Preparedness of medical students and junior doctors for their role as clinical leaders: A systematic review

Clinical leadership in nursing homes: A qualitative study of healthcare professionals' perspectives on concept and characteristics

AIM(S)

To conceptualise and identify characteristics of clinical leadership in the nursing home setting.

DESIGN

A qualitative study using semi-structured focus group interviews and a thematic analysis.

METHODS

Five semi-structured focus group interviews were conducted with 41 healthcare professionals from nursing and other healthcare disciplines working in nursing homes (such as nurse assistants, licensed practical nurses, registered nurses (RNs), occupational therapists, recreational therapists, psychologists and gerontologists). Qualitative thematic content analysis of the gathered data was done.

RESULTS

Clinical leaders in nursing homes can be defined as passionate healthcare professionals providing person-centred care with strong communication skills. They are clinical experts in their field and motivated to engage in lifelong learning. They are team players with informal leadership skills. They are visionary, committed, resilient and responsive. Awareness of the definition and the main characteristics of clinical leadership is necessary to facilitate the identification, support and development of healthcare professionals. Focussing on the development of competencies, training courses and monitoring and assessment methods is necessary to improve the evidence of clinical leadership in nursing homes.

The impact of comprehensive licensure review on nursing students' clinical competence, self-efficacy, and work readiness

This study aims to assess the effectiveness of comprehensive licensure reviews and adaptive quizzing assignments on nursing students' clinical competence, self-efficacy, and work readiness-an under-researched topic. Additionally, it seeks to explore the mediating effect of self-efficacy in the relationship between students' clinical competence and work readiness. A quasi-experimental (pre- and post-test), single-group design was employed. The study was conducted in a public university in Saudi Arabia and included a total of 293 senior nursing students in their last year of the bachelor program. An intervention was developed based on the blueprints of the Saudi Nursing Licensing Exam and NCLEX-RN and consisted of a weekly 3-h synchronous comprehensive licensure review bundled with 23 adaptive quizzing assignments over 15 weeks. Data were collected prior to and after the intervention using three scales: clinical competence, self-efficacy, and work readiness. The mean scores of clinical competence, self-efficacy, and two subscales of work readiness (work competence and social intelligence) increased significantly post-intervention. Self-efficacy (β = 0.353, p < 0.001) and clinical competence (β = 0.251, p < 0.001) influenced work readiness (F [5, 226] = 21.03, p < 0.001) and accounted for 31.8% of the explained variability in work readiness. In the mediation analysis, clinical competence had a significant and indirect effect on work readiness through self-efficacy (B = 0.464, p < 0.001, 95% CI 0.250 to 0.699). The proportion of mediation indicated that 37.2% of the total effect of clinical competence on work readiness was due to the indirect effect of self-efficacy. Comprehensive licensure review and adaptive quizzing assignments improve students' perceptions of clinical competence and self-efficacy. Such interventions could ease the transition of senior nursing students to clinical practice.

Crafting Tomorrow's Medical Leaders: Insights from Medical Students and Interns in Saudi Arabia

Introduction

Leadership is increasingly recognized as a crucial competency in medicine, with physicians expected to provide leadership skills throughout their careers. This study explores the perceptions, attitudes, and interests of medical students and interns in Saudi Arabia regarding medical leadership. Medical graduates are expected to "provide leadership skills that enhance team functioning, the learning environment, and the healthcare delivery system", according to the Association of American Medical Colleges (AAMC).

Methods

A cross-sectional study was conducted from January to July 2023, involving 519 medical students and interns in Saudi Arabia. An online survey covered demographic data, perceptions, attitudes, interests, and self-perceived leadership skills. A pilot study was conducted to ensure the questionnaire's validity and reliability. Data were analyzed using SPSS 26, employing descriptive statistics and inferential tests.

Results

Most participants had a positive perception of leadership (38.3%), with higher scores associated with medical specialties as a career choice (p < 0.001). The majority expressed average interest in medical leadership (29.1%). Communication and organizational skills were highly self-rated leadership attributes. Barriers to leadership implementation included lack of interest (49.3%), inadequate training (45.1%), and time constraints (43.2%). Only 14.6% rated leadership education in medical school as "very good".

Conclusion

This study underscores the importance of leadership in medical education. Integrating comprehensive and structured leadership programs into medical curricula, addressing barriers, and promoting awareness can foster future medical leaders. Continuous evaluation and adaptation are essential for ensuring the relevance and effectiveness of leadership training.

UK trainees' perceptions of leadership and leadership development

PURPOSE

This paper reports on trainees' perceptions of leadership and leadership development, to inform the support that may be provided to them. It draws on a formative evaluation of the new role of clinical leadership mentor (CLM), introduced by Health Education England South-West in 2018. CLMs are responsible for 'overseeing the process and progress of leadership development among the trainees within their Trust/Local Education Provider'.

METHODS

The evaluation was a formative evaluation, based on interviews with CLMs, trainees and trainers and a survey of trainees and trainers. Recruitment was through 8 of the 19 CLMs in the South West. A report for each participating CLM was available to support the development of their individual role. In exploring trainees' perceptions of leadership and leadership development, this paper draws on data from trainees: 112 survey returns which included over 7000 words of free text data and 13 interviews.

FINDINGS

Our findings suggest a more nuanced understanding of leadership in medical trainees than was previously reported in the literature, and a wider acceptance of their leadership role. We highlight the problem of considering postgraduate doctors as a homogeneous group, particularly with reference to specialty. We also highlight that the organisational context for leadership development can be supportive or non-supportive. Leadership learning through genuine leadership experience with appropriate support from trainers and the wider Trust offers opportunities for both trainees and Trusts.

PRACTICAL IMPLICATIONS

Trainees are accepting of their roles as leaders. The value of leadership learning through genuine leadership experience was highlighted. Improving the environment for leadership development offers Trusts and trainees opportunities for genuine service improvement.

Learning by doing: A phenomenological study of medical student leaders

INTRODUCTION

Despite being recognised as a key physician competency, leadership development is an area of improvement especially in undergraduate medical education. We sought to explore the lived experience of leaders who served in elected, representative roles during their time in medical school.

METHODS

We used a hermeneutic phenomenological approach to uncover the essence of the medical student leader experience. From late 2020 to early 2021, we interviewed 12 medical residents who served in elected leadership roles from 2015 to 2019. Each participant graduated from a different Canadian medical school. We deliberately chose a limited and historic time period in order for participants to be able to reflect on their past experiences while accounting for differences in the medical student leadership experience over time. We then engaged in a reflexive thematic analysis to generate the final themes.

RESULTS

We identified the following five themes: (i) living with busyness, (ii) the role of faculty mentorship and support, (iii) competing demands of leadership, (iv) medical student leadership as enriching and (v) creating better physicians. Though demanding, medical student leadership was found to be rewarding and particularly key in the development of a more well-rounded physician. Furthermore, being well supported by faculty contributed to an overall positive leadership experience.

DISCUSSION

In addition to describing the hardships and rewards that make up their experience, this study suggests that medical student leadership can enhance core physician competencies. The findings also support the notion that faculties have an important role to play in supporting medical student leaders.

Transition from undergraduates to residents: A SWOT analysis of the expectations and concerns of Japanese medical graduates during the COVID-19 pandemic

Introduction

Interruptions in undergraduate clinical clerkship during the COVID-19 pandemic have reduced the confidence and preparedness of residents beginning their postgraduate training. We explore the thoughts of new residents about this transition and reflect on the support needed.

Methods

An exploratory qualitative case study was conducted with 51 residents. All had experienced interruptions in clinical training due to the pandemic and had just started their postgraduate training. Qualitative data were collected through 6 focus groups and 12 individual follow-up interviews. A thematic analysis was undertaken, and the data were categorised using a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework.

Results

Graduates beginning their residency were aware of their professionalism and independence during the transition. They also faced the predicament of needing close supervision while their supervisors managed pandemic conditions. Residents emphasised the importance of developing relationships with colleagues and supervisors during the transition to residency and wanted direct observation and detailed feedback from their supervisors during procedures.

Conclusions

The experiences of residents were not uniformly negative. In fact, some had developed a positive mindset when entering the clinical field. Medical faculty members reflecting on interactions with new residents and planning future clinical internships could benefit from placing a high value on building relationships among residents, who may expect direct observation and detailed feedback from their supervisors.

Enhanced model for leadership development for trainees and early career health professionals: insights from a national survey of UK clinical scientists

Introduction

The importance of shared or distributed leadership in healthcare is recognised; however, trainees, early career professionals and others for whom the exercise of leadership is a recent development report being underprepared for leadership roles. Trainee clinical scientists exemplify such groups, being both early in their career and in a profession for which clinical leadership is less well established. Their insights can inform understanding of appropriate forms of leadership development for health professionals.

Methods

We explored perceptions of leadership and its development for trainee clinical scientists on the UK preregistration Scientist Training Programme through semi-structured interviews with trainees, training officers, academic educators and lead healthcare scientists; and through an online questionnaire based on the UK multiprofessional Clinical Leadership Competency Framework (CLCF). Responses were analysed statistically or thematically as appropriate.

Results

Forty interviews were undertaken and 267 valid questionnaire responses received. Stakeholders recognised clinical expertise as integral to leadership; otherwise their perceptions aligned with CLCF domains and ‘shared leadership’ philosophy. They consider learning by ‘doing’ real tasks (leadership activities) key to competency acquisition, with leadership education (eg, observation and theory) complementing these. Workplace affordances, such as quality of departmental leadership, training officer engagement and degree of patient contact affect trainees’ ability to undertake leadership activities.

Conclusions

From our research, we have developed an enhanced model for leadership development for trainee and early career clinical scientists that may have wider applicability to other health professions and groups not traditionally associated with clinical leadership. To foster their leadership, we argue that improving workplace affordances is more important than improving leadership education.

Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study

INTRODUCTION

Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners' solicited and unsolicited conceptualisations of P4P over their early graduate transition.

METHODS

We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio-diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross-sectionally and longitudinally.

RESULTS

We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3).

DISCUSSION

This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders' conceptualisations, and over a duration beyond the early graduate transition.

Leadership and surgical training part 1: preparing to lead the way?

Every day surgeons lead teams on the wards, in clinics and operating theatres, but most trainees and some surgeons do not consider themselves as leaders. Leadership skills are increasingly important for surgeons, who need knowledge of organizational structure and policy, management strategy and team dynamics to deliver and improve health care in resource-constrained environments. The Royal Australasian College of Surgeons recognizes leadership as one of 10 core surgical competencies but leadership curricula within surgical training programmes are not well defined. There is limited opportunity for formal leadership training and development prior to becoming a consultant.

Are We Preparing Medical Students for Their Transition to Clinical Leaders? A National Survey

INTRODUCTION

Leadership is important for organisational teams and patient safety. We aimed to identify leadership behaviours that medical students are developing and consider whether these prepare new graduates to become leaders.

METHODS

We conducted a mixed methods study using an online questionnaire comprising the Clinical Leadership Survey and additional free-text questions. All New Zealand fifth-year medical students and junior doctors (postgraduate year one) were invited to participate. Our analysis used non-parametric testing and general thematic analysis.

RESULTS

Seventy-five students and 43 doctors participated. Participants neither agreed nor disagreed that they were clinical leaders (3 vs 3, n.s.). Students were less sure they used clinical leadership behaviours than doctors (4 vs 3, p = 0.014), but all were using transformational leadership behaviours in clinical environments (60 vs 63 out of a maximum of 75, n.s.). Thirty percent could not give an example of acting as clinical leaders, but 97% described using leadership-type behaviours. Thematic analysis yielded four clinical leadership themes: advocacy, collaboration, leading the way and individualism.

DISCUSSION

Undergraduates appear to be developing and practicing transformational leadership behaviours and junior doctors associate leadership with their role. Participants were unaware of several important leadership behaviours, which could be further developed within an explicit structured curriculum.

Medical Students' perceptions and attitudes toward Medical Leadership and Management

Objectives:

To find out medical students’ perceptions and attitudes toward medical leadership and management (MLM).

Methods:

A total of 336 medical students from the 2^nd to 6^th academic years from King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia (KSA), were included in this cross-sectional study. This study was conducted in January-February 2020. The students were asked about their perceptions, attitudes, and interests in the leadership of medical care and clinicians. A four-part questionnaire was used for collecting data. SPSS-21 was used for analysis.

Results:

The participants included 172 (51.2%) males and 164 (48.8%) females. In total, 105 (31.3%) participants agreed that they had been very well educated about their perception, behavior, and interest in the field of medical leadership and clinic management, and 175 (52.1%) students agreed that clinicians should influence management decisions in a healthcare setting. Overall, 167 (49.7%) students agreed that management/leadership skills are important for clinicians. In total, 145 students (43.2%) desired to have more leadership training in medical school, and 129 (38.4%) students agreed to seek additional leadership/management training in their postgraduate research studies. When asked about their self-perception of good leadership skills, the students indicated that good leadership skills included integrity (47.9%), conflict resolution (46.7%), organization (44.4%), confidence (41.9%), communication (40.5%), self-reflection (40.2%), time management (33.6%), the ability to motivate others (36.9%), and the ability to keep calm under stress (33.3%).

Conclusion:

Many students were well aware of the MLM concepts. However, students agreed that management/leadership skills are important for clinicians, and there should be more leadership training in medical schools.