Qualitative study identifying leadership challenges encountered in real-world scholarly projects within a faculty development program

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Mancuso This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8801288/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Faculty development programs often incorporate structured pieces of academic work, i.e. action learning projects, to provide participants with experiential learning while also addressing real world problems. The Leadership in Academic Medicine Program (LAMP), a faculty development program at Weill Cornell Medicine, contains a project expectation, i.e. a capstone, that culminates in submission of a final written abstract. This study analyzed LAMP capstone abstracts to characterize the scope of projects undertaken, and to identify common leadership challenges encountered by faculty participants during execution of their project. Methods This retrospective qualitative review was performed on abstracts submitted between 2017–2025. Two investigators discerned unique challenges described in the project abstracts and labelled them as concepts. Similar concepts were clustered into categories, and categories were clustered into themes. Frequencies of concepts were calculated to identify top themes; projects were additionally classified by scholarly type, e.g. research, education, clinical. Results There were 294 abstracts, 42% categorized as research, 37% as clinical quality improvement, and 22% as education. Over time, there was a shift towards more quality improvement (22% to 40%) and education projects (9% to 37%). The authors coded 133 unique concepts, occurring 784 times. Concepts were clustered into 26 categories and from these categories, 6 overarching themes representing leadership challenges were identified: 1) collaborate across area, 2) engage stakeholders, 3) develop something new, 4) negotiate resources, 5) respond to a problem, and 6) change existing culture. Conclusions Identification of six prevalent leadership challenges confronted by faculty during execution of distinct types of capstone projects provides unique insights to the needs of faculty leaders, assists with data driven improvements to the LAMP curriculum, and offers guidance to other academic faculty development programs. Leadership development leadership challenges action learning project capstone project Figures Figure 1 Figure 2 Figure 3 Background Leadership is the foundational driver of organizational effectiveness in academic medical centers, influencing health care quality, scientific advancement, and workforce engagement. 1 – 3 Leadership development is challenging because medical leaders need to balance personal and organizational goals, respond to the interests of evolving health systems as well as higher educator sectors, comply with regulatory standards, navigate financial constraints, adapt to technological advancements, and promote a diverse and inclusive workforce. 4 , 5 Consequently, institutions invest significantly in leadership development, often as major components of faculty development programs. 6 , 7 Faculty development programs have been shown to be effective in improving participant knowledge, skills, self-efficacy, scholarship, academic promotion and acquisition of leadership roles as well as through positive impacts on organizations and patient care. 8 – 12 Successful faculty development programs are often characterized by three essential components: 1) a curriculum that uses multiple learning methods such as seminars, role plays, and reflective exercises 2) opportunities for individualized mentorship, coaching and feedback, and 3) action learning projects that allow for experiential learning and deliberate practice. 10 , 13 , 14 Action learning projects are structured pieces of academic work that offer participants an opportunity to address real-world challenges. When embedded in faculty development programs, they are a meaningful way to apply classroom concepts, and when coupled with mentorship, create a space for reflection, feedback, and growth. Use of projects for learning is consistent with conceptual frameworks on leadership development that espouse applied practice, supportive networks and real time feedback as critical elements for leadership competency. 15 Systematic reviews of leadership development programs reveal that 37% to 68% utilize projects, either individual or group, 8,10,12,16 and programs that include a project expectation are more often associated with participant achievements, e.g. publication or promotion, and organizational outcomes, e.g. patient satisfaction, cost savings, improved working environments. 11 , 12 In surveys, faculty report that projects ground curricular lessons, enhance personal accountability, improve their institutional visibility, 17 and overall had three major effects on their professional lives: 1) produced a tangible outcome, 2) helped them with a career focus, and 3) established new relationships and networks. 18 At our institution, we offer a faculty development program called the Leadership in Academic Medicine Program (LAMP). Aimed at early career faculty who serve or are preparing to serve in leadership roles, it enrolls approximately 36 participants annually, and to date has graduated over 400 faculty. Outcomes from previous LAMP cohorts show improvements in participant’s self-ratings across a variety of competencies, as well as an increased rate of academic promotion and retention of participants at the institution. 19 , 20 To enroll in LAMP, interested participants respond to an institution-wide announcement, submit an application which includes a nomination letter from a sponsor, often the division chief or department chair, attesting their trajectory as a leader. The program meets one afternoon monthly over the course of an academic year (September to June) and incorporates the essential elements of a mature leadership development program; an interactive curriculum, a capstone project and small mentoring groups. The curriculum includes seminars on self-awareness, career planning, academic skills such as scientific writing and oral presentations, and core leadership competencies such as negotiating, supervising, and managing conflict. The capstone project is an academic assignment designed to align with professional objectives, that addresses a real-world clinical, scientific, or education problem encountered in their work environments. It is also an opportunity for participants to apply lessons from the seminars, e.g., secure a mentor, balance competing priorities, and negotiate resources. The small mentor groups utilize senior leaders in the college as well as participant peers to provide reflection, coaching, and feedback on project and career challenges. In the final session of LAMP, all participants give oral presentations of their capstone projects and submit written summaries, i.e., 1 page capstone abstracts, that are bound and distributed to class participants and their sponsors. To better understand the scope of projects that LAMP participants engaged in, and to glean understanding of common leadership challenges that participants confronted in the pursuit of their projects, we undertook an in-depth analysis of these abstracts. We hypothesized that the capstone abstracts would provide a nuanced view of real-world leadership challenges that participants faced while carrying out their scholarly, institutional work. Identified challenges could then be used to broaden the LAMP curriculum to more directly address anticipated leadership challenges during scholarly work. Methods This retrospective review was performed on the capstone abstracts submitted by LAMP faculty between 2017 and 2025. Data acquisition One investigator (CM), experienced in qualitative data analysis and not a member of the LAMP faculty, reviewed all abstracts to glean leadership-related challenges faced by LAMP participants during their scholarly work. This investigator discerned unique challenges (e.g. gaining administrative support to implement a practice guideline, obtaining funding for a project, assembling a team of collaborators from different medical disciplines), labelled them as concepts, and then assigned a specific code to each concept. Multiple concepts (and their respective codes) were assigned per capstone abstract to reflect the multiple challenges described for each project. Another investigator (JT), who is the LAMP program director, independently reviewed all abstracts, confirmed proposed concepts and added new concepts to capture additional nuances. The first investigator (CM) then reviewed these additional concepts to provide consensus. Finally, the investigators clustered similar concepts (e.g. negotiate for additional clinic staff and negotiate for clinic space) into categories (e.g. negotiate for clinical resources) and then clustered similar categories (e.g. negotiate for clinical resources and negotiate for research funding) into overarching themes (e.g. negotiate resources). Projects were additionally categorized into topic areas, e.g., research, education, and clinical quality improvement (QI). Participants’ demographic information (e.g. department, academic rank, gender, degree, and years since terminal degree) was obtained from information provided by participants at the time of their program enrollment and from institutional databases. All data were de-identified and aggregated before analysis. Data analysis Descriptive statistics were used to report demographic information and year of participation. Frequencies of concepts were calculated and reported as overall, and by project topic area. Analyses were carried out in SAS 9.1. Ethics Data from the LAMP program, including participant information, surveys, and capstone abstracts, were collected primarily for internal programmatic quality improvement. The Institutional Review Board at Weill Cornell Medicine determined the study protocol (#23-09026453) to analyze program data retrospectively qualified for exemption due to minimal risk, waiving the requirement for informed consent. Results We identified 294 capstone abstracts submitted by LAMP participants from 9 consecutive years (2017 through 2025). The number of participants per year ranged from 23 to 37. Most participants were women (n = 200, 68%), physicians (n = 223, 86%), and at the assistant professor rank (n = 241, 82%). The range of years from the terminal degree to enrollment in LAMP was 2 to 28 with a median of 8 years (Table 1 ). Table 1 Demographic Characteristics of Leadership in Academic Medicine (LAMP) Participants Characteristic Participants (N = 294) Gender Women 200 (68%) Academic degree MD only 189 (64%) MD + other* 65 (22%) PhD only 32 (11%) MS only 8 (3%) Academic rank Instructor 38 (13%) Assistant Professor 241 (82%) Associate Professor 8 (3%) Staff 6 (2%) Time from terminal degree to enrollment in LAMP Median (yrs) 8 Range (yrs) 2–28 *Additional graduate degrees (e.g. PhD, MA, MBA, MS, MPH, MsEd, MPhil) Three scholarly topic areas were discerned from the range of work described in the abstracts: education, research, and clinical quality improvement. Projects were most often categorized as research (n = 123, 42%), followed by quality improvement (n = 107, 37%) and finally education (n = 64, 22%). When assessed according to year of enrollment, the proportion of education and quality improvement projects increased (9% to 37% and 22% to 40%, respectively) over the 9-year period, while the proportion of research projects decreased (69% to 23%) (Fig. 1 ). With regards to leadership challenges that were gleaned from the capstone abstracts, we coded 133 unique concepts, occurring 784 times across the 294 abstracts. We clustered the 133 unique concepts into 26 categories and then into 6 overarching themes (Table 2 ). We calculated the frequencies of concepts across the 6 overarching themes to identify the most frequent or top themes (Fig. 2 ). These were 1) collaborate across areas (n = 247, 30%), 2) engage stakeholders (n = 175, 22%), 3) develop something new (n = 132, 17%), 4) negotiate resources (n = 87, 11%), 5) respond to a problem (n = 85, 11%) and 6) change existing culture (n = 57, 7%). Table 2 Final overarching themes from some selected concepts THEMES SELECTED CONCEPTS 1. Collaborate across areas Collaborate across different clinical teams Collaborate across disciplines for education initiatives Collaborate with different institutional research personnel Collaborate across institutions and organizations 2. Engage stakeholders Get stakeholder buy-in for new or revised clinical initiatives Get stakeholder buy-in for new educational program Get stakeholder agreement to reduce or modify existing activities Get institutional leadership to support or drive change Get faculty to agree to new protocols, systems, assignments 3. Develop something new Design or expand a curriculum or educational program Establish or enhance a clinical service or patient registry Develop and implement new clinical protocols or practice guidelines Design and conduct a series of related research studies 4. Negotiate resources Redirect or optimize use of existing institutional resources Negotiate personnel and space for clinical initiatives Secure funding and support for research initiatives Address shortages in educational infrastructure Negotiate upgrades to technical or electronic systems 5. Respond to a problem Address deficiency in learner skills Address gap in clinical quality or safety Comply with an accreditation, policy, or regulatory mandate 6. Change culture Address faculty burnout, dissatisfaction, or disengagement Foster a culture of continuous improvement Overcome organizational setbacks When analyzed by the project topic area, some differences in the top themes emerged (Fig. 3 ). Collaborate across area was the most prevalent challenge seen across research projects (n = 130, 71%) followed by negotiate resources (n = 27, 14%). In quality improvement projects, engage stakeholders (n = 94, 27%) was the most prevalent challenge, followed by collaborate across area (n = 86, 24%). Engage stakeholders (n = 73, 30%) was also identified as the top challenge for educational projects, with develop something new (n = 58, 24%) as the next most frequently encountered challenge. The specific leadership challenges described by the faculty participants ranged widely, and here we provide illustrative examples across the six overarching themes: Collaborate across areas : Project activities that required collaborating across areas included the “need to gain access to biological samples from another department”, “partner with colleagues in technology to change electronic infrastructures”, “engage nurses on new mandates that altered their workflow”. Challenges occurred when faculty crossed disciplines, departments, or encountered different operational or financial structures. In one project, a LAMP participant described, “significant cross-area collaboration challenges across multiple research departments and institutes...with integrating investigators from diverse fields, including neurology, radiology, pathology, and biomarker discovery... to find alignment on technical standards, data-sharing protocols, and equitable access to the new core facility.” Engage stakeholders : Getting buy-in or agreement from a variety of stakeholders was critical to successful execution of many projects, whether that be the need to “get approval from practice administrators for new clinical protocols”, or “convince course leaders to add curricula to existing educational programs”. One faculty member articulated trying to get buy-in from multiple members of hospital teams to achieve her project goal of increasing hospital discharges before noon. She wrote, “Maintaining engagement across all disciplines proved difficult over time. As participation and communication declined, discharge rates before noon decreased. Re-engaging key stakeholders temporarily improved outcomes, showing that sustained success depends on continued teamwork, clear accountability, and consistent leadership support. Ongoing collaboration and regular feedback were seen as essential to make early discharge practices sustainable.” Develop something new : Creating novel programs was another common project focus amongst the LAMP faculty. “New guidelines to standardize clinical care”, “new curriculum to fill knowledge gaps”, and “new systems to verify competency” were examples of efforts undertaken by LAMP faculty. Such initiatives required needs assessments, targeted innovations, time, and space for implementation, which challenged the faculty. In one project, a new curriculum for nurses to address their unfamiliarity with pediatric patients was developed in the emergency department. This physician described, Developing the new curriculum required identifying knowledge gaps, selecting key pediatric topics, and finding time for training while balancing clinical duties. In addition, securing IRB approval and ensuring participation also presented challenges. Negotiate resources : Project activities often required faculty to navigate institutional structures to obtain needed support and resources. Participants described working to “secure or negotiate funding” for their research, “address shortages in the educational infrastructure”, or “find staff to carry out the workflow”. In one example, a faculty member highlighted challenges in securing multiple types of resources for a project that provided access to palliative care at an affiliate hospital. He shared, “We identified several structural, financial and operational barriers to program implementation, including institutional financial buy-in… securing sustainable funding… ensuring adequate resources and personnel. Considerations included a stand-alone vs. co- located clinic… telemedicine visit capabilities… specific provider/ancillary staffing… to define the palliative care practice scope.” Respond to a problem : Many projects were launched to address pressing institutional or external needs, such as a “critical gap in trainee skills”, “a necessary pivot during the pandemic”, and a response to “changes to accreditation mandates.” In each case, faculty framed their work as a direct solution to an identified problem requiring timely action. One project described the urgent need to develop an integrated, ophthalmology internship after changes to Accreditation Council for Graduate Medical Education (ACGME) requirements. The faculty wrote, Beginning in 2021, the ACGME requires programs to integrate three months of ophthalmology training within the internship...few guidelines exist on how to fulfill this requirement. Our goal was to design an integrated internship from the ground up...negotiating rotation dates and shift numbers... balancing inpatient and outpatient components...for the inaugural class by July 1, 2021. Change existing culture : Projects in this theme sought to influence norms and practices by addressing a challenge within the existing institutional culture, e.g., “positively affect the motivation and meaning of work”, promote practices that “foster a culture of continuous improvement”, and “create a culture in which projects are valued”. In one example, a participant shared the challenge of implementing an updated Hepatitis B vaccination protocol by shifting work from physicians to nurses, As of 2017, the American Academy of Pediatrics officially changed guidelines to implement the Hepatitis B vaccine within 24 hours of life… Previously, physicians were tasked with obtaining consent for the vaccine… in the new protocol, nurses are authorized to take over this procedure…While this practice has been in effect for over a year... adoption has been slower than expected, a culture shift we needed to address. These illustrative examples demonstrate the prevailing challenges that spanned the range of projects experienced by participants in our faculty development program. Discussion Early career leaders are engaged in a wide spectrum of scholarly work, as evidenced by the breadth of abstracts submitted by the faculty enrolled in the Leadership in Academic Medicine Program. Projects, over nine years of the program, spanned efforts in research (42%), clinical quality improvement (37%), and education (22%). Our analysis revealed a shift of project focus, in more recent years, to education (from 9% to 37%) and quality improvement (from 22% to 40%), with corresponding decreases in research (from 69% to 23%). Our main study finding was the 6 overarching themes that emerged from the 784 concepts identified within the abstracts. These 6 themes, representing challenges most frequently confronted by faculty leaders conducting scholarly projects, were collaborating cross area (30%), engaging stakeholders (22%), developing something new (17%), negotiating for resources (11%), responding to a problem (11%) and changing existing culture (7%). Our study additionally revealed that there were similarities and differences in the top challenges by project type. Cross area collaboration was a challenge in 71% of research projects with resource negotiation, a distant second at 14%, a little surprising given the constant strain on investigators to secure research support and funding. In quality improvement projects, stakeholder engagement (27%) and cross area collaboration (24%) were reported as primary challenges, highlighting the complexity of interdisciplinary interactions necessary for patient care. Leading challenges for educational projects also included stakeholder engagement (30%), but developing something new (24%) showed up within the top 2, underscoring the importance of innovation in education. These findings offer guidance to leadership development programs in academic institutions, especially those that include action learning projects as a component of their structure. For LAMP, the findings provide the data to drive specific curricular and structural improvements. For example, the program currently fosters cross area collaboration through its deliberate enrollment of faculty from different backgrounds and disciplines. The smaller mentor groups are also strategically composed of individuals from different departments but with similar scholarly interests. The hope is that these arrangements foster cross-area collaborations; however, our results reveal that the challenges of collaborating with people from unfamiliar work areas need even more explicit addressing. Specific lessons on identifying and reconciling differences could be incorporated into the current seminar on working within teams. The program could also more explicitly encourage participants to engage in shared capstone efforts, allowing for potential differences and disagreements to be negotiated under supervised mentorship. Another improvement to add involves the senior mentors paired with each small group. Currently, the mentors are provided with loose guidance on how to facilitate advancement of capstone projects. A “mentors guide” can be constructed from the overarching themes to help mentors coach participants on foreseeable project challenges. For example, senior mentors can receive instruction on an exercise in stakeholder identification, e.g. who is needed for this project to advance, what motivation does this person have to advance or to stall the project, what area of alignment can be found to better engage this stakeholder. Finally, this study provides awareness that LAMP faculty are increasingly engaged in education and quality improvement work, two scholarly pursuits that participants might need additional skills in. We can incorporate resources, i.e. other coursework or programs, pertaining to curriculum development and QI skillsets in the session on promotional pathways (specifically in clinical innovation and education leadership). The findings from this study deepen the existing body of knowledge on action learning projects within faculty development programs. With respect to types of projects, our study revealed research as the leading endeavor that participants engaged in, consistent with the findings of one national obstetrics and gynecology education leadership program where 56% of participants conducted research, 34% designed curriculum, and 12% performed quality improvement. 21 However, over time, the focus of our participants’ projects shifted to clinical quality improvement and education. This might reflect a growing recognition that physicians are expected to lead in quality improvement, 22 or that quality improvement and education innovations are increasingly counted as scholarship at academic medical centers. 23 At our medical campus, this shift could also reflect new faculty development offerings directed at the research faculty, resulting in greater selection of LAMP by participants engaged in education or clinical QI. This study's identification of the six overarching challenges experienced by faculty leaders adds to our prior research that leaders experience greatest discomfort in the following leadership competencies: negotiation, balancing competing demands and managing conflict. 19 , 20 Negotiation skills are needed in resource procurement and for navigating cross-area collaboration. Conflict management is often a necessary component of stakeholder engagement and culture change. And addressing competing demands is an important skill for developing new initiatives and responding to urgent problems. Cross-walking needed leadership development skills to ameliorate our identified leadership challenges is one strategy for faculty development designers. This study is unique in its discernment of the challenges experienced by faculty leaders pursuing scholarly work. Prior studies addressed general barriers to physician leadership or completion of scholarly projects. For example, one study interviewed 77 leaders about barriers in their work environment to effective leadership and identified systems issues such as bureaucratic silos, non-systemic selection of leaders, negative or close-minded culture, and lack of resources as main impediments. 24 Another study interviewed 54 participants enrolled in an offsite faculty development program about challenges they experienced in implementing their projects back at home; this analysis revealed competing responsibilities, lack of protected project time, and limited resources as barriers to successful completion of their projects. 25 Both studies identified predominantly structural issues that are out of scope for leadership development programs to affect. In contrast, our study offers a project-centered, multi-year analysis of challenges faced by 294 early career faculty; it draws from 784 occurrences of challenges described within participants’ scholarly abstracts to identify six overarching themes that reflect practical and skill-based obstacles. These challenges are unique in that they arise within day-to-day execution of scholarly work, represent competencies that map to existing leadership models for health care, 26 and when addressed in the course of projects mentored within a leadership development program, represent best practice in leadership training. 27 Furthermore, in examining challenges across three distinct types of scholarly initiatives, and highlighting shifts in project focus over time, this study provides unique insights that are not found in prior literature. These features offer a distinct contribution by identifying practical and training-focused skills, highlighting how leadership challenges can differ by type of scholarly initiative, and offering concrete guidance for other leadership development programs seeking to prepare for the needs of future academic leaders. Our study had several limitations. The analysis was conducted on a convenience sample of available abstracts across 9 years of a single program, limiting its generalizability to other faculty development programs or faculty scholarly projects. The participants were not asked to address encountered challenges explicitly in their capstone summaries; these concepts and themes were gleaned by the investigators from project descriptions which varied greatly by abstract author. Research abstracts that followed a more traditional scientific template may have contained fewer descriptions about barriers, leading to potential underestimation of identified challenges across the research projects. Future studies can advance this body of work by directly querying participants about the barriers they faced while executing their project, and how the program helped or could help to overcome those barriers. Conclusions In summary, we identified six overarching challenges, that varied by project type, confronted by faculty conducting projects in a faculty development program: 1) collaborating across-areas, 2) engaging stakeholders, 3) developing something new, 4) negotiating resources, 5) responding to a problem and, 6) changing the existing culture. These insights provide guidance on practical additions to faculty development leadership programs that better support faculty leaders conducting scholarly work. Abbreviations LAMP Leadership in Academic Medicine Program QI Quality Improvement ACGME Accreditation Council for Graduate Medical Education Declarations Ethics approval and consent to participate: Data from the LAMP program, including participant information, surveys, and capstone abstracts, were collected primarily for internal programmatic quality improvement. The Institutional Review Board at Weill Cornell Medicine determined the study protocol (#23-09026453) to analyze program data retrospectively qualified for exemption due to minimal risk, waiving the requirement for informed consent. The study was conducted in compliance with the ethical principles outlined in the Declaration of Helsinki. Consent for publication : Not applicable Competing interests: The authors have no relevant financial or non-financial interests to disclose. Author contributions All authors contributed to the study conception and design and to drafting or reviewing the work critically for intellectual content. JT and CAM conceived and designed the study, acquired, and interpreted the data, drafted, and wrote the manuscript. AA acquired and interpreted the data and edited the manuscript. All authors approved the final version of the manuscript, consent for publication, and agree to be accountable for all aspects of the work. Funding: The study was supported by the Office of Faculty Development and the Department of Medicine, Weill Cornell Medicine and Hospital for Special Surgery. Author Contribution All authors contributed to the study conception and design and to drafting or reviewing the work critically for intellectual content. JT and CAM conceived and designed the study, acquired, and interpreted the data, drafted, and wrote the manuscript. AA acquired and interpreted the data and edited the manuscript. All authors approved the final version of the manuscript, consent for publication, and agree to be accountable for all aspects of the work. Acknowledgments: The authors would like to acknowledge the Office of Faculty Development for their support of the Leadership in Academic Medicine Program and the LAMP participants for their insights, engagement and steadfast efforts. Data Availability The datasets generated and/or analyzed for this study are not publicly available due to the local and proprietary nature of the data, but are available from the corresponding author on reasonable request. References Sfantou DF, Laliotis A, Patelarou AE, Sifaki-Pistolla D, Matalliotakis M, Patelarou E. Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthc (Basel). 2017;5(4):73. Dyrbye LN, Major-Elechi B, Hays JT, Fraser CH, Buskirk SJ, West CP. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8801288","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":594578488,"identity":"0211d953-53de-455c-9ec4-91f4e4cd87d3","order_by":0,"name":"Judy Tung","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBACxgYGxgcJBv/kgGwDiBA7cwMDAxs+LczMBh8qDhgjtDAz4tcCVMEmOePMgcQGorUwz8g/Js3bdid9bXvzBoYfFffy+EFaPpQdxu2wGcnM1rxtz3K3nTlWwNhzprhYspmxgXHGObxaGG/ztjHnbruRY8DM2JaQuOEw0H+8bXi1MAAdxpxudv8NRMt+kJa/+LUwAb1/OMHsBg/UFqBfgAw8WnoeGwMDOc1w25m0goM9ZxISZwBtOdhzLh2nFsP2xIfAqLSRNzt+eOODHxUJif3tzQcf/Cizxq2lAYlzAIOBDcjjkxwFo2AUjIJRAAYApHZcg8mzqAgAAAAASUVORK5CYII=","orcid":"","institution":"Weill Cornell Medicine","correspondingAuthor":true,"prefix":"","firstName":"Judy","middleName":"","lastName":"Tung","suffix":""},{"id":594578489,"identity":"5fce7097-a6f6-40b2-8698-8d9debe61f24","order_by":1,"name":"Amna Aslam","email":"","orcid":"","institution":"Weill Cornell Medicine","correspondingAuthor":false,"prefix":"","firstName":"Amna","middleName":"","lastName":"Aslam","suffix":""},{"id":594578490,"identity":"9664c419-a5b0-462c-ad3b-ec7948eeacfc","order_by":2,"name":"Carol A. Mancuso","email":"","orcid":"","institution":"Hospital for Special Surgery","correspondingAuthor":false,"prefix":"","firstName":"Carol","middleName":"A.","lastName":"Mancuso","suffix":""}],"badges":[],"createdAt":"2026-02-05 23:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8801288/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8801288/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103321738,"identity":"f6ac1aff-d5fb-4a1b-84cd-1b7dadc917c0","added_by":"auto","created_at":"2026-02-24 12:05:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":106740,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of capstone abstracts by topic area:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEducation, Clinical quality improvement, and Research (N=294)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8801288/v1/fe1594cd839c855ed1bd3aea.png"},{"id":103506197,"identity":"b3ef8478-26de-43ba-b2aa-b10683a319b6","added_by":"auto","created_at":"2026-02-26 13:34:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":101322,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOccurrences of all 784 Concepts across the Top 6 Themes\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8801288/v1/556a16be118535a37a6b06b8.png"},{"id":103321739,"identity":"845f1da5-fc2b-4599-8c49-a82f8db1126e","added_by":"auto","created_at":"2026-02-24 12:05:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":103486,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOccurrences of Concepts across Themes by Project Type\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8801288/v1/3bb3146d332c6624fcaf35c2.png"},{"id":103509754,"identity":"9708c4c5-568e-4bd5-8d44-3d3db43eaf56","added_by":"auto","created_at":"2026-02-26 14:00:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":963035,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8801288/v1/260abe99-ae14-46d1-a326-94c216b99003.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Qualitative study identifying leadership challenges encountered in real-world scholarly projects within a faculty development program","fulltext":[{"header":"Background","content":"\u003cp\u003eLeadership is the foundational driver of organizational effectiveness in academic medical centers, influencing health care quality, scientific advancement, and workforce engagement.\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Leadership development is challenging because medical leaders need to balance personal and organizational goals, respond to the interests of evolving health systems as well as higher educator sectors, comply with regulatory standards, navigate financial constraints, adapt to technological advancements, and promote a diverse and inclusive workforce.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Consequently, institutions invest significantly in leadership development, often as major components of faculty development programs.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFaculty development programs have been shown to be effective in improving participant knowledge, skills, self-efficacy, scholarship, academic promotion and acquisition of leadership roles as well as through positive impacts on organizations and patient care.\u003csup\u003e\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Successful faculty development programs are often characterized by three essential components: 1) a curriculum that uses multiple learning methods such as seminars, role plays, and reflective exercises 2) opportunities for individualized mentorship, coaching and feedback, and 3) action learning projects that allow for experiential learning and deliberate practice.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAction learning projects are structured pieces of academic work that offer participants an opportunity to address real-world challenges. When embedded in faculty development programs, they are a meaningful way to apply classroom concepts, and when coupled with mentorship, create a space for reflection, feedback, and growth. Use of projects for learning is consistent with conceptual frameworks on leadership development that espouse applied practice, supportive networks and real time feedback as critical elements for leadership competency.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Systematic reviews of leadership development programs reveal that 37% to 68% utilize projects, either individual or group,\u003csup\u003e8,10,12,16\u003c/sup\u003e and programs that include a project expectation are more often associated with participant achievements, e.g. publication or promotion, and organizational outcomes, e.g. patient satisfaction, cost savings, improved working environments.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e In surveys, faculty report that projects ground curricular lessons, enhance personal accountability, improve their institutional visibility,\u003csup\u003e17\u003c/sup\u003e and overall had three major effects on their professional lives: 1) produced a tangible outcome, 2) helped them with a career focus, and 3) established new relationships and networks.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAt our institution, we offer a faculty development program called the Leadership in Academic Medicine Program (LAMP). Aimed at early career faculty who serve or are preparing to serve in leadership roles, it enrolls approximately 36 participants annually, and to date has graduated over 400 faculty. Outcomes from previous LAMP cohorts show improvements in participant\u0026rsquo;s self-ratings across a variety of competencies, as well as an increased rate of academic promotion and retention of participants at the institution.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e To enroll in LAMP, interested participants respond to an institution-wide announcement, submit an application which includes a nomination letter from a sponsor, often the division chief or department chair, attesting their trajectory as a leader. The program meets one afternoon monthly over the course of an academic year (September to June) and incorporates the essential elements of a mature leadership development program; an interactive curriculum, a capstone project and small mentoring groups. The curriculum includes seminars on self-awareness, career planning, academic skills such as scientific writing and oral presentations, and core leadership competencies such as negotiating, supervising, and managing conflict. The capstone project is an academic assignment designed to align with professional objectives, that addresses a real-world clinical, scientific, or education problem encountered in their work environments. It is also an opportunity for participants to apply lessons from the seminars, e.g., secure a mentor, balance competing priorities, and negotiate resources. The small mentor groups utilize senior leaders in the college as well as participant peers to provide reflection, coaching, and feedback on project and career challenges.\u003c/p\u003e \u003cp\u003eIn the final session of LAMP, all participants give oral presentations of their capstone projects and submit written summaries, i.e., 1 page capstone abstracts, that are bound and distributed to class participants and their sponsors. To better understand the scope of projects that LAMP participants engaged in, and to glean understanding of common leadership challenges that participants confronted in the pursuit of their projects, we undertook an in-depth analysis of these abstracts. We hypothesized that the capstone abstracts would provide a nuanced view of real-world leadership challenges that participants faced while carrying out their scholarly, institutional work. Identified challenges could then be used to broaden the LAMP curriculum to more directly address anticipated leadership challenges during scholarly work.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This retrospective review was performed on the capstone abstracts submitted by LAMP faculty between 2017 and 2025.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData acquisition\u003c/strong\u003e \u003cp\u003eOne investigator (CM), experienced in qualitative data analysis and not a member of the LAMP faculty, reviewed all abstracts to glean leadership-related challenges faced by LAMP participants during their scholarly work. This investigator discerned unique challenges (e.g. gaining administrative support to implement a practice guideline, obtaining funding for a project, assembling a team of collaborators from different medical disciplines), labelled them as concepts, and then assigned a specific code to each concept. Multiple concepts (and their respective codes) were assigned per capstone abstract to reflect the multiple challenges described for each project. Another investigator (JT), who is the LAMP program director, independently reviewed all abstracts, confirmed proposed concepts and added new concepts to capture additional nuances. The first investigator (CM) then reviewed these additional concepts to provide consensus. Finally, the investigators clustered similar concepts (e.g. negotiate for additional clinic staff and negotiate for clinic space) into categories (e.g. negotiate for clinical resources) and then clustered similar categories (e.g. negotiate for clinical resources and negotiate for research funding) into overarching themes (e.g. negotiate resources). Projects were additionally categorized into topic areas, e.g., research, education, and clinical quality improvement (QI).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eParticipants\u0026rsquo; demographic information (e.g. department, academic rank, gender, degree, and years since terminal degree) was obtained from information provided by participants at the time of their program enrollment and from institutional databases. All data were de-identified and aggregated before analysis.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData analysis\u003c/strong\u003e \u003cp\u003eDescriptive statistics were used to report demographic information and year of participation. Frequencies of concepts were calculated and reported as overall, and by project topic area. Analyses were carried out in SAS 9.1.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics\u003c/strong\u003e \u003cp\u003e Data from the LAMP program, including participant information, surveys, and capstone abstracts, were collected primarily for internal programmatic quality improvement. The Institutional Review Board at Weill Cornell Medicine determined the study protocol (#23-09026453) to analyze program data retrospectively qualified for exemption due to minimal risk, waiving the requirement for informed consent.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e We identified 294 capstone abstracts submitted by LAMP participants from 9 consecutive years (2017 through 2025). The number of participants per year ranged from 23 to 37. Most participants were women (n\u0026thinsp;=\u0026thinsp;200, 68%), physicians (n\u0026thinsp;=\u0026thinsp;223, 86%), and at the assistant professor rank (n\u0026thinsp;=\u0026thinsp;241, 82%). The range of years from the terminal degree to enrollment in LAMP was 2 to 28 with a median of 8 years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of Leadership in Academic Medicine (LAMP) Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants (N\u0026thinsp;=\u0026thinsp;294)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200 (68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMD only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e189 (64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMD\u0026thinsp;+\u0026thinsp;other*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhD only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMS only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic rank\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstructor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (13%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssistant Professor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e241 (82%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate Professor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStaff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime from terminal degree to enrollment in LAMP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange (yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e*Additional graduate degrees (e.g. PhD, MA, MBA, MS, MPH, MsEd, MPhil)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThree scholarly topic areas were discerned from the range of work described in the abstracts: education, research, and clinical quality improvement. Projects were most often categorized as research (n\u0026thinsp;=\u0026thinsp;123, 42%), followed by quality improvement (n\u0026thinsp;=\u0026thinsp;107, 37%) and finally education (n\u0026thinsp;=\u0026thinsp;64, 22%). When assessed according to year of enrollment, the proportion of education and quality improvement projects increased (9% to 37% and 22% to 40%, respectively) over the 9-year period, while the proportion of research projects decreased (69% to 23%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWith regards to leadership challenges that were gleaned from the capstone abstracts, we coded 133 unique concepts, occurring 784 times across the 294 abstracts. We clustered the 133 unique concepts into 26 categories and then into 6 overarching themes (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). We calculated the frequencies of concepts across the 6 overarching themes to identify the most frequent or top themes (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These were 1) collaborate across areas (n\u0026thinsp;=\u0026thinsp;247, 30%), 2) engage stakeholders (n\u0026thinsp;=\u0026thinsp;175, 22%), 3) develop something new (n\u0026thinsp;=\u0026thinsp;132, 17%), 4) negotiate resources (n\u0026thinsp;=\u0026thinsp;87, 11%), 5) respond to a problem (n\u0026thinsp;=\u0026thinsp;85, 11%) and 6) change existing culture (n\u0026thinsp;=\u0026thinsp;57, 7%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal overarching themes from some selected concepts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTHEMES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSELECTED CONCEPTS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e1. Collaborate across areas\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaborate across different clinical teams\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaborate across disciplines for education initiatives\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaborate with different institutional research personnel\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaborate across institutions and organizations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e2. Engage stakeholders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGet stakeholder buy-in for new or revised clinical initiatives\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGet stakeholder buy-in for new educational program\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGet stakeholder agreement to reduce or modify existing activities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGet institutional leadership to support or drive change\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGet faculty to agree to new protocols, systems, assignments\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e3. Develop something new\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDesign or expand a curriculum or educational program\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEstablish or enhance a clinical service or patient registry\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDevelop and implement new clinical protocols or practice guidelines\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDesign and conduct a series of related research studies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e4. Negotiate resources\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRedirect or optimize\u0026nbsp;use of existing institutional resources\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegotiate personnel and space for clinical initiatives\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecure funding and support for research initiatives\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAddress shortages in educational infrastructure\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegotiate upgrades to technical or electronic systems\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e5. Respond to a problem\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAddress deficiency in learner skills\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAddress gap in clinical quality or safety\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComply with an accreditation, policy, or regulatory mandate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e6. Change culture\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAddress faculty burnout, dissatisfaction, or disengagement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFoster a culture of continuous improvement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOvercome organizational setbacks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWhen analyzed by the project topic area, some differences in the top themes emerged (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Collaborate across area was the most prevalent challenge seen across research projects (n\u0026thinsp;=\u0026thinsp;130, 71%) followed by negotiate resources (n\u0026thinsp;=\u0026thinsp;27, 14%). In quality improvement projects, engage stakeholders (n\u0026thinsp;=\u0026thinsp;94, 27%) was the most prevalent challenge, followed by collaborate across area (n\u0026thinsp;=\u0026thinsp;86, 24%). Engage stakeholders (n\u0026thinsp;=\u0026thinsp;73, 30%) was also identified as the top challenge for educational projects, with develop something new (n\u0026thinsp;=\u0026thinsp;58, 24%) as the next most frequently encountered challenge.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe specific leadership challenges described by the faculty participants ranged widely, and here we provide illustrative examples across the six overarching themes:\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCollaborate across areas\u003c/span\u003e: Project activities that required collaborating across areas included the \u0026ldquo;need to gain access to biological samples from another department\u0026rdquo;, \u0026ldquo;partner with colleagues in technology to change electronic infrastructures\u0026rdquo;, \u0026ldquo;engage nurses on new mandates that altered their workflow\u0026rdquo;. Challenges occurred when faculty crossed disciplines, departments, or encountered different operational or financial structures. In one project, a LAMP participant described,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;significant cross-area collaboration challenges across multiple research departments and institutes...with integrating investigators from diverse fields, including neurology, radiology, pathology, and biomarker discovery... to find alignment on technical standards, data-sharing protocols, and equitable access to the new core facility.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEngage stakeholders\u003c/span\u003e: Getting buy-in or agreement from a variety of stakeholders was critical to successful execution of many projects, whether that be the need to \u0026ldquo;get approval from practice administrators for new clinical protocols\u0026rdquo;, or \u0026ldquo;convince course leaders to add curricula to existing educational programs\u0026rdquo;. One faculty member articulated trying to get buy-in from multiple members of hospital teams to achieve her project goal of increasing hospital discharges before noon. She wrote,\u003c/p\u003e \u003cp\u003e\u0026ldquo;Maintaining engagement across all disciplines proved difficult over time. As\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eparticipation and communication declined, discharge rates before noon decreased. Re-engaging key stakeholders temporarily improved outcomes, showing that sustained success depends on continued teamwork, clear accountability, and consistent leadership support. Ongoing collaboration and regular feedback were seen as essential to make early discharge practices sustainable.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDevelop something new\u003c/span\u003e: Creating novel programs was another common project focus amongst the LAMP faculty. \u0026ldquo;New guidelines to standardize clinical care\u0026rdquo;, \u0026ldquo;new curriculum to fill knowledge gaps\u0026rdquo;, and \u0026ldquo;new systems to verify competency\u0026rdquo; were examples of efforts undertaken by LAMP faculty. Such initiatives required needs assessments, targeted innovations, time, and space for implementation, which challenged the faculty. In one project, a new curriculum for nurses to address their unfamiliarity with pediatric patients was developed in the emergency department. This physician described,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDeveloping the new curriculum required identifying knowledge gaps, selecting key pediatric topics, and finding time for training while balancing clinical duties. In addition, securing IRB approval and ensuring participation also presented challenges.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNegotiate resources\u003c/span\u003e: Project activities often required faculty to navigate institutional structures to obtain needed support and resources. Participants described working to \u0026ldquo;secure or negotiate funding\u0026rdquo; for their research, \u0026ldquo;address shortages in the educational infrastructure\u0026rdquo;, or \u0026ldquo;find staff to carry out the workflow\u0026rdquo;. In one example, a faculty member highlighted challenges in securing multiple types of resources for a project that provided access to palliative care at an affiliate hospital. He shared,\u003c/p\u003e \u003cp\u003e\u0026ldquo;We identified several structural, financial and operational barriers to program\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eimplementation, including institutional financial buy-in\u0026hellip; securing sustainable funding\u0026hellip; ensuring adequate resources and personnel. Considerations included a stand-alone vs. co- located clinic\u0026hellip; telemedicine visit capabilities\u0026hellip; specific provider/ancillary staffing\u0026hellip; to define the palliative care practice scope.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRespond to a problem\u003c/span\u003e: Many projects were launched to address pressing institutional or external needs, such as a \u0026ldquo;critical gap in trainee skills\u0026rdquo;, \u0026ldquo;a necessary pivot during the pandemic\u0026rdquo;, and a response to \u0026ldquo;changes to accreditation mandates.\u0026rdquo; In each case, faculty framed their work as a direct solution to an identified problem requiring timely action. One project described the urgent need to develop an integrated, ophthalmology internship after changes to Accreditation Council for Graduate Medical Education (ACGME) requirements. The faculty wrote,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eBeginning in 2021, the ACGME requires programs to integrate three months of ophthalmology training within the internship...few guidelines exist on how to fulfill this requirement. Our goal was to design an integrated internship from the ground up...negotiating rotation dates and shift numbers... balancing inpatient and outpatient components...for the inaugural class by July 1, 2021.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eChange existing culture\u003c/span\u003e: Projects in this theme sought to influence norms and practices by addressing a challenge within the existing institutional culture, e.g., \u0026ldquo;positively affect the motivation and meaning of work\u0026rdquo;, promote practices that \u0026ldquo;foster a culture of continuous improvement\u0026rdquo;, and \u0026ldquo;create a culture in which projects are valued\u0026rdquo;. In one example, a participant shared the challenge of implementing an updated Hepatitis B vaccination protocol by shifting work from physicians to nurses,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAs of 2017, the American Academy of Pediatrics officially changed guidelines to implement the Hepatitis B vaccine within 24 hours of life\u0026hellip; Previously, physicians were tasked with obtaining consent for the vaccine\u0026hellip; in the new protocol, nurses are authorized to take over this procedure\u0026hellip;While this practice has been in effect for over a year... adoption has been slower than expected, a culture shift we needed to address.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThese illustrative examples demonstrate the prevailing challenges that spanned the range of projects experienced by participants in our faculty development program.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEarly career leaders are engaged in a wide spectrum of scholarly work, as evidenced by the breadth of abstracts submitted by the faculty enrolled in the Leadership in Academic Medicine Program. Projects, over nine years of the program, spanned efforts in research (42%), clinical quality improvement (37%), and education (22%). Our analysis revealed a shift of project focus, in more recent years, to education (from 9% to 37%) and quality improvement (from 22% to 40%), with corresponding decreases in research (from 69% to 23%). Our main study finding was the 6 overarching themes that emerged from the 784 concepts identified within the abstracts. These 6 themes, representing challenges most frequently confronted by faculty leaders conducting scholarly projects, were collaborating cross area (30%), engaging stakeholders (22%), developing something new (17%), negotiating for resources (11%), responding to a problem (11%) and changing existing culture (7%). Our study additionally revealed that there were similarities and differences in the top challenges by project type. Cross area collaboration was a challenge in 71% of research projects with resource negotiation, a distant second at 14%, a little surprising given the constant strain on investigators to secure research support and funding. In quality improvement projects, stakeholder engagement (27%) and cross area collaboration (24%) were reported as primary challenges, highlighting the complexity of interdisciplinary interactions necessary for patient care. Leading challenges for educational projects also included stakeholder engagement (30%), but developing something new (24%) showed up within the top 2, underscoring the importance of innovation in education.\u003c/p\u003e \u003cp\u003eThese findings offer guidance to leadership development programs in academic institutions, especially those that include action learning projects as a component of their structure. For LAMP, the findings provide the data to drive specific curricular and structural improvements. For example, the program currently fosters cross area collaboration through its deliberate enrollment of faculty from different backgrounds and disciplines. The smaller mentor groups are also strategically composed of individuals from different departments but with similar scholarly interests. The hope is that these arrangements foster cross-area collaborations; however, our results reveal that the challenges of collaborating with people from unfamiliar work areas need even more explicit addressing. Specific lessons on identifying and reconciling differences could be incorporated into the current seminar on working within teams. The program could also more explicitly encourage participants to engage in shared capstone efforts, allowing for potential differences and disagreements to be negotiated under supervised mentorship. Another improvement to add involves the senior mentors paired with each small group. Currently, the mentors are provided with loose guidance on how to facilitate advancement of capstone projects. A \u0026ldquo;mentors guide\u0026rdquo; can be constructed from the overarching themes to help mentors coach participants on foreseeable project challenges. For example, senior mentors can receive instruction on an exercise in stakeholder identification, e.g. who is needed for this project to advance, what motivation does this person have to advance or to stall the project, what area of alignment can be found to better engage this stakeholder. Finally, this study provides awareness that LAMP faculty are increasingly engaged in education and quality improvement work, two scholarly pursuits that participants might need additional skills in. We can incorporate resources, i.e. other coursework or programs, pertaining to curriculum development and QI skillsets in the session on promotional pathways (specifically in clinical innovation and education leadership).\u003c/p\u003e \u003cp\u003eThe findings from this study deepen the existing body of knowledge on action learning projects within faculty development programs. With respect to types of projects, our study revealed research as the leading endeavor that participants engaged in, consistent with the findings of one national obstetrics and gynecology education leadership program where 56% of participants conducted research, 34% designed curriculum, and 12% performed quality improvement.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e However, over time, the focus of our participants\u0026rsquo; projects shifted to clinical quality improvement and education. This might reflect a growing recognition that physicians are expected to lead in quality improvement,\u003csup\u003e22\u003c/sup\u003e or that quality improvement and education innovations are increasingly counted as scholarship at academic medical centers.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e At our medical campus, this shift could also reflect new faculty development offerings directed at the research faculty, resulting in greater selection of LAMP by participants engaged in education or clinical QI.\u003c/p\u003e \u003cp\u003eThis study's identification of the six overarching challenges experienced by faculty leaders adds to our prior research that leaders experience greatest discomfort in the following leadership competencies: negotiation, balancing competing demands and managing conflict.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Negotiation skills are needed in resource procurement and for navigating cross-area collaboration. Conflict management is often a necessary component of stakeholder engagement and culture change. And addressing competing demands is an important skill for developing new initiatives and responding to urgent problems. Cross-walking needed leadership development skills to ameliorate our identified leadership challenges is one strategy for faculty development designers.\u003c/p\u003e \u003cp\u003eThis study is unique in its discernment of the challenges experienced by faculty leaders pursuing scholarly work. Prior studies addressed general barriers to physician leadership or completion of scholarly projects. For example, one study interviewed 77 leaders about barriers in their work environment to effective leadership and identified systems issues such as bureaucratic silos, non-systemic selection of leaders, negative or close-minded culture, and lack of resources as main impediments.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Another study interviewed 54 participants enrolled in an offsite faculty development program about challenges they experienced in implementing their projects back at home; this analysis revealed competing responsibilities, lack of protected project time, and limited resources as barriers to successful completion of their projects.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Both studies identified predominantly structural issues that are out of scope for leadership development programs to affect. In contrast, our study offers a project-centered, multi-year analysis of challenges faced by 294 early career faculty; it draws from 784 occurrences of challenges described within participants\u0026rsquo; scholarly abstracts to identify six overarching themes that reflect practical and skill-based obstacles. These challenges are unique in that they arise within day-to-day execution of scholarly work, represent competencies that map to existing leadership models for health care,\u003csup\u003e26\u003c/sup\u003e and when addressed in the course of projects mentored within a leadership development program, represent best practice in leadership training.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Furthermore, in examining challenges across three distinct types of scholarly initiatives, and highlighting shifts in project focus over time, this study provides unique insights that are not found in prior literature. These features offer a distinct contribution by identifying practical and training-focused skills, highlighting how leadership challenges can differ by type of scholarly initiative, and offering concrete guidance for other leadership development programs seeking to prepare for the needs of future academic leaders.\u003c/p\u003e \u003cp\u003eOur study had several limitations. The analysis was conducted on a convenience sample of available abstracts across 9 years of a single program, limiting its generalizability to other faculty development programs or faculty scholarly projects. The participants were not asked to address encountered challenges explicitly in their capstone summaries; these concepts and themes were gleaned by the investigators from project descriptions which varied greatly by abstract author. Research abstracts that followed a more traditional scientific template may have contained fewer descriptions about barriers, leading to potential underestimation of identified challenges across the research projects. Future studies can advance this body of work by directly querying participants about the barriers they faced while executing their project, and how the program helped or could help to overcome those barriers.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, we identified six overarching challenges, that varied by project type, confronted by faculty conducting projects in a faculty development program: 1) collaborating across-areas, 2) engaging stakeholders, 3) developing something new, 4) negotiating resources, 5) responding to a problem and, 6) changing the existing culture. These insights provide guidance on practical additions to faculty development leadership programs that better support faculty leaders conducting scholarly work.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLAMP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLeadership in Academic Medicine Program\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eQI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQuality Improvement\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACGME\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAccreditation Council for Graduate Medical Education\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003eData from the LAMP program, including participant information, surveys, and capstone abstracts, were collected primarily for internal programmatic quality improvement. The Institutional Review Board at Weill Cornell Medicine determined the study protocol (#23-09026453) to analyze program data retrospectively qualified for exemption due to minimal risk, waiving the requirement for informed consent. The study was conducted in compliance with the ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e \u003cb\u003eConsent for publication\u003c/b\u003e:\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003e \u003cb\u003eAuthor contributions\u003c/b\u003e \u003c/h2\u003e \u003cp\u003eAll authors contributed to the study conception and design and to drafting or reviewing the work critically for intellectual content. JT and CAM conceived and designed the study, acquired, and interpreted the data, drafted, and wrote the manuscript. AA acquired and interpreted the data and edited the manuscript. All authors approved the final version of the manuscript, consent for publication, and agree to be accountable for all aspects of the work.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe study was supported by the Office of Faculty Development and the Department of Medicine, Weill Cornell Medicine and Hospital for Special Surgery.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design and to drafting or reviewing the work critically for intellectual content. JT and CAM conceived and designed the study, acquired, and interpreted the data, drafted, and wrote the manuscript. AA acquired and interpreted the data and edited the manuscript. All authors approved the final version of the manuscript, consent for publication, and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eThe authors would like to acknowledge the Office of Faculty Development for their support of the Leadership in Academic Medicine Program and the LAMP participants for their insights, engagement and steadfast efforts.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed for this study are not publicly available due to the local and proprietary nature of the data, but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSfantou DF, Laliotis A, Patelarou AE, Sifaki-Pistolla D, Matalliotakis M, Patelarou E. Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review. Healthc (Basel). 2017;5(4):73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDyrbye LN, Major-Elechi B, Hays JT, Fraser CH, Buskirk SJ, West CP. Relationship Between Organizational Leadership and Health Care Employee Burnout and Satisfaction. Mayo Clin Proc. 2020;95(4):698\u0026ndash;708.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMete M, Goldman C, Shanafelt T, Marchalik D. Impact of leadership behaviour on physician well-being, burnout, professional fulfilment and intent to leave: a multicentre cross-sectional survey study. BMJ Open. 2022;12(6):e057554.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrook RH. Medical leadership in an increasingly complex world. JAMA. 2010;304(4):465\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh PK, Singh S, Kumari V, Tiwari M. Navigating healthcare leadership: Theories, challenges, and practical insights for the future. J Postgrad Med. 2024;70(4):232\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLucas R, Goldman EF, Scott AR, Dandar V. Leadership Development Programs at Academic Health Centers: Results of a National Survey. Acad Med. 2018;93(2):229\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinert Y. Faculty development: From rubies to oak. Med Teach. 2020;42(4):429\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinert Y, Naismith L, Mann K. Faculty development initiatives designed to promote leadership in medical education. A BEME systematic review: BEME Guide 19. Med Teach. 2012;34(6):483\u0026ndash;503.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStraus SE, Soobiah C, Levinson W. The impact of leadership training programs on physicians in academic medical centers: a systematic review. Acad Med. 2013;88(5):710\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrich JC, Brewster AL, Cherlin EJ, Bradley EH. Leadership development programs for physicians: a systematic review. J Gen Intern Med. 2015;30(5):656\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeerts JM, Goodall AH, Agius S. Evidence-based leadership development for physicians: A systematic literature review. Soc Sci Med. 2020;246:112709.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyons O, George R, Galante JR, et al. Evidence-based medical leadership development: a systematic review. BMJ Lead. 2021;5(3):206\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStoller JK, Commentary. Recommendations and remaining questions for health care leadership training programs. Acad Med. 2013;88(1):12\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLacerenza CN, Reyes DL, Marlow SL, Joseph DL, Salas E. Leadership training design, delivery, and implementation: A meta-analysis. J Appl Psychol. 2017;102(12):1686\u0026ndash;718.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldman E, Manikoth N, Fox K, Jurjus R, Lucas R. Faculty leadership development: A case study of a synergistic approach. Med Teach. 2021;43(8):889\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore Simas TA, Cain JM, Milner RJ, et al. A Systematic Review of Development Programs Designed to Address Leadership in Academic Health Center Faculty. J Contin Educ Health Prof. 2019;39(1):42\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDannels S, McLaughlin J, Gleason KA, McDade SA, Richman R, Morahan PS. Medical school deans' perceptions of organizational climate: useful indicators for advancement of women faculty and evaluation of a leadership program's impact. Acad Med. 2009;84(1):67\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGusic ME, Milner RJ, Tisdell EJ, Taylor EW, Quillen DA, Thorndyke LE. The essential value of projects in faculty development. Acad Med. 2010;85(9):1484\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTung J, Nahid M, Rajan M, Logio L. The impact of a faculty development program, the Leadership in Academic Medicine Program (LAMP), on self-efficacy, academic promotion and institutional retention. BMC Med Educ. 2021;21(1):468.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTung J, Nahid M, Rajan M, Bogdewic S, Mancuso CA. Enhancing a Faculty Development Program: Identifying and Addressing Leadership Skill Gaps Using an Established Leadership Framework. J Healthc Leadersh. 2025;17:259\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinauer JE, Hueppchen NA, Ricciotti HA, et al. The APGO Academic Scholars and Leaders Program: Supporting obstetrics and gynecology faculty development for 20 years. Med Teach. 2023;45(10):1155\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong BM, Levinson W, Shojania KG. Quality improvement in medical education: current state and future directions. Med Educ. 2012;46(1):107\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrisby RK, Thorndyke L, Perspective. Recognizing and rewarding clinical scholarship. Acad Med. 2011;86(1):127\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBharwani A, Kline T, Patterson M, Craighead P. Barriers and enablers to academic health leadership. Leadersh Health Serv (Bradf Engl). 2017;30(1):16\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMennin S, Kalishman S, Eklund MA, Friedman S, Morahan PS, Burdick W. Project-based faculty development by international health professions educators: practical strategies. Med Teach. 2013;35(2):e971\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHargett CW, Doty JP, Hauck JN et al. Developing a model for effective leadership in healthcare: a concept mapping approach. J Healthc Leadersh. 2\u0026ndash;017;9:69\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSonnino RE. Health care leadership development and training: progress and pitfalls. J Healthc Leadersh. 2016;12:8:19\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Leadership development, leadership challenges, action learning project, capstone project","lastPublishedDoi":"10.21203/rs.3.rs-8801288/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8801288/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFaculty development programs often incorporate structured pieces of academic work, i.e. action learning projects, to provide participants with experiential learning while also addressing real world problems. The Leadership in Academic Medicine Program (LAMP), a faculty development program at Weill Cornell Medicine, contains a project expectation, i.e. a capstone, that culminates in submission of a final written abstract. This study analyzed LAMP capstone abstracts to characterize the scope of projects undertaken, and to identify common leadership challenges encountered by faculty participants during execution of their project.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective qualitative review was performed on abstracts submitted between 2017\u0026ndash;2025. Two investigators discerned unique challenges described in the project abstracts and labelled them as concepts. Similar concepts were clustered into categories, and categories were clustered into themes. Frequencies of concepts were calculated to identify top themes; projects were additionally classified by scholarly type, e.g. research, education, clinical.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were 294 abstracts, 42% categorized as research, 37% as clinical quality improvement, and 22% as education. Over time, there was a shift towards more quality improvement (22% to 40%) and education projects (9% to 37%). The authors coded 133 unique concepts, occurring 784 times. Concepts were clustered into 26 categories and from these categories, 6 overarching themes representing leadership challenges were identified: 1) collaborate across area, 2) engage stakeholders, 3) develop something new, 4) negotiate resources, 5) respond to a problem, and 6) change existing culture.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIdentification of six prevalent leadership challenges confronted by faculty during execution of distinct types of capstone projects provides unique insights to the needs of faculty leaders, assists with data driven improvements to the LAMP curriculum, and offers guidance to other academic faculty development programs.\u003c/p\u003e","manuscriptTitle":"Qualitative study identifying leadership challenges encountered in real-world scholarly projects within a faculty development program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 12:05:08","doi":"10.21203/rs.3.rs-8801288/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-23T07:09:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-22T17:08:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"187025077827103128300037852296881703049","date":"2026-02-27T19:26:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-23T19:32:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184280500264725351066070247715579476276","date":"2026-02-23T19:04:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309417492838101721392339746445770851382","date":"2026-02-23T18:34:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-18T16:26:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-18T16:19:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-13T18:48:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-12T13:29:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-02-12T13:18:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a8060070-ba5d-47f1-b288-52fee9cffdf8","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T14:23:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-24 12:05:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8801288","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8801288","identity":"rs-8801288","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}