The Importance of Leadership Development in Medical Curricula: A UK Perspective (Stars are Aligning).

"Medical leadership and management" describes the engagement of doctors in the leadership and management of both individual patient care and of the departments, organizations and systems within which they work. Around the world, doctors are generally accepted as the leaders of clinical teams, holding ultimate accountability for individual patient care. However, the role of doctors as organizational and system leaders within healthcare, despite evidence of benefit, shows considerable variation. In this article, we briefly explore the history of leadership development for doctors, and then, taking a UK perspective on recent developments in undergraduate education and postgraduate training, consider the opportunities and challenges for medical schools, educators and doctors in implementing these. The future of medical leadership and management development is promising although there is still a lack of evidence on the longer-term outcomes and impact on patients of current interventions. It is clear, however, that faculty need to be skilled in holding effective developmental conversations and structuring formative experiences for those they educate, and that leadership development must be integrated longitudinally throughout a doctor's career, with undergraduate development being a critical stage for helping medical students recognize and understand their wider responsibility to the system, as well as the patient in front of them.

How do pharmacy students select their pre-registration training providers? A mixed methods evaluation of the national recruitment scheme in England and Wales.

OBJECTIVES: A national pre-registration pharmacist recruitment scheme, which replaces the local recruitment models, was introduced in England and Wales in 2017. This study aimed to explore pharmacy students' behaviour and associated factors in their selection of pre-registration training programmes. METHODS: A mixed-method study using (a) analysis of data from all applicants (n = 2694) of the national recruitment scheme, (b) an online survey and (c) a virtual focus group was undertaken. Survey and focus group questions were developed based on the Theoretical Domains Framework (TDF). Descriptive and inferential analysis of quantitative data was undertaken using Stata software. Qualitative data from focus groups and responses from the open-ended questions were analysed using framework technique. KEY FINDINGS: A vast majority of applicants (n = 2182, 83.9%) selected a hospital training programme as their first ranked preference, with the rest opting for community pharmacy. Urban areas, particularly London, were most popular geographically. A total of 307 survey responses were returned. Long-term career aspirations, followed by geographical factors, were rated most highly in applicants' decision-making. Qualitative data from survey and focus group demonstrated information about programmes/employers, perceived opportunity for skills development and aspiration towards a career path as key contributory factors in their decision-making. CONCLUSIONS: Secondary care was the most desirable destination for pharmacy students to undertake early career training. The clinical roles and career opportunities in community pharmacy needs to be promoted as there is a risk that community pharmacy training programme places may be seen as a 'left over' opportunity for less competitive candidates to uptake.

National recruitment scheme for pre-registration pharmacist training in England and Wales: a mixed method evaluation of experiences of applicant pharmacy students.

BACKGROUND: A national pre-registration pharmacist training recruitment scheme, which replaces local recruitment models, was introduced in England and Wales in 2017. The national recruitment system allows pharmacy students to apply for the 52 weeks training programmes (mandatory requirement for registration as a pharmacist), through a single application system prior to undertaking a nationally administered assessment. This study aimed to explore experiences of pharmacy students on the national recruitment scheme, particularly their views on the selection methodology, application process, and offer outcomes. METHODS: This mixed method study involved a) an online survey of all (approximate n = 2800) year 4 (final year of MPharm degree) pharmacy students in England and Wales and b) a qualitative focus group with four students. The study population was eligible to participate in the 2017/18 national recruitment scheme. Survey respondents were invited to participate in a focus group. Quantitative data were analysed using descriptive and inferential analysis. Qualitative data were analysed using the framework technique. Participation was voluntary. Ethical approval from University of Birmingham was obtained. RESULTS: A total of 307 completed surveys were returned (approximate response rate 11%). Respondents were generally satisfied with the application process and commended the fairness of the selection methodology and convenience in allowing them to apply to multiple training providers. Most survey respondents (n = 181, 72.9%) were either satisfied or highly satisfied with the training programme they were offered based on their assessment performances. Three themes and eight sub-themes obtained from the analysis of over 200 open comments data from the survey and transcript of a focus group with four participants. Results suggested the need to widen the timeframe available for applicants to shortlist their preferred employers, improve the method of programme listing in the application system, and consideration of prior achievements including academic performances and placement experiences to be included in the selection methodology. CONCLUSIONS: Experiences of pharmacy students on the national recruitment scheme suggest that respondents considered the selection methodology to be fair. Student engagement and satisfaction with the recruitment system can be maximised through improved listing of employers and widening the timescales for students to shortlist their preferred employers during application process. Inclusion of University achievements in the selection methodology will require consideration of evidence based approaches. Low response rate limits generalisation of findings.

From the workshop to the workplace: Relocating faculty development in postgraduate medical education.

INTRODUCTION: Postgraduate medical education takes place almost entirely in the clinical workplace, supported by healthcare professionals who strive to combine service and educational roles. Over the past decade, we have witnessed the emergence and growth of new forms of educational activity within postgraduate medical education. Under the umbrella term of "faculty development", these activities move beyond a narrow emphasis on "teaching the teachers to teach" to a wide range of interventions focused on enhancing educational climate, educational infrastructure and educational practices within and across healthcare organizations. METHOD: Drawing on key developments in the UK over the last 10 years, we trace how faculty development in postgraduate medical education has evolved, illustrate the plurality of purposes, and practices currently being adopted and signal emerging trends. DISCUSSION: We highlight that due to the location of UK medical training programs outside "the academy", innovations and developments in faculty development are largely silent in the formal medical education literature. Changing demographics, service pressures, and evolving healthcare systems continue to present serious challenges to both work-based training and learning.

Twelve tips for integrating leadership development into undergraduate medical education.

Healthcare systems need effective leadership. All healthcare professionals can and should "learn to lead" and this requires a clear focus on leadership development from the earliest stages of a career. Within medicine, undergraduate students should be provided with opportunities to thrive and develop their skills in terms of leadership, management and followership. Drawing from the existing evidence base, the authors' expertise and the latest "thought leadership", these 12 tips provide practical guidance to universities and associated provider organizations, and to academic and clinical faculty, on how to integrate leadership development into their undergraduate medical programs. These 12 tips will help educators provide medical education that incorporates leadership as a core part of a professional's identity, and help students gain a deeper understanding of themselves and the teams, organizations and system they work within.

Clinical leadership development in postgraduate medical education and training: policy, strategy, and delivery in the UK National Health Service.

Achieving high quality health care against a background of continual change, increasing demand, and shrinking financial resource is a major challenge. However, there is significant international evidence that when clinicians use their voices and values to engage with system delivery, operational efficiency and care outcomes are improved. In the UK National Health Service, the traditional divide between doctors and managers is being bridged, as clinical leadership is now foregrounded as an important organizational priority. There are 60,000 doctors in postgraduate training (junior doctors) in the UK who provide the majority of front-line patient care and form an "operating core" of most health care organizations. This group of doctors is therefore seen as an important resource in initiating, championing, and delivering improvement in the quality of patient care. This paper provides a brief overview of leadership theories and constructs that have been used to develop a raft of interventions to develop leadership capability among junior doctors. We explore some of the approaches used, including competency frameworks, talent management, shared learning, clinical fellowships, and quality improvement. A new paradigm is identified as necessary to make a difference at a local level, which moves learning and leadership away from developing "leaders", to a more inclusive model of developing relationships between individuals within organizations. This shifts the emphasis from the development of a "heroic" individual leader to a more distributed model, where organizations are "leader-ful" and not just "well led" and leadership is centered on a shared vision owned by whole teams working on the frontline.

Developing a multisource feedback tool for postgraduate medical educational supervisors.

PURPOSE: Supervisors play a key role in the development of postgraduate medical trainees both in the oversight of their day-to-day clinical practice but also in the support of their learning experiences. In the UK, there has been a clear distinction made between these two activities. In this article, we report on the development of a web-based multisource feedback (MSF) tool for educational supervisors in the London Deanery, an organisation responsible for 20% of the UK's doctors and dentists in training. METHODS: A narrative review of the literature generated a question framework for a series of focus groups. Data were analysed using an interpretative thematic approach and the resulting instrument piloted online. Instrument performance was analysed using a variety of tools including factor analysis, generalisability theory and analysis of performance in the first year of implementation. RESULTS: Two factors were initially identified. Three questions performed inadequately and were subsequently discarded. Educational supervisors scored well, generally rating themselves lower than they were by their trainees. The instrument was launched in July 2010, requiring five respondents to generate a summated report, with further validity evidence collated over the first year if implementation. CONCLUSIONS: Arising out of a robust development process, the London Deanery MSF instrument for educational supervisors is a tool that demonstrates considerable evidence of validity and can provide supervisors with useful evidence of their effectiveness.

Clinical leadership development requires system-wide interventions, not just courses.

BACKGROUND: This is the third article in a series on clinical leadership and medical education. In the first two articles in this series we looked at the nature of leadership and examined professional outcomes, standards and competency frameworks from around the world that describe what it is we are trying to instil in medical students and doctors in postgraduate training. In this article we explore current trends in leadership development and describe broad approaches to clinical leadership development, highlighting those strategies that are likely to be more (or less) successful. METHODS: Narrative review and discussion. RESULTS: Key trends and principles for best practice in leadership development are identified. Recommendations for the design of leadership development programmes are made alongside suggestions for system-wide interventions. DISCUSSION: Leadership development should be both drawn from and embedded in work-based activities, and as far as possible linked to the development of the organisation as a whole. Intervening at the level of the individual may not be enough. System-wide interventions are required that actively engage students and trainees in the practices of management and leadership, and involve them early.

Leadership development for clinicians: what are we trying to achieve?

BACKGROUND: The role of all health practitioners is changing as a result of social, technological and demographic shifts, and clinicians are increasingly required to participate in leadership activities. Worldwide, there are emerging examples of policy agendas, professional standards and competency frameworks and approaches to leadership development for clinicians. CONTEXT: This article looks at what leadership development programmes for clinicians are trying to achieve, the rationale behind them and the outcomes that are deemed to be important. It offers a critical description of competency frameworks and their use in practice. INNOVATION: The UK, along with other Western countries, has embedded leadership and management learning outcomes into professional frameworks for students and qualified clinicians. There is increasing recognition that leadership development is best rooted in work-based activities, reflecting the realities of clinical life, with an emphasis on learning across the education and training continuum. IMPLICATIONS: If leadership is deemed to be relevant 'at all levels', then 'leadership development' must be addressed throughout the education and training undertaken by health professionals. Leadership as a topic is gathering momentum as a key curriculum area. But effective clinical leaders and managers need to be nurtured and supported by the organisations and health systems within which they work and learn. Although a wide range of leadership development activities exist for individuals, without system-wide change these initiatives may not produce the most effective 'leadership', nor the health improvements to which they aspire.

What is clinical leadership and why is it important?

BACKGROUND: The 'invitation' for clinicians to participate in leadership practices, previously considered the province of the professional health service manager, is driven by a number of international policy and professional agendas. This article, the first in a short series, considers definitions and theories of clinical leadership and management, and explores leadership roles and responsibilities of the clinician in terms of levels of engagement. Recent developments in the UK's National Health Service (NHS), the largest health care organisation in the world, are used as illustrations of how theory has informed clinical leadership development. METHODS: Narrative review and discussion. RESULTS: The tensions arising from the situation of health care professionals within managed health care are described. Leadership is defined alongside its relationship to management. Key theories of leadership are considered and applications of theory to practice explored. The role and usefulness of the 'competency framework' in leadership development is debated. DISCUSSION: Health care is delivered by complex systems often involving large numbers of individuals and organisations. The effective clinician needs to understand these pathways and systems of care if they are to be able to function effectively, and must be comfortable working both within, and with, these systems for the benefit of their patients. Engaging in leading and managing systems of health care, on whatever scale - team, department, unit, hospital or health authority - is therefore a professional obligation of all clinicians. Just as leadership is argued to be necessary 'at all levels', so 'leadership development', assessment and feedback must be provided throughout the education and training of health professionals.

Web-based faculty development: e-learning for clinical teachers in the London Deanery.

BACKGROUND: the London Deanery has provided a web-based resource for supporting the educational development needs of clinical teachers since 2002. This forms part of a range of resources supporting the professional development of clinical teachers and postgraduate supervisors. Following a review in 2007, the deanery commissioned a series of new e-learning modules designed as an introduction to clinical teaching. CONTEXT: the deanery's faculty development initiatives are one response to requirements of the Postgraduate Medical Education and Training Board (PMETB), other policy drivers, workforce demands and service changes. Increasingly, doctors are required to provide an educational portfolio of evidence, and satisfy the teaching and training component of Good Medical Practice in revalidation or recertification. INNOVATION: 'E-learning for clinical teachers' comprises 16 short, open-access, free-standing modules. The modules are built around a unifying structure, and cover core topics in clinical teaching: feedback; supervision; workplace-based learning; assessment; diversity and equal opportunities; career development; appraisal; lecturing; small group teaching; interprofessional education; and setting learning objectives. The modules can be used as a complementary resource to award-bearing programmes. On completion of a module, a certificate can be printed out for the teacher's portfolio. IMPLICATIONS: reflective practice and engagement with an individual's teaching practice is encouraged through self-assessment and a reflective log. The open-access, web-based format enables engagement with the material to suit a doctor's working and learning patterns, and is a valuable adjunct to other forms of learning. The site has been accessed by over 64000 health professionals (including students, trainees, qualified professionals, supervisors and staff developers) from 155 countries.

Introducing a professional development framework for postgraduate medical supervisors in secondary care: considerations, constraints and challenges.

PURPOSE OF STUDY: As the duration of postgraduate training becomes shorter, direct patient contact time is reduced, and supervision becomes more distributed, there is a move to 'professionalise' postgraduate medical education. This paper reports an initiative in one postgraduate training institution (the London Deanery) to develop and introduce a developmental framework and system of portfolio-based review of educational supervisors in the secondary care setting. STUDY DESIGN: 16 acute, mental health, foundation and primary-care Trusts participated in a pilot project, which was subsequently evaluated using focus groups and a semistructured questionnaire. RESULTS: Thematic analysis of transcripts identified a number of considerations, constraints and challenges, important observations given the current policy intention of the UK health departments to introduce mandatory training and performance review for educational supervisors. CONCLUSION: This pilot study shows that such a process can be implemented at local level if facilitated by a clear and unambiguous developmental framework that can be applied flexibly across all specialities. Systems of review also need to be simple and straightforward, take into account existing appraisal processes, and simultaneously address issues of motivation, recognition and reward.