Leadership in medical education : competencies, challenges and strategies for effectiveness
Abstract
The complex nature of health care and medical educational organizations, their different primary goals (clinical service versus education), different organizational structures and the necessity for ensuring efficient and harmonious relationships between these two types of organizations create a challenging environment in which to provide effective medical education leadership. The calls for reform in both medical education and health care have added to these challenges.
The purpose of the study was to develop a framework of leadership for medical education and contribute to the literature on leadership in medical education, based on an analysis of the perceptions of key health education leaders in Saskatchewan medical education organizations at the national level in Canada.
The main objectives were the identification of core competencies, challenges and strategies for effectiveness in medical education with a focus on unique aspects of about leadership in the medical education setting. Multiple methods of data collection (individual interviews and an “event” study with components of focus groups interviews and short surveys) with subjects of varied backgrounds and at different levels of leadership in medical education were entailed in this study.
The data were collected over a period of 13 months (January, 2009 - February, 2010). The perceptions of 32 medical education leaders, stratified into first- (11), middle- (6) and senior-level (15) leadership positions, based upon the hierarchical position and the scope of the job, were obtained and analyzed. Quantitative data were analyzed through descriptive statistics. Qualitative data were analyzed for themes through content analysis.
The findings provide useful information on leadership competencies, challenges and effectiveness strategies in medical education. Leadership competencies included five domains including personal and interpersonal characteristics, skills for effective leadership, skills as an efficient manager, skills in medical education delivery, skills as a teacher and skills as a researcher. All leaders considered personal and interpersonal characteristics to be at the core of leadership; while skills in medical education delivery, and skills as a medical education teacher and researcher were considered least important. The senior-level leaders spent most of their time in activities requiring leadership functions (e.g., strategic planning and creating alignment) followed by activities requiring managerial skills (e.g., operational management). This distinction in the rank ordering of leadership and managerial skills was not obvious for the first- and middle-level leaders; however, most did indicate that they spent more of their time in roles requiring more managerial skills than leadership skills. Among the key competencies, essential at all levels, were effective communication and building and managing relationships. For the most part, the leadership skills were acquired informally with only a few leaders having undergone formal leadership training.
The leaders faced three types of challenges: personal and interpersonal challenges including effective time management and personal limitations; organizational challenges including those around structures and processes, organizational communication, personal and organizational relationships, creating engagement and alignment, managing culture and resistance and limited resources; and inter-organizational challenges including competing agendas and interests of stakeholders.
The context (societal needs, multiple stakeholders and health care reform), content (medical education delivery and calls for reform) and culture (e.g. professionalism, apprenticeship model of medical education, and the hidden curriculum) of medical education and inherent dualities and conflict require situated leadership skills and strategies. The main leadership theories and approaches helpful in practicing contextual leadership included transactional, transformational, and servant leadership. However, other theoretical approaches, such as moral leadership and learner-centered leadership were also useful.
Effective leadership was considered to include personal and interpersonal strategies, strategies for becoming an efficient manager and strategies for practicing inspiring and effective leadership. Personal and interpersonal strategies included looking after self, seeking advice, consciously developing fortitude, allotting time for priorities and thinking and personal development. Becoming an efficient manager involved diligent delegation, appropriate organizational communication and managing priorities. Practicing inspiring leadership involved developing the structure and processes to achieve vision, providing hope, developing mutually valued relationships which were considered key to engagement, alignment, leading change and managing resistance, moving from power to process, using appropriate leadership styles, developing the art of leading change and managing resistance, proactively influencing culture and accomplishing the vision.
In conclusion, medical education leadership was perceived as requiring both effective leadership and efficient management. The practice of inspiring and effective leadership, however, appeared to be more an art requiring an alchemy of strategies than a simple matter of application.