an additional 3.5% of the variance of PGY1 leader performance after controlling for the previous academic performance markers (MCAT total score, USMLE Step 1 score and Step 2 CK score). In contrast, leader performance during the fourth year of medical school alone accounted for an additional 10.9% of the variance of PGY3 leader performance above and beyond the set of academic performance markers. Overall, UME leader performance has more predictive power in PGY leader performance than the MCAT or USMLE Step exams.
The findings of this study indicate that a positive relationship exists between leader performance at the end of medical school and leader performance in PGY1 and 3 years of residency. These correlations were stronger in PGY3 compared to PGY1. During PGY1, learners may be more focused on being a physician and an effective team member compared to PGY3 where they have a deeper understanding of their roles and responsibilities and can take on more leadership roles. Additionally, this study also found that MCAT and USMLE Step exams performance was not predictive of PGY1 or PGY3 leader performance. These findings provide evidence of the power of continued leader development in UME and beyond.
培养医生成为领导者已经引起了全美的关注。本科医学教育（UME）和研究生医学教育（GME）领导者发展项目有所增加。在住院医师培训期间（PGY），毕业生将他们的领导力教育带到了床边；然而，医学院校领导表现与 GME 之间的联系在很大程度上尚不清楚。找到可以评估领导表现的经验是很重要的，这些经验可能有助于预测未来的表现。本研究的目的是确定（1）医学生第四年的领导表现与 PGY1 和 3 的领导表现之间是否存在相关性，以及（2）在考虑以前的学业成绩指标的情况下，医学生第四年的领导表现是否与 PGY1 和 3 的军事领导力表现相关。
本研究考察了学习者（2016-2018 年班级）在医学生第四年的整体领导表现以及他们毕业后的研究生领导表现。领导表现由教师在医学实地实习期间评估（UME 领导表现），研究生领导表现由 PGY1 结束时的项目主任评估（N=297；58.3%）和 PGY3 结束时评估（N=142；28.1%）。Pearson 相关分析考察了 UME 领导表现与 PGY 领导表现项目之间的关系。此外，还进行了逐步多元线性回归分析，以考察医学生毕业时的领导表现与 PGY1 和 3 的军事领导力表现之间的关系，同时考虑学业成绩指标。
Pearson 相关分析显示，UME 领导表现与 PGY1 的 10 个变量中的 3 个相关，与 PGY3 的 10 个变量中的 10 个相关。逐步多元线性回归分析的结果表明，在控制以前的学业成绩指标（MCAT 总分、USMLE 第 1 步成绩和第 2 步 CK 成绩）后，医学生第四年的领导表现解释了 PGY1 领导表现变化的额外 3.5%。相比之下，医学生第四年的领导表现仅占 PGY3 领导表现变化的额外 10.9%，超出了学业成绩指标的设定范围。总的来说，UME 领导表现比 MCAT 或 USMLE 第 1 步考试在 PGY 领导表现中具有更大的预测能力。
本研究的结果表明，医学生毕业时的领导表现与 PGY1 和 3 年住院医师培训期间的领导表现之间存在正相关关系。在 PGY3 中，这种相关性比 PGY1 更强。在 PGY1 期间，学习者可能更专注于成为一名医生和一名有效的团队成员，而在 PGY3 中，他们对自己的角色和责任有了更深入的理解，可以承担更多的领导角色。此外，本研究还发现，MCAT 和 USMLE 第 1 步考试成绩并不能预测 PGY1 或 PGY3 的领导表现。这些发现为 UME 及以后持续领导力发展的力量提供了证据。
