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Purpose To determine whether a brief leadership curriculum including high-fidelity simulation can improve leadership skills among resident physicians. Method This was a double-blind, randomized controlled trial among obstetrics–gynecology and emergency medicine (EM) residents across 5 academic medical centers from different geographic areas of the United States, 2015–2017. Participants were assigned to 1 of 3 study arms: the Leadership Education Advanced During Simulation (LEADS) curriculum, a shortened Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum, or as active controls (no leadership curriculum). Active controls were recruited from a separate site and not randomized to limit any unintentional introduction of materials from leadership curricula. The LEADS curriculum was developed in partnership with the Council on Resident Education in Obstetrics and Gynecology and Council of Residency Directors in Emergency Medicine as a novel way to provide a leadership toolkit. Both LEADS and the abbreviated TeamSTEPPS were designed as six 10-minute interactive web-based modules. The primary outcome of interest was the leadership performance score from the validated Clinical Teamwork Scale instrument measured during standardized high-fidelity simulation scenarios. Secondary outcomes were 9 key components of leadership from the detailed leadership evaluation measured on 5-point Likert scales. Both outcomes were rated by a blinded clinical video reviewer. Results One hundred ten obstetrics–gynecology and EM residents participated in this 2-year trial. Participants in both LEADS and TeamSTEPPS had statistically significant improvement in leadership scores from “average” to “good” ranges both immediately and at the 6-month follow-up, while controls remained unchanged in the “average” category throughout the study. There were no differences between LEADS and TeamSTEPPS curricula with respect to the primary outcome. Conclusions Residents who participated in a brief structured leadership training intervention had improved leadership skills that were maintained at 6-month follow-up.

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INTRODUCTION: Enhanced recovery after surgery (ERAS) pathways have decreased postoperative pain and shortened hospital stays. This quality improvement project at a tertiary care academic medical center sought to implement an ERAS pathway for patients undergoing minimally invasive hysterectomy (MIH) for benign indications and evaluate perioperative outcomes. METHODS: Consecutive patients managed under an ERAS protocol (implemented June 1, 2016) undergoing MIH for benign indications from August 1-October 31, 2016 were compared to consecutive historical controls (August-October 2015). Demographic, operative, and clinical information was abstracted. Descriptive statistics and bivariate analyses were performed. RESULTS: There were 41 procedures performed by 15 surgeons pre-ERAS intervention and 47 performed by 18 surgeons post-ERAS implementation. There was no statistical difference between the groups by age, race, insurance status, ASA class, or BMI. After ERAS implementation, the percentage of patients discharged by noon increased (14.6 to 36.2%, P= .022) with a significant difference in length of stay (P=.029). The use of patient controlled analgesia (PCA) decreased from 51.2 to 10.6% (P<.001). Postoperative narcotic use decreased significantly with a reduction in intravenous oral morphine equivalents (OME) from a median of 5mg (SD 0-25mg) to 0mg (SD 0-4 mg) [P<.001] and in median total OME from 45mg (SD 25-128.5mg) to 24mg (SD 5-48mg) [P<.001]. There was no significant change in postoperative complications or readmissions. CONCLUSION: An ERAS pathway quality improvement initiative for benign MIH can be effectively implemented at a large academic center. Our quality improvement program resulted in improved postoperative recovery outcomes and a significant reduction in post-operative narcotic usage.

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