BMJ Leader最新文献

{"title":"Reading the record: what medicolegal review teaches surgical leaders.","authors":"Alan D Rogers","doi":"10.1136/leader-2026-001663","DOIUrl":"https://doi.org/10.1136/leader-2026-001663","url":null,"abstract":"<p><p>Medicolegal expert witness work is often understood in procedural terms: reviewing records, assessing standard of care, considering causation, preparing reports and, at times, giving testimony. For clinicians, however, this work can also become an unexpected form of leadership education. It offers a distinctive view of adverse outcomes, documentation, uncertainty, accountability and the records that remain after care has been delivered.Drawing on 5 years of medicolegal review in plastic surgery and related areas of complex surgical care, this article reflects on what expert witness work has taught me about surgical leadership. Retrospective review is powerful, but vulnerable to hindsight bias. Clinical records may preserve decision-making, escalation and communication, but may also fail to capture fatigue, ambiguity, urgency and system constraints. Poor outcomes are not always evidence of poor care, and imperfect documentation does not necessarily mean that care was poor.Medicolegal review reinforces the importance of documenting reasoning, building just cultures, supporting clinicians after adverse outcomes, listening carefully to patients and families and examining systems as well as individuals. It reminds surgical leaders that accountability and compassion are not opposites. The fairest assessments of care are independent, evidence-informed, humane and attentive to the realities of clinical practice.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Countermeasures for doctors' leadership handicaps.","authors":"James K Stoller","doi":"10.1136/leader-2025-001519","DOIUrl":"https://doi.org/10.1136/leader-2025-001519","url":null,"abstract":"","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What ancient wisdom and science know about drivers to high performance in organisations.","authors":"Peter Rea, Alan Kolp, James K Stoller","doi":"10.1136/leader-2025-001477","DOIUrl":"https://doi.org/10.1136/leader-2025-001477","url":null,"abstract":"<p><p>First principles are foundational building blocks from which all other knowledge, decisions and actions flow. In medicine, this means starting with the most basic, undeniable reality: the human body seeks homeostasis and healing. Regarding performance and relationships, virtue is the foundational truth that drives excellence. The seven classical virtues are trust, compassion, courage, justice, wisdom, temperance and hope. This perspective cites experiential evidence that adherence to the seven classical virtues drives high performance in organisations including in healthcare. The virtues provide a common language that leaders can espouse to release discretionary effort in their organisation-people will do the right thing when no one is watching. Examples are replete in healthcare. Trust among team members undergirds high performance in the Intensive Care Unit. Surgical outcomes are enhanced when team members know and care for one another, exemplifying compassion. At the same time, virtue-based leadership is not about sainthood. Practising the virtues is a lifelong aspiration and is action-based. It is not a virtue until you act. The perspective offers practical tools by which the virtues can be enacted. Creating a common language of the virtues can cascade awareness through the organisation. Deepening trust by practising gratitude can enhance psychological safety, which is associated with high performance. Finally, defining and weakening restraining forces like pressure to perform, time limitations, focus on short versus long-term actions and fear can then be weakened by integrating virtue habits into daily operations.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From resignation to meaning: leveraging individual purpose to encourage healthcare worker engagement.","authors":"Joel Freibaum, Sharon Smyth, Jonathan Hansen, Arjun Chanmugam","doi":"10.1136/leader-2025-001339","DOIUrl":"https://doi.org/10.1136/leader-2025-001339","url":null,"abstract":"","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of spousal support with career attrition in academic medicine: a multi-specialty cross-sectional survey study.","authors":"Ciara C O'Sullivan, Sarah M Jenkins, Andrea L Hunderfund, Kathryn J Ruddy, Colin P West, Ariela L Marshall","doi":"10.1136/leader-2025-001407","DOIUrl":"https://doi.org/10.1136/leader-2025-001407","url":null,"abstract":"<p><strong>Importance: </strong>Little is known about how factors external to the workplace, such as spousal support, influence physician attrition.</p><p><strong>Objectives: </strong>To explore associations of spousal support among married/partnered physicians with both 'hard' attrition ((HA), considering leaving academic medicine within 2 years) and 'soft' attrition ((SA), having ever considered part-time work), before and after adjusting for demographic variables, burnout and satisfaction with work-life integration (WLI).</p><p><strong>Design: </strong>This cross-sectional survey study was conducted among faculty physicians employed at Mayo Clinic.</p><p><strong>Outcomes and measures: </strong>Survey items measured demographics, spousal support (five items), HA, SA, satisfaction with WLI (single-item measure) and burnout (two-item measure). Check-all-that-apply questions explored reasons for considering attrition. We investigated associations of spousal career support with attrition consideration using logistic regression analyses, adjusting for demographic variables then for WLI satisfaction and burnout.</p><p><strong>Results: </strong>739/2103 physicians responded (response rate 35.1%); 666 (90.1%) were married or partnered and responded to the HA question. 42.5% (283/666) reported considering HA and 60.9% of full-time employees (288/473) had ever considered SA. 65.5% (437/666) considered any attrition (AA). Respondents reporting more frequent spousal career support had lower odds of HA (OR 0.80, 95% CI 0.68 to 0.94, p=0.006), though this was not significant when considering AA (OR 0.85, 95% CI 0.71 to 1.01, p=0.07). Neither association was significant after adjusting for WLI satisfaction and burnout (OR 1.01, 95% CI 0.80 to 1.29, p=0.91 (HA), OR 1.10, 95% CI 0.86 to 1.37, p=0.45 (any attrition)).</p><p><strong>Conclusions: </strong>While spousal support was no longer significantly associated with attrition after adjusting for WLI satisfaction and burnout, it may mitigate attrition.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forming the humanistic leader: a systematic review of arts and humanities in medical education.","authors":"Bibi Sumera Keenoo, Beebee Zeba Mahetaab Mubarak Jan, Veer Prabhakar Choollun","doi":"10.1136/leader-2025-001371","DOIUrl":"https://doi.org/10.1136/leader-2025-001371","url":null,"abstract":"<p><strong>Background: </strong>Arts and humanities (A&H) are increasingly used in medical education to address and mitigate burnout and professional disengagement. While their role in humanising clinical practice is recognised, their impact on leadership development remains insufficiently synthesised.</p><p><strong>Objective: </strong>To systematically review empirical studies evaluating the effects of A&H interventions on undergraduate (UG) and postgraduate (PG) medical learners, focusing on outcomes formation, explicitly linked to leadership awareness, ensuring development, such as ethical decision-making, team management and system awareness, ensuring relevance for educators and policymakers.</p><p><strong>Methods: </strong>This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search of six databases (PubMed, Scopus, ScienceDirect, Directory of Open Access Journals (DOAJ), Education Resources Information Center (ERIC) and Excerpta Medica dataBASE (EMBASE) was conducted for studies published from January 2000 to 15 May 2024. Eligible studies included empirical evaluations of diverse A&H-based interventions, such as literature, visual arts, theatre and narrative ethics, targeting UG or PG medical trainees and measuring leadership-related outcomes.</p><p><strong>Results: </strong>Thirty-two studies were included. Empathy was the most frequently assessed outcome (n=21), with high-certainty evidence supporting improvements from interventions using literature, narrative writing, visual arts and theatre. Visual arts training significantly enhanced diagnostic observation (n=3; Grading of Recommendations, Assessment, Development and Evaluation (GRADE): high). Reflective capacity and professional identity formation were strengthened by literature, narrative and art-based methods (GRADE: moderate). Improvisation and performance-based interventions improved communication and collaboration (n=6; GRADE: moderate). Although underrepresented, A&H interventions also showed early potential in addressing emotional resilience and burnout.</p><p><strong>Conclusions: </strong>A&H interventions contribute meaningfully to developing leadership competencies in medical education, especially empathy, ethical reflection and identity formation. Their integration into curricula can be a strategic step toward cultivating humanistic clinical leaders.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the NHS and having a family.","authors":"Chloe Matthews, Amy Broad, Sahrash Andleeb, Sarbjit Clare, Laura Pearson","doi":"10.1136/leader-2025-001338","DOIUrl":"https://doi.org/10.1136/leader-2025-001338","url":null,"abstract":"<p><strong>Introduction: </strong>The proportion of women entering UK medical schools has increased rapidly, with women now making up 60% of students. The changing gender composition of the medical workforce brings to the forefront the National Health Service's (NHS) need to adapt to help women thrive in the workplace.</p><p><strong>Methods: </strong>Our Women's Clinical Network organised a free Trust-based half-day event called 'Navigating the NHS and Having a Family', open to all doctors of any gender, grade and specialty, with presentations on topics including NHS family leave entitlements and less than full-time training. Pre-event and post-event surveys collected qualitative and quantitative data.</p><p><strong>Results: </strong>Pre-event, we identified a lack of knowledge regarding family leave entitlements and processes. A quarter of attendees felt it possible to have a great career and a family, pre-event. This rose to over three-quarters, post-event. We also demonstrated improved knowledge on how to navigate the NHS and have a family post-event.</p><p><strong>Discussion: </strong>Changes need to be made to ensure clinicians make informed decisions when planning a family. Our half-day information session highlighted one relatively simple way in which this can be addressed. Integrating events such as ours will help disseminate information effectively and with lasting impact.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate change and the operating room: perceptions of orthopaedic surgeons on environmental sustainability.","authors":"Cameron Nosrat, Aidan Foley, Ryan T Halvorson, Ishaan Swarup","doi":"10.1136/leader-2025-001473","DOIUrl":"https://doi.org/10.1136/leader-2025-001473","url":null,"abstract":"<p><strong>Purpose: </strong>Orthopaedic surgery has a significant environmental impact, yet limited research has explored the perspectives of orthopaedic surgeons and trainees regarding operating room (OR) sustainability. The OR contributes extensively to healthcare waste, energy consumption and greenhouse gas emissions, underscoring the need for innovative solutions to address these challenges. The purpose of this study is to assess current sustainable OR practices, attitudes and barriers to sustainability within orthopaedic surgery.</p><p><strong>Methods: </strong>A 36-question survey addressing demographics, climate beliefs, OR sustainability attitudes, practice patterns and educational exposure was distributed across five US orthopaedic surgery programmes. Responses were analysed using χ² and analysis of variance tests to evaluate differences by age group, training level, fellowship type and geographic region.</p><p><strong>Results: </strong>92 participants completed the survey. While almost all respondents (98.9%) believed climate change is occurring, fewer believed human actions can meaningfully alter its course (64.4%) or that OR waste is a major contributor to the crisis (46.0%). Most respondents (79%) considered reusing single-use devices, but less than 3% factored in life cycle assessments when making decisions, and only 21% considered environmental impact when ordering imaging.Although respondents identified significant opportunities to reduce OR waste and improve environmentally friendly practices at their institutions, few expressed satisfaction with current efforts, and 79% were unaware of any existing plans for improvement. Barriers included lack of incentives (79%), cost (62.9%) and insufficient knowledge (62.9%). Notably, respondents emphasised the need for formal education on sustainability within orthopaedic training programmes.</p><p><strong>Conclusion: </strong>Orthopaedic surgeons and trainees recognise the need for better OR sustainability practices but face systemic barriers to progress. Addressing these gaps through institutional support, cost-effective strategies and targeted education could significantly reduce environmental impacts in orthopaedic surgery.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seven 'E's of leadership: reflections from clinical practice to global public health.","authors":"Douglas J Noble","doi":"10.1136/leader-2025-001443","DOIUrl":"https://doi.org/10.1136/leader-2025-001443","url":null,"abstract":"<p><p>Leadership is shaped by personal and organisational narratives and lived experience. This reflection considers lessons from over two decades across medicine, public health and emergencies. Seven themes emerge which I describe as the 'seven E's of leadership': Existential, Empathy, Exploration, Embeddedness, Emergency, Environmental Attunement and Encouragement. Each arose from practice, including early encounters with mortality, exploring non-traditional career paths, grounding leadership on the frontline, learning in the face of emergencies, adapting to new contexts and encouraging teams in uncertain times. These are presented as a framework that is intended to be self-reflective and practical. Each is explored in terms of why it matters, what it means, how to cultivate it and the challenges that can arise. The 'seven E's' offer a way of understanding how leaders can remain purposeful, adaptive and empathetic in times of complexity and change.</p>","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging the <i>BMJ Leader</i> to grow a healthcare management and leadership praxis in Africa.","authors":"Pugie Chimberengwa, Shrikant M Peters, Hargovan Mumta, Jibril Bello, Uba Dennis, Jamiu O Busari, Brian Chirombo","doi":"10.1136/leader-2026-001541","DOIUrl":"https://doi.org/10.1136/leader-2026-001541","url":null,"abstract":"","PeriodicalId":36677,"journal":{"name":"BMJ Leader","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}