Development of a leadership and management module for the undergraduate medical curriculum | BMC Medical Education

Leadership involves creating a vision, setting direction, and inspiring and motivating others towards achieving this vision, while management involves the planning, organizing, directing, and controlling resources to achieve this vision effectively and efficiently [1]. Effective leadership requires a combination of interpersonal skills, strategic thinking, and the ability to foster a positive and productive organizational culture [2]. Despite the terms “leader” and “manager” often being used interchangeably, they are not equivalent. Leaders often focus on change, innovation, and long-term goals, playing a crucial role in shaping the values and behaviours of their teams. Managers are responsible for maintaining stability, optimizing performance, and ensuring that day-to-day operations run smoothly. They focus on short-term goals, resource allocation, and adherence to established procedures and policies [3]. There are several key theories / models of leadership and management [4], which collectively provide a comprehensive framework for developing essential skills that are vital for navigating the complexities of healthcare environments, by emphasizing vision creation, empathy, adaptability, and fostering a positive organizational culture.

In the healthcare sector, both leadership and management are essential for delivering high-quality patient care [5]. Leadership is correlated with quality care and various patient outcomes, such as mortality, safety, satisfaction, and pain management, across different care settings [6]. Effective leadership styles, particularly transformational leadership, are associated with lower patient mortality and higher patient satisfaction [6]. Relational and task-oriented leadership also positively impact patient satisfaction. There are various levels which require both leadership and management, including individual, team, organizational, and national level leadership [7]. Effective leaders foster a culture of innovation and continuous improvement by inspiring and motivating healthcare professionals. At the same time, effective managers ensure that resources are used efficiently, processes are optimised, and organisational goals are met. To achieve high-standard medical leadership, physicians need a broad understanding of healthcare, including political, economic, social, and technological drivers, as well as funding, organisation, governance, and management.

Aspiring leaders need non-technical skills such as vision creation, direction setting, negotiation, self-awareness, collaboration and networking [8]. Despite physicians playing an important leadership role in the management and governance of the healthcare system, many develop such necessary skills through “accidental leadership” (falling into the role without necessarily setting out to become a leader) rather than formal training. The Institute of Medicine (now National Academy of Medicine) recommends that academic health centres develop leaders at all levels to manage the organizational and systems changes necessary to improve health through innovation in health professions education, patient care, and research [9]. In 2015, the Royal College of Physicians and Surgeons of Canada renamed the role of “Manager” to “Leader” as one of the seven principal roles in the CanMEDS Physician Competency Framework [10]. The UK General Medical Council (GMC) identifies that doctors are more than just good clinicians; they also provide leadership to their colleagues and organizations [11]. Demonstrating these responsibilities is a key part of revalidation and maintaining a license to practice. The UK National Health Service (NHS) introduced the Healthcare Leadership Model [12], which consists of nine dimensions of leadership with examples of general leadership behaviours, aiming to help healthcare professionals become better leaders. The model was developed through evidence-based research that reflects NHS values and knowledge on effective leadership and what the patients and communities themselves ask from healthcare providers as leaders.

Leadership and management skills are crucial in postgraduate medical education, but must be incorporated early in the curriculum to prevent “accidental leadership” and equip physicians with the necessary skills to take on more important leadership roles in the healthcare system [13]. Despite this, there has been little effort in reforming undergraduate medical programmes and limited literature on how to incorporate such skills into undergraduate medical programs. A systematic review by Kiesewetter and colleagues identified 8 studies teaching various interpretations of leadership, with only 2 offering this training to undergraduate medical students [14]. Common themes in graduate leadership training include teamwork, leadership models, and change management; however, even postgraduate leadership curricula are heterogeneous and limited in effectiveness [15]. The fundamentals of management should be fully embedded in the curriculum, and partnering with business school faculty to adapt concepts to the healthcare context and integrate this knowledge into practice is desirable [16].

In 2009, the Mayo Medical School conducted a study to identify faculty, student and administrator perspectives on the knowledge and competencies necessary in a leadership curriculum, which at the time did not exist at the School [17]. The Mayo Leadership Education Program for Physicians is now a three-tiered program aimed at various roles, including department and division chairs, staff physicians, scientists, and non-medical administrative leaders. In 2017, Barts and The London Medical School launched the first UK MedTech and Leadership module, “Barts X Medicine”, for medical students. Even though this was a welcome move towards modernization of medical curricula, this module was more about empowerment through digital health concepts, as opposed to a leadership and management course per se [18]. The Physician Leadership Certificate (PLC) developed by the Faculty of Medicine at Memorial University of Newfoundland involved eight 3-hour online asynchronous modules across the 4-year undergraduate programme (2 modules per year) and pre- and post-module tests [19], though the asynchronous mode of delivery may not be ideal for undergraduate students. Evidence suggests a more comprehensive approach to leadership development, addressing emotional intelligence, character, and cognitive competence [20] is needed. The Duke Leadership and Education and Development (LEAD) program, a student-initiated 4-year longitudinal leadership curriculum included aspects of emotional intelligence and selflessness, and was a requirement for graduation.

The key to building high-quality healthcare lies with good medical leadership, with the fundamentals of management fully embedded in the curriculum, partnering with business school faculty to adapt concepts taught in business courses to the healthcare context, and provide opportunities to integrate this knowledge into practice [16]. A “Management 101” module should cover topics related to individual and interpersonal dynamics, team and unit dynamics, and organizational dynamics [21], while also addressing character and emotional intelligence. The inclusion of leadership content in medical curricula will help physicians consider leadership as a desirable option for continuing professional development and career choices in leadership positions [19].

This study aims to address this gap by developing a leadership/management module specifically for undergraduate medical students. The study leverages inter-professional opportunities through partnering with the Medical School and School of Management to develop a module that strengthens leadership components in undergraduate medical programs with adapted material routinely taught to business students. The module design also considers the opinions of medical educators, medical students, and key stakeholders, such as physicians in leadership positions, regarding the necessary knowledge and skills for leadership and management in healthcare. The module was delivered as a pilot to volunteer students of a 6-year undergraduate Doctor of Medicine (MD) program, and participant opinions on its efficacy were assessed after delivery.