Prioritizing an overlooked lesson in medical school: How to lead

Leadership training at the medical school level provides the opportunity for health professions students to become collaborators and lead change. Yet the concept of training tomorrow’s physicians to be leaders is relatively unestablished in medical education. “This is very new for most of medical education. There is no uniform model or blueprint to follow,” said Rajesh S. Mangrulkar, MD, associate dean for medical student education at the University of Michigan Medical School. “There are many competing agendas, and thus it is taking multiple different forms at multiple schools.”

Dr. Mangrulkar, who has done extensive work on student leadership, was among the presenters at a recent AMA Innovations in Medical Education Webinar, "Leadership Training: Developing the Next Generation of Physician Leaders." The webinar offered a look at curricular initiatives involving leadership and insight on medical students’ perspective on the topic.

In August 2017, University of Michigan Medical School hosted the Accelerating Change in Medical Education Student-Led Conference on Leadership. The conference was organized by medical students from Michigan and eight other institutions.

In the aftermath of that event, two students from Vanderbilt University School of Medicine—Julia Pitkin, MD, a recent Vanderbilt graduate, and Shilpa Mokshadundam, a rising fourth-year student— surveyed student stakeholders to get their vantage point medical student leadership opportunities. Their research identified a number of recurring themes among survey respondents, including:

• A lack of opportunities for medical student leadership.
• A desire for practical, hands-on leadership curriculum, including student-driven leadership projects and opportunities for collaboration with other professional schools.
• Student interest in participating on curriculum committees and contributing to administrative decision-making.
• The hierarchical nature of medicine as a barrier in seeking out new leadership roles.
• The importance of institutional culture in supporting med student leadership.

In addition to listing a number of barriers to medical student leadership and offering practical solutions, Dr. Pitkin highlighted the importance of heeding medical student feedback on this topic. “Not only are we investing in the physicians of the future by supporting student leaders, but as [the student-led conference proved], students provide a wealth of unique ideas,” she said. “It is in the best interest of all parties to give them an opportunity to voice them.”

In examining the leadership training methods used by the University of North Carolina (UNC) Kenan-Flagerler Business School, Timothy P. Daaleman, DO, was intrigued by the program’s emphasis on shaping leaders, developing character and improving performance.

“Clearly there are transferrable lessons when you look at those basic principals in applying toward leadership development within a school of medicine,” said Dr. Daaleman, a professor of family medicine and the director of leadership development at University of North Carolina School of Medicine. Based on the Kenan-Flagerler’s template for leadership training, the UNC School of Medicine Leadership Initiative is now in the pilot phase. The program is broken down into three phases that extend throughout a student’s undergraduate medical training:

• The foundational phase, which focuses on increasing self-awareness and effective communication. To give students an idea of where they stand, UNC utilizes StrengthsFinders, an assessment tool with a wide range of different types of inventories, during orientation for first-year medical students.
• The application phase emphasizes learning with others and building through collaborative relationships. To further examine how students begin to look at peer communication, UNC has incorporated a Situation Behavior Impact and Assessment (SBIA model) into the teaching of the traditional physical diagnosis.
• The individualization phase aims to give students the tools to manage conflict and act with integrity. To learn these tenets, UNC has incorporated a simulation in a selective course that is required for fourth-year medical students. As part of the simulation, students receive communications from different mediums and stakeholders and are required to prioritize them according to importance.