Intended for healthcare professionals

Careers

Junior doctors need better training in leadership and management

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1326 (Published 17 March 2016) Cite this as: BMJ 2016;352:i1326
  1. Matthew Limb
  1. BMJ Careers
  1. Limb{at}btinternet.com

Abstract

Medical training needs to focus more on leadership and management, senior medical and health service leaders believe. Matthew Limb reports

Medical students and junior doctors need to learn more about leadership and management if the health service is to have a long term future, senior medical and health service leaders have said.

Stephen Gillam, a general practitioner and lecturer at Cambridge University’s Institute of Public Health, argues that there needs to be a better understanding of leadership and management in the medical curriculum. “I think it’s important because often at a very early stage, perhaps less acute than it was but I think it still obtains, students have started to form quite prejudicial preconceptions about what managers are and what managers do,” he says.

“There’s been an enormous amount of emphasis on providing opportunities for training and learning about leadership and management,” he adds. “But I’m not sure what impact they’ve had.”

Lisi Gordon, a research fellow at Dundee University’s Centre for Medical Education, believes that medical students should be learning “from the start” about leadership and management. “I would like to see people learning as part of interprofessional education, so within teams rather than pulling individuals out of their workplace and into a classroom,” she says. “We also need to shift away from the notion of leaders as individuals,” she says. “My focus would be more on the process of leadership and less on individuals as leaders.”

Difficult attitudes

Kate Langford, who chairs the BMA’s medical managers committee and is deputy medical director of Guy’s and St Thomas’ Hospital, London, says that the attitude of doctors in training towards leadership and management can cause difficulties. “I think those in roles managing at the organisational level see it as an extension of the role of clinical leader rather than distinct from it. It is essentially providing leadership in the care of a large number of patients at a distance rather than in a smaller number of patients at close quarters.

“I do not think most juniors see it as a valuable extension of the clinical leadership role but I do think that is changing,” she says. “My view is that it does create a problem if it stops people opting in to leadership at the service, organisation, or system level as there is good evidence of the benefits to patients of having doctors in those roles. In my view you cannot lead effectively what you do not know how to manage, so it is important that those who seek service, organisation, or systems leadership acquire management skills.”

Chris Hewitt, chief executive of Leicester, Leicestershire and Rutland Local Medical Committee, says, “Whether we are full-time or part-time clinicians, full-time or part-time clinical leaders, or clinical managers we need to work with non-clinical managers, politicians, patients and carers. We have to strive to achieve a culture where people are not saying, ‘You must do this.’ We need to really listen to each other and start saying, ‘We must do this.’”

Peter Wilson, a fellow of the Health Foundation’s Generation Q leadership development programme, suggests that while juniors are being taught to become good doctors they are not taught to challenge the status quo. “I feel now that if we’re going to survive long term as an NHS we do need to look at how we do things differently,” he says.

Michael West, head of thought leadership at the King’s Fund, says clinicians at all levels are well placed to drive improvements in care quality and safety. “It is up to those in formal leadership roles to create the right environment to empower clinicians to make constant improvement a reality,” he says.

West says that the best team leaders create a strong sense of team identity, develop an inspiring vision, and listen closely to staff and patients. Board leaders, including clinical leaders, “are most effective when they display the organisation’s vision and values through what they say, do and reward,” he says. “For aspiring leaders through to clinical directors, the need to develop soft skills to engage staff to develop cultures of compassionate care is vital. They should offer supportive, available, empathic, fair, respectful, compassionate and empowering leadership.”

Footnotes

  • Competing interests: None declared.