title: Leadership and management training of pediatric intensivists: how do we gain our skills?
abstract: BACKGROUND
  Intensivists manage a diverse team of health care professionals. For decades, business literature has recognized the value of leadership and management skills, yet this is relatively unexplored in critical care.
  
  
  OBJECTIVE
  Investigate the status of intensivists' preparation for the clinical leadership and management roles that they will assume after medical training.
  
  
  METHODS
  Authoritative business leadership literature was reviewed to identify attributes of successful leadership and management relevant to critical care. A survey was designed to assess the process by which intensivists learn these attributes and to assess their perceived level of preparedness (20 items). Each survey item received a preparedness score structured as a Likert scale (1=not prepared, 5=very prepared), representing the averaged response to each item. In addition, an inadequate preparedness percentage was created representing the percentage of respondents answering "not at all prepared" and "hardly prepared" on the Likert-scaled items.
  
  
  METHODS
  Pediatric Critical Care Medicine Board Review Course, Washington, DC, 2004.
  
  
  METHODS
  Physician course participants (n=259).
  
  
  METHODS
  Survey administration.
  
  
  RESULTS
  The response rate was 61% (n = 159). The majority of respondents (69%) had completed fellowship training (median, 1 yr posttraining). Modeling the behavior of other physicians was the dominant technique for leadership and management skill acquisition (86%). The respondents were taught these skills by a variety of sources (attendings, 92%; other fellows, 42%; nurses, 37%; teachers, 20%; residents, 14%). Most (82%) thought that leadership and management training was important or very important, yet only 47% had received any formal training (40% fellowship, 36% residency, 21% medical school, 16% masters, 30% other). Overall, respondents felt only "somewhat prepared" for the 20 leadership and management items surveyed (mean+/- sd of preparedness score, 2.8+/- 0.2). Respondents were least prepared to manage conflict within a team, manage conflict with other groups, and manage stress effectively (preparedness scores of 2.5, 2.4, and 2.6 and inadequate preparedness percentages of 19.5%, 15.7%, and 18.9%, respectively). Respondents were most prepared to "set high standards" (preparedness score=3.3). Of the respondents feeling at least somewhat prepared, only 33% credited medical training as preparing them.
  
  
  CONCLUSIONS
  Although leadership and management training was perceived as important to this sample of pediatric generally young intensivists, most feel inadequately prepared for critical aspects of these responsibilities, most notably, stress and conflict management. These findings provide an opportunity for specific curriculum development in leadership and management for those believing these skills should be further refined.
authors.affiliation: Division of Critical Care Medicine, Children's National Medical Center, Washington DC, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Stockwell
authors.forename: Murray M
authors.initials: MM
authors.lastname: Pollack
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Turenne
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Slonim
mesh_terms: D003422:Critical Care / Q000458:organization & administration*; D006801:Humans; D007324:Institutional Management Teams / Q000458:organization & administration*; D007857:Leadership; D010372:Pediatrics / Q000193:education* / Q000458:organization & administration*; D011361:Professional Competence; D013192:Staff Development