**6. Training future leaders: the growing importance of physician leadership and leadership education**

Leadership in healthcare is extremely important, and there needs to be more emphasis on fostering the development of physician-leaders within our GME

programs [25]. The physician's primary purpose is patient care, accompanied by the education of patients, students, residents, colleagues, and various decision-makers within the society. In doing so, physicians bear the social responsibility of not only individual healthcare, but also the public's general health and well-being. Beyond this, it is critical that physicians understand what leadership is, are skilled in applying it, and know how to effectively interact within the "leadership sphere." As such, they will be well suited to advocate for patient safety, efficacious delivery of care, and financial stewardship of resources – factors required for sustainable healthcare.

*Contemporary Topics* represents a tremendous effort by many GME leaders, and this second Volume will hopefully serve as a foundation for further texts as educators continue to explore the general question of "what are the best approaches to train tomorrow's doctors?" The challenges are great as both the goals and the overall GME landscape continue to evolve rapidly. Above all, a physician is an individual who is responsible for the health and well-being of his or her patients. However, being a physician is not limited to providing healthcare services or medical/administrative leadership but extends beyond these functional domains. Consequently, physician education must ensure a certain degree of proficiency across all relevant spheres of professional functioning. In addition, unique challenges may arise regarding the most optimal ways of instilling the sense of "ownership" regarding patient outcomes and creating accountability within a framework where constructive feedback is not perceived as unfair or punishing. These concepts, especially as they relate to the ethical basis of "what physicians do" at the fundamental level, permeate throughout this text, along with the key question related to GME – "how do we best educate physicians-in-training"?

Interprofessional education is becoming increasingly important as an integral part of modern GME methodology [41]. Within interprofessional collaboration, the most fundamental operating principle is the maintenance of multilateral communication, respect, and open-minded attitude [42, 43]. As more areas of medicine evolve toward team-based and multidisciplinary models of care, we must actively pursue effective ways to train physicians to embrace the leadership of interprofessional, collaborative, and team-based models [44–47].

Effective multidisciplinary teams require strong, yet flexible, leaders who possess a good understanding of clinical research and key scientific principles, the ability to comfortably approach complex disease states and pathophysiology, familiarity with medical economics, ethics, diversity and inclusion, as well as skills required to build and maintain collaborative relationships across disciplines [25]. Physicians are uniquely suited to provide such leadership, and it is critical for our GME systems to adequately prepare such leaders of tomorrow by teaching flexibility, nimbleness, and adaptability. Our medical education system must effectively adapt and evolve with the times because change is a continuous state of this noble profession.

Unfortunately, as we argue for physicians to emerge as leaders and wear several "hats" all at once, the time crunch of everyday clinical practice stands in stark contrast to this call. Physicians find themselves unable to "do it all" as "patientconsumer" demands, new technologies, and increased administrative burdens [48] become more prominent. Because the evolution of medicine is inevitable and ultimately a necessity, the physician of the future may be prone to misperceive himself or herself to be overwhelmed or potentially even redundant. If physicians are expected to teach, listen, innovate, and lead, in addition to the traditional procedural and diagnostic aspects of the job, then the time dedicated to such pursuits must be re-allocated from some other aspect of their professional life. This would seem particularly true for primary care physicians who appear to be disproportionately affected by the often competing time pressures [49].

Although controversial, physicians may have to "give up" some of their traditional role to take on new challenges. Some solutions could include outsourcing

#### *Introductory Chapter: Navigating Challenges and Opportunities in Modern Graduate Medical… DOI: http://dx.doi.org/10.5772/intechopen.101016*

diagnostics to artificial intelligence and advanced electronic medical record (EMR) and software [50, 51]. Additionally, particularly in the case of outpatient primary care and hospitalist practice, physicians and physicians-in-training may face the risk of being increasingly replaced by advanced practitioners [52, 53] with little or no perceptible compromise to patient safety or satisfaction. Similarly, one study points out that physical therapists could replace physicians during encounters for assessment of knee osteoarthritis and other similar conditions [54].

This outsourcing of work may ultimately improve the primary care shortage, without increasing the cost to the healthcare system at large. Additionally, it may lessen the time constraints on physicians while enabling them to take on more leadership and teaching roles. However, as physicians render themselves increasingly redundant or replaceable in more fields, there is also the danger of devaluation of the profession itself. Any solutions to the above will require a fine balance involving the creation of appropriate synergies between advanced practitioners and physicians, and the associated process will necessitate significant amounts of time and investment by all stakeholders. This delicate equilibrium is one area that will need to be addressed in GME training - the creation of a carefully crafted framework that fosters the interplay of team care models and inclusivity. It is a unique opportunity to include all types of clinicians in shaping the future of patient care in the post-COVID era.

## **7. Focus on diversity, equity, and inclusion**

It is of utmost importance for the medical community (and the society, in general) to address the challenge of, and opportunity for, inclusion and advancement for underrepresented minorities and women in medical leadership positions. There is an established bias in academic medicine leadership, which, if not addressed, will continue to propagate. Only 21% of women are full professors and only 15% of department chairs are female [55, 56]; moreover, a disproportionately small 8% of academic faculty are underrepresented minorities [56]. This gap is very likely to widen post-COVID. We will not fully understand the toll of the COVID-19 pandemic, but the tremendous burdens placed by our society on women physicians have resulted in formidable challenges for maintaining clinical practice. Addressing this fundamental issue, especially within GME, is of highest priority. If properly structured and implemented, solutions based on diversity, equity, and inclusion will lead to improved health care and outcomes for patients, which is our ultimate goal.

A simple yet profound concept in medical learning is that of interdependent opposites: presentation of opposing ideas to explore the alternatives and stake out the trainee's own position on a given matter. Through this repeated exercise, the trainee develops a medical attitude that informs future decision-making and philosophy. Ultimately, this allows expression of the developing practitioner's unique medical personality, a blend of personal thought and collective information grounded in the latest scientific and ethical frameworks.

### **8. Synthesis and conclusion**

Graduate medical education continually evolves to meet the challenges facing physicians-in-training. *Contemporary Topics in Graduate Medical Education* discusses concepts of physician leadership in team-based healthcare models, the lasting impact of the COVID-19 pandemic on medical training and resources, and

#### *Contemporary Topics in Graduate Medical Education - Volume 2*

the importance of inclusivity and advancement of underrepresented minorities and women in academic medicine. The recognition and ongoing discussion of these topics will be important at the level of graduate medical education. These fundamental sets of knowledge and skills will help positively shape a physician's career to support the development of competent future leaders who have the foundational skills to adapt to the inevitable transformation of medicine and healthcare delivery over time.
