LAUSR

D ear editor, As current and former general internal medicine (GIM) fellows, we read with great interest Dr. Essien and colleagues’ updated guide to a successful GIM fellowship. Throughout their manuscript, the authors present in well-described detail the tenets necessary for a successful GIM fellowship. However, we propose a sixth tenet necessary for successful GIM fellowship training, leadership development, may be missing. The authors highlight that various leadership positions in both academia and health systems are filled by GIM fellows upon completion of their fellowship. We agree as we have both filled those roles ourselves. However, in their recommended timeline, the authors propose coursework in academic leadership during the second half of the second year of fellowship. We posit that leadership training at that point in time and of that short duration may be too little, too late. If leadership development is not explicitly included within GIM fellowship curricula, it may be assumed that physicians enter their fellowships with the requisite skills for the various leadership roles they fill after graduation. Unfortunately, this may not be the case. While the majority of published leadership curricula are within primary care specialties (graduates from which faculty development fellowships are traditionally comprised), these curricula are limited in both number and effectiveness. Given the heterogeneity of GIM fellowships, the tenet of leadership development may take various forms. Internal leadership training sessions should be organized and led by division chiefs, department chairs, deans, and program directors. Departmental support should be offered for external leadership development through specialty societies or physician leadership organizations. The formal leadership coursework proposed in the authors’ editorial may be supplemented with Massive Open Online Courses (MOOCs), especially if obtaining departmental funding for university classes proves difficult. The relatively small number of GIM fellows matriculating each year lends itself well to program individualization. Finally, any leadership curriculum that is implemented should ideally be longitudinal to ensure optimal effectiveness. Now more than ever, as many of us find ourselves thrust into new leadership roles, it is imperative that we hold the knowledge, skills, and attitudes of a successful leader. On the job training may not suffice. With the likelihood of future leadership roles for graduating GIM fellows, coupled with inconsistent leadership entry skills, inclusion of leadership development as a main theme of GIM fellowship training is a must! Sincerely, Benjamin Vipler Division of General Internal Medicine Penn State Hershey Medical Center Ami DeWaters Division of Hospital Medicine Penn State Hershey Medical Center