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Mil Med. 2017 Jul;182(7):e1815-e1822. doi: 10.7205/MILMED-D-16-00365.

Moving Beyond Accidental Leadership: A Graduate Medical Education Leadership Curriculum Needs Assessment.

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Department of Internal Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda MD 20814.
Department of Graduate Medical Education, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889.
Department of Internal Medicine, Landstuhl Regional Medical Center, 6 Geb 3377, 66849 Landstuhl, Germany.
Office of the Surgeon General, DASG-PSZ-M, Medical Education Directorate, 7700 Arlington Boulevard, Falls Church, VA 22042-5145.
Group Health, 1st Special Forces Group, Joint Base Lewis-McChord, Box 339500, MS 78, WA 98433-5400.



Despite calls for greater physician leadership, few medical schools, and graduate medical education programs provide explicit training on the knowledge, skills, and attitudes necessary to be an effective physician leader. Rather, most leaders develop through what has been labeled "accidental leadership." A survey was conducted at Walter Reed to define the current status of leadership development and determine what learners and faculty perceived as key components of a leadership curriculum.


A branching survey was developed for residents and faculty to assess the perceived need for a graduate medical education leadership curriculum. The questionnaire was designed using survey best practices and established validity through subject matter expert reviews and cognitive interviewing. The survey instrument assessed the presence of a current leadership curriculum being conducted by each department, the perceived need for a leadership curriculum for physician leaders, the topics that needed to be included, and the format and timing of the curriculum. Administered using an online/web-based survey format, all 2,041 house staff and educators at Walter Reed were invited to participate in the survey. Descriptive statistics were conducted using SPSS (version 22).


The survey response rate was 20.6% (421/2,041). Only 17% (63/266) of respondents stated that their program had a formal leadership curriculum. Trainees ranked their current leadership abilities as slightly better than moderately effective (3.22 on a 5-point effectiveness scale). Trainee and faculty availability were ranked as the most likely barrier to implementation. Topics considered significantly important (on a 5-point effectiveness scale) were conflict resolution (4.1), how to motivate a subordinate (4.0), and how to implement change (4.0). Respondents ranked the following strategies highest in perceived effectiveness on a 5-point scale (with 3 representing moderate effectiveness): leadership case studies (3.3) and small group exercises (3.2). Online power points were reported as only slightly effective (1.9). Free text comments suggest that incorporating current duties, a mentoring and coaching component, and project based would be valuable to the curriculum.


Few training programs at Walter Reed have a dedicated leadership curriculum. The survey data provide important information for programs considering implementing a leadership development curriculum in terms of content and delivery.

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