A new study helps define leadership in medicine

Excellence in medical leadership is clearly key to patient outcomes, as it impacts everything from the delivery of treatment to envisioning new technologies or administrative practices to improve care. Identifying leadership traits and behaviours early and accurately in medical trainees should be a priority for supervisors.

Reframing perceptions of medical leadership

The reality is that hectic medical work schedules, reward systems and established cultural norms often submerge leadership potential. When objective measurement is made difficult, supervisors come to rely on subjective evaluation. New research by Samantha Jones, Ka Hong Chan, Joshua Bourdage and Aleem Bharwani, funded by CCAL, suggests that trainees, supervisors and educators give differing value to the qualities that constitute good leadership. Consequently, young medical leaders with positive leadership qualities are often overlooked.

Furthermore, the research offers a new competency-based framework to assess medical leadership potential in an increasingly diverse work environment. Jones et al used a multi-disciplinary lens, drawing on psychology and management theory, to construct a standardized measurement tool for medical leadership recognition.

Seven qualities of a leader in medicine

The research had two phases. At the outset, 33 subject matter experts (SMEs) were asked to review and rate a broad list of potential competencies derived from previous work in the medical domain and from the leadership literature, and rank the importance of each of these to medical leadership. This resulted in seven core medical leadership qualities: Ethical and Social Responsibility, Civility, Self-Leadership, Team Management, Vision and Strategy, Creativity and Innovation, and Communication and Interpersonal Influence. These seven competencies were presented as the foundation for a nuanced and multi-faceted framework of medical leadership, which is more broadly defined as:

“The harnessing of medical knowledge, and interpersonal skills and abilities, by healthcare professionals to motivate and persuade others towards a common goal in both formal (e.g., management positions) and informal (e.g., acting as a leader during daily clinical work) settings.”

Next, 181 medical trainees aged 22 to 45, working in a variety of specialisms at a Canadian university, were asked to self-assess using the new 7 competency framework. To validate the self-assessment, researchers had 167 supervisors provide leadership competency ratings for 132 trainees and, on the clinical side, were able to access 399 clinical evaluations for 157 trainees.

Detailed statistical analysis yielded two significant disconnects worthy of further investigation:

A mismatch in perceptions

First, trainees and supervisors rated the trainee’s leadership abilities differently. The leadership behaviours trainees thought they were exhibiting were not viewed as successful in the same way by their supervisors, indicating a mismatch between trainees who think they are good leaders and trainees who are viewed that way by their supervisors.

Second, although Civility was recognized by the trainees and leaders when it came to leadership evaluations, it was largely unrelated to clinical performance. In other words, trainees who may engage in bullying did not appear to receive lower performance ratings than those who did not, and those that were civil did not receive higher performance ratings. In contrast, when judging the potential of trainees who showed high competence in Ethical and Social responsibility, supervisors seemed to regard this as a sign of poor leadership, although they again agreed it was a core competency.

It seems that trainees who perceived themselves to be good leaders were sometimes seen as poor leaders and clinical performers by their supervisors.

Further, it seems that supervisors in general tend to be swayed by trainees who appeared better organized, conscientious and socially bold, irrespective of other measurable leadership competencies.

Based on the findings, the researchers proposed a threefold prescription for healthier appraisal of potential medical leaders in increasingly diverse workplaces: a measurable leadership framework should be built into the curriculum and evaluations; assessment tools should look at long and short-term performance; and assessors should be taught how to judge leadership behaviours in early training so that young leaders are not passed over.