Texas Children’s Hospital Educational Scholarship

Large Project Award Grant Application

Authors:

Dr. Adam Cohen, Pediatric Hospital Medicine Fellow, PGY -4

Texas Children’s Hospital and Baylor College of Medicine
Email: adcohen.md@gmail.com
Phone: 914-319-0632

Dr. Anna Suessman, Pediatric Emergency Medicine Fellow, PGY-6

Texas Children’s Hospital and Baylor College of Medicine
Email: anna.suessman@gmail.com
Phone: 908-247-3049

Amount Requested:
$40,000

https://orit.research.bcm.edu/EPSA/Home/Default.aspx
Executive Summary (250 words):
The behaviors and best practices of education leaders are not well described in the

literature to date. Burn-out is becoming prominent throughout the spectrum of learners in

medical education, which may impact learner education and productivity as future physicians.

We propose a new Education Leader Framework which theorizes that a leader with strong

emotional intelligence skills and who takes into account the principles of learner wellness and

building resilience can create a more productive system of education, for both instructors and

learners. In order to show this, our project will take four main steps. First, we will do a thorough

review of the literatures and prevailing theories on emotional intelligence, wellness and

resilience in order to create a conceptual framework for our new leadership model. Second, we

will use this framework to develop an interview guide and qualitatively study prominent

education leaders on their skills in emotional intelligence and their ability to foster wellness and

resilience in their followers. Third, based on the data we receive, we will create a Resilience

Leadership Course in order to train education leaders in our found best practices. Fourth, we will

evaluate the effect of this training on education leaders and the culture they build in their

followers via pre- and post-course assessment surveys.

Goals & Objectives
Goals

1. We will define a new leadership theory of leadership in education involving the use of
emotional intelligence to foster wellness and resilience in students and instructors,
creating a more productive culture and environment.

2. We will evaluate the current practices of education leaders in the context of this new
theory.

3. We will teach current and future education leaders in how to use this leadership theory in
order to create a better system.

4. We will analyze the effect of this leadership training on education leaders, instructors and
students.

Objectives

1. Create a conceptual framework of Resilience Leadership based on a review of the

literature, current theory, and expert opinion, as well as an iterative revision process.

2. Perform semi-structured interviews on education leaders and their current practice in the
context of this conceptual framework.

3. Analyze the interview data qualitatively for themes regarding the use of emotional
intelligence, building resilience and creating wellness and the skills and strategies to
foster these ideas in instructors and students until data saturation is met.

4. Use the findings of the study to create a Resilience Leadership Training course using the
principles of andragogy.

5. Train education leaders from multiple programs in the skills and strategies of Resilience
Leadership through the training course.

6. Survey leaders before, directly following, and 6 months after to assess for changes in
knowledge, skills and attitudes of the leaders.

7. Survey students and instructors at each institution to compare productivity, wellness, and
work environment prior to, directly following and 6 months after course completion.
Background

Emotional intelligence (EI) is the ability to recognize, understand and manage emotions

in oneself and in others.1 Subsequently, one must apply their EI skills to guide their thoughts and

actions. EI is not an innate skill set, it is one that is developed and can be greatly enhanced with

deliberate learning and practice. In medical education, EI influences interpersonal

communication, assists with conflict resolution and promotes professionalism. Healthcare

depends greatly on multidisciplinary teamwork to effectively provide safe, cost-conscious and

best-outcome driven patient care. According to the Joint Commission Online 2015 report,

deficiencies in EI were the root cause of reported sentinel events.2 Medical care, and therefore

the education needed in preparing one to provide the best care, requires adaptive personality

traits linked to Emotional Intelligence.

Although algorithms exist, knowledge and interplay between diagnostic tests and various

treatments requires situational awareness and strong EI to successfully prevail over common

challenges faced in modern medicine.3 A medical provider is a leader, regardless of his/her

specialty, that needs to lead, coordinate, respond and adapt to a multitude of conditions,

behaviors and barriers. It is ideal to train rising providers in skills and strategies to overcome

adaptive challenges. Through this education, focusing on cognitive and affective elements can

significantly improve trainees and leaders’ EI.

1 Roth CG, Eldin KW, Padmanabhan V, Friedman EM. Twelve tips for the introduction of emotional intelligence in
medical education. Medical Teacher; 2018.
2 Schumacher, P. The Joint Commission Online Patient Safety 2014. April 2015.
3 Himmer R. Emotional Intelligence in Health Care; 2014.
 Practicing medicine requires resilience. Physician jobs within healthcare have high

demands and stress, leading to a high risk of burnout. These challenges impact medical students,

residents, fellows and practicing attending physicians. Research has shown that stress has led to

the decline of empathy, altruism, professionalism, and overall health as well as increase of

fatigue, drug use, psychological distress and suicide rates.4 Therefore, it is important to create a

leadership framework with emphasis on resiliency. Resilience within medical education can be

defined as the capacity to cope with or resist/manage adversity without developing physical or

psychological disabilities.5 If resilience is looked at as a mediator to the stressors within

medicine, strategies can be implemented to create more effective, productive and overall

healthier physicians and trainees.

Strategies to improve resilience in trainees include: 1) support from peers and mentors, 2)

widespread education of cognitive behavioral techniques, 3) availability of trainee/attending

wellness programs, and 4) courses on coping mechanisms, including mindfulness. Improving

resilience in medical instructors will also help in spreading resilience down to trainees through

positive experience and impactful mentorship.

In addition to resilience, overall focus on wellness of a leader and incorporation of

wellness within medical education is important. Targeting wellness to address the underlying

source of stressors instead of the manifestations of this stress is key.6 This leadership theory will

4 Farquhar J, Kamei R, Vidyarthi A. Strategies for enhancing medical student resilience: student and faculty
member perspectives. Int J Med Educ. 2018;9:1–6.
5 Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-
RISC) Depress Anxiety. 2003;18(2):76–82.
6 Gaw, CHristopher. Wellness Programs in Medical School: Reevaluating the Current Paradigm. Academic
Medicine: 7/2017; 92(7):899.
focus on strategies surrounding mental health, diversity and work-life balance to ensure not only

the leader’s well-being, but the followers’ as well.

“I will remember that there is art to medicine as well as science, and that
warmth, sympathy, and understanding may outweigh the surgeon's knife
or the chemist’s drug.”
- Oath of Louis Lasagna

In medical school, we all heard these enchanting words, and it is therefore critical not to forget

that being a leader within healthcare is more than providing care -- it is providing the most

compassionate, empathetic, altruistic and scientifically sound care to patients, as well as

fostering that environment in students and trainees, that should be one’s ultimate goal as a leader

in healthcare education.

Our leadership theory focuses on using these skills and concepts to empower a leaders

and educators in medicine. The goal is to create, support and encourage an emotionally

intelligent leader, one who will have self-awareness and control to prevent conflicts with

trainees, students, and instructors as well as see where possible infra-follower conflicts may

arise, and can help adjust environmental and personal factors to create a culture of wellness and

resilience that will help these followers handle setbacks and conflicts a leader cannot prevent.

Figure 1 below represents a preliminary conceptual framework of this leadership theory

in action. As shown, using EI skills such as social awareness and relationship management to

impact the environment and followers (trainees, students and instructors) through EI strategies to

approach the implementation of resilience and wellness.

Figure 1.

Flowchart created on Visme.co

Project Design
Methodology
A draft of the conceptual framework of Resilience Leadership can be found in Figure 1 above.
After an extensive literature review for the concepts of student and worker wellness, and
emotional intelligence in leadership, the conceptual framework will be revised. Following this
revision, it will be share with experts in the field of wellness, leadership, education and
emotional intelligence for comments and revisions in an iterative fashion. The framework will
then be discussed with stakeholders in the field, such as students and educational leaders, and
revised again. The final product will be the theoretical basis for creating the interview guide in
order to refine and build upon our theory. The interview guide itself will be piloted among
education leaders and go through iterative revisions prior to study enrollment. Also prior to
enrollment, a proposal will be submitted to the Baylor College of Medicine Institutional Review
Board in order to ensure full ethical standards are met.
Education leaders from Texas Children’s Hospital and Baylor College of Medicine will be
identified by position within the college and faculty/self-referral to offer participation in a
qualitative interview. The guide will allow for an open conversation about how the previously
defined conceptual framework of emotional intelligence, wellness and resilience integrates with
leadership and education in their positions as leaders.
After analysis of the data (see below), the major themes will be combined with the expert and
literature derived conceptual framework to create a theoretical basis for a training program.
Based on the theory created, goals and objective will be designed and guide development of a
curriculum on Resilience Leadership and its application to education leaders. The goals and
objectives will also help design an evaluation survey on how each leader utilizes the main tenets
of the theory in their position as leaders. Course participants will be surveyed prior to, directly
after and 6 months after the course is completed. Data will be compiled as noted below.
Finally, a second survey will be derived from the conceptual framework and qualitative analysis
of the interviews to assess leadership effectiveness in the lens of Resilience Leadership. Students
and instructors at participating institutions will be surveyed on the effectiveness of their leaders
both prior to and 6 months after these leaders complete the Resilience Leadership training course
to determine the effectiveness of the theory and techniques taught.

Data Analysis
Survey data will be analyzed with descriptive statistical analysis to determine the mean and
median responses to each survey question. Interview data will be transcribed in preparation for
analysis, with any identifying data removed. De-identified transcripts will be analyzed iteratively
and coded for statements of interest. Constant comparative methodology will be used to cluster
codes into like categories and develop themes. Experienced qualitative researchers on the study
team will help to resolve disagreements and enhance credibility, transferability, dependability,
and confirmability.

Potential Limitations
Our study has a few potential limitations. Firstly, in order to make the study feasible, we are
limiting our initial qualitative study to a single institution and its associated leaders, which may
be detrimental to the generalizability of the results
Secondly, we are using a purposive sample of leaders who will be identified by their positions,
colleagues, or themselves, which may not be identifying true educational leaders in the
institution. However, in the case of qualitative study design, purposive sampling is an effective
and recommended method of subject selection.
Timeline

Activity Month Month Month Month Month Month Month Month

1-3 4-6 7-9 9-12 13-15 15-18 19-21 22-24
Refine conceptual
framework

Create interview
guide

IRB submission and

approval

Perform semi-
structured interviews

Qualitative data
analysis

Create resilience
leadership course

IRB submission and

approval

Recruit faculty for

leadership training

Administration of
tests and surveys

Data Analysis

Preparation of
Manuscript

Literature Cited

1. Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-
Davidson Resilience Scale (CD-RISC) Depress Anxiety. 2003;18(2):76–82.
 2. Farquhar J, Kamei R, Vidyarthi A. Strategies for enhancing medical student resilience:
student and faculty member perspectives. Int J Med Educ. 2018;9:1–6.

3. Gaw, Christopher. Wellness Programs in Medical School: Reevaluating the Current

Paradigm. Academic Medicine: 7/2017; 92(7):899.

4. Goleman, Daniel. Emotional Intelligence: Why It Can Matter More Than IQ; 2005.

5. Himmer R. Emotional Intelligence in Health Care; 2014.

6. Merriam SB, Tisdell EJ. Chapter 4: Designing your study and selecting your sample. In:
Qualitative research: A guide to design and implementation. Fourth ed. San Francisco,
CA: Jossey-Bass; 2016:73.

7. Northouse, PG. Leadership: Theory and practice. Thousand Oaks: Sage Publications.
2016.

8. Roth CG, Eldin KW, Padmanabhan V, Friedman EM. Twelve tips for the introduction of
emotional intelligence in medical education. Medical Teacher; 2018.

9. Schumacher, P. The Joint Commission Online Patient Safety 2014. April 2015.

10. Wiegand DM. Exploring the role of emotional intelligence in behavior-based safety
coaching. J Safety Res 2007;38:391-8.

Impact Statements

Medical Education Leaders

 This study will spread awareness of newly defined leadership theory of leadership
in medical education which will focus to involve EI in order to achieve a balance
between improved wellness and resilience cultivating a productive culture. This
will establish more effective education leaders and directly benefit learners.

Learners/Trainees
Learners within healthcare are exposed to and challenged by stressful
environments that impact not only their education, but also the attitude with
which they provide care. Providing learners strategies disseminated from
educators who are taught this leadership theory, as well as creating a culture of
wellness and resilience, will increase focus on positive mental health in order to
decrease unhealthy work outlooks, overall physician burnout as well as suicide.
Also, an environment that nurtures wellness and resilience will not only improve
mental health outcomes, but decrease sentinel events and increase overall health
engagement from all members of the team, including the patients.

Wider Medical and Business Community

In addition to trainees, medical faculty and staff as well as patients and families
all suffer from the consequences of burn-out. The successful implementation of
leadership strategies geared towards wellness and resilience in students can act as
a prototype for implementation in a variety of other settings, therefore creating a
downstream effect to decrease burn-out and its related negative outcomes.
Lessons learned in the healthcare field can also be applied in a variety of business
settings, creating better, more productive workplaces and happier, more satisfied
workers.

Budget Plan
Item Justification Price Quantity Line Total
Digital Recorder: High quality audio $100 2 $200
Sony recording will allow for
ICDUX560BLK more accurate
Digital Voice transcription and data
Reorder collection.
Atlas.ti To optimize team $3000 1 $3000
Qualitative approach to data
Software 5- analysis, allowing better
member license trustworthiness and
transferability
Transcription Fast and accurate $100/hour 30 x 60- $3000
Services transcription will allow minute
researchers to meet all interviews
deadlines given the large
amount of data being
processed.
Conference Conference $300 registration 2 $4200
Presentation and dissemination and
$1200 flights
Dissemination presentation will allow
for a broader research $600 lodging
impact prior to full
publication.
Comprehensive In order to allow for the $1375 2 $2750
Qualitative development of future
Research Course scholars and improve
expertise in our subject
matter
Salary Support In order to support the $13,425 2 $26,850
creation of this project,
project leaders will need
to decrease clinical load
by 10%.
Total $40,000