Medical training: a curriculum for leadership?

Last week I came across some interesting research carried out by Google, looking at why some of their teams are highly productive and others, not so much. The results got me reflecting on our own teams and how relevant this research might be for healthcare professionals.

Thinking more widely, it brought me to the question: does undergraduate and postgraduate training prepare doctors for the leadership challenges they face for the rest of their working lives?

Most postgraduate programs have extensive curricula, challenging examination hurdles, and are many years duration. When I think about advanced specialty trainees as they approach the end of their training, almost unanimously their anxieties are about their level of practical skills or clinical knowledge. Are they going to be able to cut it as a boss, to be the all-knowing leader of a clinical team? They angst about whether they can do the procedures, if they have enough operations under their belt to be the slick consultant they want to be. A leader who is good enough, in turn, to mentor his or her own registrars.

Becoming the boss
But what does it actually take to be a leader? What skills are necessary to lead a successful team? What do clinical Directors look for when interviewing for a new consultant? Registrars are often surprised when I tell them that clinical or surgical expertise is rarely one of the differentiating values between candidates. It's actually taken as read that you can do the job if you fulfill the criteria to be shortlisted. You've done your time, you've got your Fellowship. I don't care if you've done 50 or 500 hysterectomies - the clinical expertise will come with time and support. What is most important is can I work with this person every day of my life? Are they going to bring value to the team? Are they emotionally intelligent? Or are they going to cause chaos and disharmony in the workplace that requires constant fire-fighting. When you bring a colleague into your team, you are selecting a new family member. So it needs to be a good one. 

Evidence-based leadership qualities
As I mentioned, Google found that some teams within their company were excelling, whilst others were poorly functioning, even though they all seemed to have members with similar technical abilities. So they looked to determine the characteristics of the leaders of the best functioning teams within their organisation. Google's Project Oxygen worked through exit interviews, team reviews and 360 degree ratings, amounting to over 10,000 observations of leaders' behaviours. There were 8 characteristics identified in leaders of high quality teams - and technical expertise was at the bottom of the list.

  1. Be a good coach
  2. Empower people - don't micromanage
  3. Be interested in the wellbeing and success of each of your team members
  4. Be productive and results-orientated
  5. Be a good communicator and listen to your team
  6. Help team members with their career development
  7. Have a clear vision and strategy for your team
  8. Have key technical skills

Think about what you look for in your leaders as you train, is it not all of the above? Teams want a leader who helps them to puzzle out problems themselves. Always giving the answers implies superiority and shuts down the conversation. Asking questions implies confidence in your team and sustains communication. People need constructive feedback, within a caring and supportive environment. Your team needs to know that you believe in them and to provide them with adequate mentorship for their growth. One of the most valuable things you can give your team is one-on-one time. We cannot lead from a distance.

Improved patient care
The most important consequence of this, is that it doesn't just produce happy workers, it builds teams that are highly functional. Leaders who focus on these characteristics will have teams that embody respect for each other and support one other in their day to day work. This means better patient care and fewer adverse events. Highly functional teams will go above and beyond the call of duty to get the job done.

But how to start? When to start?
You might not have explicitly thought about it, but all through postgraduate training (and often before, as a student), we are put in situations where we are expected to lead. These include:

  • Therapeutic relationships with our patients and their family relies on team work
  • When you're looking after a group of medical students
  • If you're the administration RMO or registrar
  • When you're the on-call registrar overnight
  • When you're the most senior doctor around for the day's ward duties
  • Senior registrars taking on increasing clinical team responsibilities

Notice that I'm not talking about only medical teams. If you're the registrar on duty, you are a member of more than one clinical team, and many of these are multidisciplinary: your ward team including the RMO and nurses responsible for your patients, the MET call team, the surgical team in theatre, the birth suite team, including the shift co-ordinator and all the midwives. Our responsibilities don't only lie with other medical staff. It's as much our role to provide all the 8 leadership qualities to the nurses, midwives and other health care workers within our wider MDTs.

So, when & where to start? Right here, right now. Think about how you can map the leadership qualities above to your own daily experience and responsibilities as a doctor.

If you think this is important, join the positive leadership movement and talk about these issues. Share/like on social media, so others know you believe in it and the word spreads. Be the change you want to see in our health care systems.