Author + information
- ∗University of Michigan, Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center, Ann Arbor, Michigan
- †Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- ↵∗Reprint requests and correspondence:
Dr. Shashank S. Sinha, University of Michigan, Samuel and Jean Frankel Cardiovascular Center, 1500 East Medical Center Drive, SPC 5853, Ann Arbor, Michigan 48109-5853.
The movement toward competency-based medical education is well under way in cardiology. In 1999, the Accreditation Council for Graduate Medical Education (ACGME) identified 6 core competencies designed to guide the training of tomorrow’s physicians (1). More recently, the ACGME proposed the Next Accreditation System to allow training programs to adapt their educational environments to continuously evolving professional responsibilities (2). The recently published Core Cardiology Training Statement 4 embraces these changes and addresses the development of a competency-based curriculum with specific milestones (3,4). This shift in focus to competency-based milestones, however, remains primarily clinical in nature and emphasizes the competencies of medical knowledge and patient care. However, the ACGME’s nonclinical competencies of interpersonal and communication skills, professionalism, practice-based learning, and systems-based practice are essential in the professional development of all physicians, from fellows-in-training (FITs) to seasoned cardiologists.
FITs appreciate that they must develop nonclinical competencies both during their training and throughout their career. Yet, no consistent guidelines are available to inform when, where, and how FITs should attain these skills. Professional societies such as the American College of Cardiology (ACC) are uniquely positioned to address these important learning gaps and complement the educational experience of FITs.
The ACC recently developed a 5-year strategic plan (5) that encompasses the following 6 themes: 1) transformation of care; 2) purposeful education; 3) membership value and engagement; 4) population health; 5) data, information, and knowledge; and 6) advocacy. The primary objectives are to improve cardiovascular health and competency, increase member engagement, and augment adoption of proven clinical policies and best practices.
This paper explores how initiatives evolving from the ACC’s Strategic Plan can help FITs develop the nonclinical competencies necessary in today’s constantly changing practice landscape. We examine opportunities for FITs to receive mentorship and pursue leadership, thereby fostering growth in professionalism, communication, practice-based learning, and systems-based practice.
Mentorship: Linchpin of Success
The importance of mentorship in cultivating the development of young trainees has long been recognized (6). Although all ACC members possess their own unique narrative, several have encountered similar obstacles during their professional journeys. Mentorship can connect members across generations to share their stories, wisdom, and experiences. The opportunity to learn from those who have come before carries particular relevance to young cardiologists. Indeed, in a 2012 ACC internal survey of early career members, 42% of respondents indicated that mentorship was the most important tool for physicians during their transition from training into practice. Furthermore, as Tong et al. (7) observed in their recent survey of ACC early career members, “Mentorship is a critical part of all training programs and outstanding mentors should be acknowledged and rewarded by institutional leadership.”
For this reason, the Early Career Professionals Section Leadership Council has developed a College-wide mentoring program. The ACC mentoring program empowers young cardiologists to connect with more experienced mentors to guide their transition from FITs to early career cardiologists and beyond (8). Mentoring, however, is a 2-way street. As DeLong et al. (9) noted in a seminal Harvard Business Review paper, “co-mentoring encourages young professionals to take some responsibility for their own careers.” As trainees build their network of mentors, they simultaneously cultivate a personal advisory board invested in their professional growth and development.
This initiative complements other ACC efforts to support mentorship. Thanks to the largesse of ACC leadership, a dramatic increase in travel awards to the annual ACC Scientific Sessions, Legislative Conference, and Cardiovascular Summit has facilitated unprecedented mentoring and networking opportunities for FITs. This strategic investment will continue to affect many FITs at this early but critical stage of their careers.
By the same token, FITs who have benefited from mentorship must become mentors themselves. For this reason, the FIT Section Leadership Council has formed a Medical Resident Member Working Group to advise this recently formed constituency of >200 medical residents and counting. This working group includes both FITs and medical residents who have demonstrated an interest in pursuing cardiology fellowship training. Membership is complimentary for these aspiring FITs. This working group aims to create opportunities for resident participation in the College’s activities, provide valuable information and resources for residents throughout the fellowship application process, and nurture long-term mentoring relationships. For those FITs who have been so fortunate to receive the gift of mentorship throughout their training, no greater honor exists than to pay it forward.
All of these mentoring opportunities help FITs develop their nonclinical competencies. Mentors can counsel FITs through challenging communication and professionalism imbroglios. Experienced mentors can help an FIT develop the reflection skills necessary to fulfill practice-based learning. Finally, mentors can help FITs navigate administrative and logistical problems to develop the competency of systems-based practice. Perhaps equally as important as the traditional clinical competencies of patient care and medical knowledge, mentorship is crucial to developing more nuanced nonclinical skills that are vital to professional success and fulfillment.
Building a Community of Leaders
Leadership opportunities provide an excellent mechanism through which FITs can develop nonclinical competencies. For example, leading clinical, administrative, educational, and research teams enhances communication skills, increases professional engagement, facilitates self-reflection, and augments understanding of health care systems. However, leadership does not mature by chance or by accident. The ACC recognizes that formal leadership development, as opposed to “trial-by-fire” or “on-the-job” training, is crucial to cultivating its next generation of leaders. ACC Immediate Past President Dr. O’Gara put it best (10): “To truly realize the College’s breadth and scope, and to understand its mission, value and potential, you must invest time, involve others, consult mentors, seek consensus, and promote the careers and aspirations of those who follow.” Dr. O’Gara also emphasized the 5 key characteristics shared by the best leaders: 1) self-awareness; 2) self-regulation; 3) motivation; 4) empathy; and 5) social skills. Leaders who possess all of these traits of “emotional intelligence” effectively guide their organizations during times of upheaval and uncertainty (11,12).
To that end, the ACC has formed the Leadership Academy to provide aspiring leaders with valuable experience and develop essential skills. Leadership Academy members examine team-building dynamics, such as negotiating difficult conversations, managing conflict resolution, and finding appropriate balance between competing priorities. This training augments the professionalism, communication, and reflection skills necessary for members’ success in future leadership endeavors. The principles in the Leadership Academy build on the well-established Emerging Faculty program for aspiring clinician-educators and provide the framework for the recently launched Emerging Advocates program for those engaged in politics, policy, and advocacy.
Additional opportunities for leadership development for FITs include serving the College through various councils, committees, and working groups. These appointments allow FITs to interface with leaders of the College and gain valuable “hands-on” leadership experience. In addition, FITs have an opportunity to pursue leadership positions in their local state chapters, potentially helping to organize the annual chapter meeting or contributing to local advocacy or educational efforts. FITs should strongly be encouraged to take advantage of these leadership opportunities to develop their nonclinical competencies.
Effective leadership requires articulate communication. Interpersonal and communication skills are represented as 1 of the 6 core ACGME competencies, which further underscores their importance to FITs’ development. Once again, the ACC provides an array of opportunities for FITs to share their ideas and cultivate their communication skills. In addition to the Journal’s FIT and Early Career Page, FITs can contribute content to any of the 20 “Clinical Topics” section pages of the ACC website. Moreover, 16 FITs have been selected to help shape the ACC.org/FIT web page as inaugural 2015 to 2016 Editorial Fellows. FITs now also have the opportunity to contribute to ACC In Touch Blog posts on a gamut of topics. Finally, FITs also have the opportunity to volunteer for the FITs-on-the-Go Blog at the Annual Scientific Sessions. By providing FITs with opportunities for purposeful and focused leadership and communication development, the ACC empowers FITs with a vital nonclinical skillset for career growth and satisfaction.
Focus on the Future
In summary, the nonclinical competencies of professionalism, interpersonal and communication skills, practice-based learning, and systems-based practice represent an oft-neglected but important component of cardiology training. The ACC is well positioned to complement the FIT educational experience in these domains through programs focused on mentoring, leadership, and teamwork. A recently launched nonclinical competencies toolkit, jointly sponsored by the FIT and Early Career sections, features a series of webinars on a gamut of topics, including leadership development, financial planning, and practice management. These topics are also addressed at the annual Cardiovascular Summit, which provides an excellent forum for assimilating essential skills in leadership, data-driven quality improvement, streamline management, and finance. Through the extensive array of aforementioned opportunities, the ACC endows FITs with the experiences and skills to achieve important nonclinical competencies to prepare them effectively for productive and rewarding careers. All FITs should be strongly encouraged to seize these opportunities and position themselves to lead the continuous transformation of cardiovascular medicine.
- Richard A. Chazal, MD, ACC President-Elect ()
RESPONSE: ACC Mentorship: An Abundance of Opportunity
Drs. Sinha and Cullen have thoughtfully articulated many of the opportunities provided by the American College of Cardiology (ACC) for those seeking mentoring in nonclinical competencies. They appropriately point out that these skills are not always formally addressed in training (or in private, academic, and research practices). Their discussion, framed in the context of the ACC Strategic Plan, enumerates multiple ways in which members can leverage the College’s programs to learn from one another.
It is ironic, but also appropriate, that Drs. Sinha and Cullen focus on the ACC strategic plan—inasmuch as the strategic plan was intended to focus on them (1). During the evolution of the plan, many College leaders, particularly (then President-Elect) Patrick O’Gara along with Trustees Bob Harrington and Mike Valentine, strongly endorsed the importance of an emphasis on fellows-in-training (FIT) and early career (EC) members. It was evident to the ACC that an evolution in planning for the future must, by necessity, relate strongly to its future leadership. Appointments of increasing numbers of FIT and EC members to ACC national committees and workgroups reflect this emphasis.
The authors list a number of College programs that provide excellent chances for exposure to experts and mentors. Several of these merit further comment because of their scope, member involvement, and accessibility.
The ACC Board of Governors, led by Drs. Mike Mansour and Bob Shor, has worked diligently to increase the involvement of FIT and EC members in ACC activities. As a result, the number of travel awards for participation in national meetings has continued to grow. The most accessible opportunities for engagement lie with state (or, in the case of international members, national) chapters. Leaders at this level are universally delighted to have the involvement of newer members. The chance for networking, learning, and skill expansion in one’s geographic area is an invaluable resource.
As Drs. Sinha and Cullen point out, “ACC members…have encountered similar obstacles during their professional journeys.” ACC membership sections and councils were specifically developed to allow communities of members with similar interests and issues to have a forum for discussion and communication (2). From sections with a particular clinical focus (interventional, heart failure, and so on) to social/gender communities (Women in Cardiology), opportunities to learn from both leaders and peers abound. (Importantly, one cannot forget the crucial FIT and EC Sections!)
The authors mention 2 annual “nonclinical” meetings. The Cardiovascular Summit is a unique meeting that brings together national leaders involved in health care delivery systems. Symposia are focused on practical solutions, based on both study and experience, with considerable time spent on techniques needed for leadership. The Legislative Conference is a forum exploring best options to improve care delivery on a national level. It also serves as an incubator for those who strive to be involved in health care policy.
The prospects for personal and professional growth from mentoring in the College abound. The challenge for new members, and for all of us, is to best utilize these resources such that the end result is improved care for all of our patients.
- Harold J.,
- O’Gara P.,
- Chazal R.
- ↵American College of Cardiology. Member sections. Available at: http://www.acc.org/membership/sections-and-councils?w_nav=S. Accessed July 14, 2015.
The authors wish to thank the ACC Staff Liaisons, especially Amalea Hijar and Kristin West, for their extraordinary contributions, including their critical review of the manuscript and indispensable contributions to the FIT Section Leadership Council.
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