December 2011

LEADERSHIP IN MEDICINE:
A MEDICAL STUDENTS
PERSPECTIVE
In my various medical rotations, I have had
the privilege to work with many doctors
on different teams and to approach things
from an outsiders view. The doctors that
embody medical leadership are those that
have picked up areas for improvement in
systems, made the extra effort to execute
effective change and advocated for the
patient beyond the medical/disease
paradigm. For me, these have been the
clinical experts whose foci were also on the
broader social determinants of health.
A word that I seem to hear with increasing
frequency in medical education is
professionalism. A recent Lancet
Commission (1) on the education of
health professionals in the 21st century
has emphasised the need to develop
leadership attributes using a new
paradigm of transformative learning. In the
report, the authors advocated for a new
professionalism with the outcome of health
professional education to develop change
agents for society.
By Philip Pinhao Chao
5th Year Medical Student
The University of Auckland
December 2011
There are examples of extracurricular
|eadersh|p-spec|fc programmes targeted
for medical students (2), including the
International Federation of Medical
Students` Assoc|at|ons (lFMSA} fagsh|p
Training New Trainers (TNT) programme.
Some extracurricular streams have
been well supported by Universities and
involve engagement with the community
(3). There is an increasing trend to
integrate leadership curriculum into
medical education. Examples include a
novel selective leadership course at the
University of North Carolina Chapel Hill
(4) and integration with gross anatomy
dissection groups at the Mayo Clinic
College of Medicine (5).
Currently at the University of Auckland, there
is a 2-day Quality and Safety Symposium
that third year medical students participate
in, together with colleagues from nursing
and pharmacy. I found this to be a valuable,
albeit brief insight into leadership in health
with inspiring keynote presenters. The
weeklong Population Health Intensive in
ffth year featured prom|s|ng aspects to
the development of leadership amongst
medical students. The experiential teamwork,
engagement with community organisations,
real-world needs analysis and problem solving
provided a pertinent demonstration of the
potential for integrated leadership development
in the curriculum.
However two initiatives in a 6-year long
course seem |nsuffc|ent when |eadersh|p
features so prominently in the role of a
doctor. As a medical student, I would like
to hear more from health professionals at
the forefront of making decisions that will
affect my future practice: Clinical leaders
who are tasked with addressing workforce
issues in New Zealand; policy advisors
who shape decisions; and global health
leaders who make an impact on a world
scale. In the same vein that researchers
involve students early in research to
inspire a lifelong pursuit of research,
clinical leaders may provide opportunities
for students to get involved in advocacy
projects in our undergraduate years.
It is not uncommon as a medical student
in social gatherings to be asked our
opinions about health policies and the
health situation de-jour. Society expects
doctors to have an opinion on health
issues and a criterion for successful
admissions interviews requires some
knowledge and demonstration of critical
analysis of the current health environment.
Yet when we go through medical school,
this critical analysis of topical health issues
is somewhat lacking. We learn more of
historic events and facts than engaging in
the discussions of today.
There is a move at both New Zealand
universities to involve more small-group
teaching. I believe this would be an opportune
avenue to facilitate the development of
leadership traits. Through more experiential
learning, being involved in either real-life
projects or by simulation, students can develop
the sk|||s and confdence to carry them |n good
stead into the workforce.
The current revision of the undergraduate
curriculum in Auckland, the foundation of
the New Zealand Centre of Excellence in
Health Care Leadership, and the launch of the
Counties Manukau District Health Board Ko
Awatea Innovation Centre all indicate that the
time for change is now.
Leadership in medicine is required to
address inequalities that exist in health
today (1). Medical students can develop the
skills to become effective clinical leaders,
even with our limited clinical experience.
Leadership training should start in the
undergraduate medical curriculum. In an
environment that is increasingly dependent
on multidisciplinary teams, medical
December 2011
students can and have played a role in
promoting inter-professional learning and
have been found to be a key element in its
success (6,7).
Change in medical education takes time
as it needs to go through many essential
processes. However medical students are
able to develop effective programmes (2) and
address local inequalities (8). Extracurricular
activities have been associated with
leadership styles and should be encouraged
(9). In addition, medical students involved in
community leadership initiatives chose to
specialise in family medicine at rate more than
three times that of their colleagues (3).
I believe that the age-old adage in
medicine of see one, do one, teach one
also applies to leadership skills. We are
increasingly seeing the importance of
hea|th |eadersh|p exemp||fed by c||n|ca|
leaders on the wards and in policymaking
taking on a more prominent role. Medical
students do not have to wait for new
education reforms to get involved in
leadership opportunities through student
groups or self-generated projects.
The next step will be teaching and
disseminating the many combined years
of experience from student leaders in New
Zealand to an upcoming generation of
medical students.
One recent initiative is the Leadership
and Global Health Workshop - a
multidisciplinary, shared collaborative
between the New Zealand Medical
Students Association (NZMSA) and
Medical Students for Global Awareness
(MSGA) across New Zealand. It makes use
of the Institute for Healthcare Improvement
(IHI) Open School and the experiences of
recent alumni to address the perceived
gap in training in the these two subjects in
the undergraduate curricula.
There is no easy solution, but judging
from the enthusiasm displayed by
many medical students, the outlook is
positive. Leadership initiatives that build
successful change agents must act locally
in collaboration with our communities to
executive sustainable change.
References
1. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al.
Health professionals for a new century: transforming education
to strengthen health systems in an interdependent world. Lancet.
[Consensus Development Conference Research Support, Non-U.S.
Govt]. 2010 Dec 4;376(9756):1923-58.
2. Hedgecock J, Steyer TE. The American Medical Student
Associations contributions to advancing primary care. Acad
Med. [Historical Article Research Support, Non-U.S. Govt]. 2008
Nov;83(11):1057-9.
3. Carufel-Wert DA, Younkin S, Foertsch J, Eisenberg T, Haq CL,
Crouse BJ, et al. LOCUS: immunizing medical students against
the loss of professional values. Fam Med. [Research Support, U.S.
Govt, P.H.S.]. 2007 May;39(5):320-5.
4. Goldstein AO, Calleson D, Bearman R, Steiner BD, Frasier PY, Slatt
L. Teaching Advanced Leadership Skills in Community Service
(ALSCS) to medical students. Acad Med. [Research Support, U.S.
Govt, P.H.S.Review]. 2009 Jun;84(6):754-64.
5. Pawlina W, Hromanik MJ, Milanese TR, Dierkhising R, Viggiano TR,
Carmichael SW. Leadership and professionalism curriculum in the
Gross Anatomy course. Ann Acad Med Singapore. [Comparative
Study]. 2006 Sep;35(9):609-14.
6. Stigler FL, Duvivier RJ, Weggemans M, Salzer HJF. Health
professionals for the 21st century: a students view. Lancet.
[Comment]. 2010 Dec 4;376(9756):1877-8.
7. /VMMTHU:19VZLULSK+.PSILY[1/=6HUKHZHU0-:[\KLU[
SLHKLYZOPWPUPU[LYWYVMLZZPVUHSLK\JH[PVU!ILUL[ZJOHSSLUNLZHUK
implications for educators, researchers and policymakers. Med
Educ. 2008 Jul;42(7):654-61.
8. Hsu LD, DeJong W, Hsia R, Chang M, Ryou M, Yeh E. Student
leadership in public health advocacy: lessons learned from the
hepatitis B initiative. Am J Public Health. [Research Support, Non-
U.S. Govt]. 2003 Aug;93(8):1250-2.
9. Sriratanaban J, Chiravisit M, Viputsiri O. Predictors of leadership
styles of medical students: implications for medical education. J
Med Assoc Thai. 1999 Sep;82(9):900-6.