Volume 7 no 2

PERSPECTIVE: Leadership in medical education: call to action

Victor Do, MD

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PERSPECTIVE: Leadership in medical education: call to action

Victor Do, MD

https//doi.org/10.37964/cr24731

 

 

Leadership development in medical trainees is a frequent topic of discussion as we continue to grapple with better equipping physicians for the realities of “modern medicine.” Leadership is a critical competency for physicians to foster. Ironically, medical education rarely integrates leadership development into formal curricula. The conversations and formal policies around leadership development are relegated to the “hidden curriculum” of medical education. This paper describes the experience of Canadian medical trainees who pursue leadership opportunities and further training to develop leadership competencies in the context of relevant literature on leadership development. As leadership is a crucial competency to prepare physicians for medicine in 2020 and beyond, promotion of early leadership development in medical training is urgently required.

 

KEY WORDS: leadership development, medical education, policy, national learner organizations

 

CITATION: Do V. Leadership in medical education: call to action. Can J Physician Leadersh 2020;7(2):72–76.

 

Current perspective of learners in undergraduate medical education

 

At their spring general meeting in 2016, Canadian Federation of Medical Student (CFMS) members wrote and endorsed a comprehensive policy paper: Advocacy and Leadership in Canadian Medical Student Curricula.1 The document was meant to serve as a resource for local schools to develop leadership and advocacy curricula. This effort highlighted the passion that medical students have for formal training in these skills. Unfortunately, little progress has been made on its recommendations.

 

As junior trainees, medical students in 2020 recognize and understand the importance of thoughtful, effective, collaborative leadership. Although physicians are often expected to take on formal or informal leadership roles, medical schools and residency continue to lack formal leadership training to prepare future physicians for these roles. At the time of writing, I was unable to find a review that provides direct comparison between leadership curricula at Canadian medical schools.

 

Where there are leadership threads in undergraduate medical programs in Canada, they exist primarily as free-standing lectures or workshops that are not thoroughly integrated into the curriculum map.2 A survey of such curricula conducted by CFMS also found that many programs omitted important concepts, such as integration of health promotion, equity, diversity, and inclusivity, as core leadership principles.2

 

As a result, there is a significant student-led effort to increase leadership education exposure, including student-organized after-hours activities and students pursuing opportunities independently through certificate programs and other course-based education.

 

Leadership development in medical education: a broader view

 

The broader medical education community has recognized the importance of leadership development in medical education for many years now. Recommendation 8 of the 2012 Future of Medical Education in Canada (FMEC) postgraduate education report3 notes the need to “Foster the development of collaborative leadership skills in future physicians, so they can work effectively with other stakeholders to help shape our healthcare system to better serve society.” Although several steps to promote progress were outlined, there has been a paucity of action on this recommendation.

 

In 2015, the CANMEDS physician competency framework4 changed the previous Manager role to Leader, which is defined: “As Leaders, physicians engage with others to contribute to a vision of a high-quality health care system and take responsibility for the delivery of excellent patient care through their activities as clinicians, administrators, scholars, or teachers.” An accompanying list of key and enabling competencies touches on other aspects of health care management, including quality improvement. Efforts have been made to develop resources to integrate this CANMEDS role into residency curricula, and a number of scholarly articles have been published detailing school- or program-specific approaches to developing formal and informal residency leadership curricula/activities.5-7

 

However, data on learner perceptions and confidence in leadership training are currently lacking. Future specific evaluations of this aspect are necessary to allow us to better understand curricular gaps and assess the effectiveness of current teaching. Top

 

Beyond the curriculum: other barriers to leadership development

 

Students who have formal peer-elected leadership positions commonly experience significant difficulty getting time off from rotations and/or rescheduling other educational activities to fulfill their commitments. Many meetings are held during regular weekday working hours and, although participating faculty may have protected time for the meetings if this work is part of their academic appointment, learners face additional barriers, even when they are “excused” from duties. To fulfill training requirements, learners report being required to work additional weekends and/or additional call, making their schedules difficult to navigate. This is a disincentive to participate in leadership.

 

Mentorship and professional development to prepare learners for these roles are often lacking. Participating in formal leadership roles is a significant time commitment and, without support from faculties, may contribute to distress among these learners. Anecdotally, many learners who participate in formal leadership roles have experienced this barrier and often remark at the end of their term that, although they appreciated the opportunity, they feel completely exhausted and would not do it again. Top

 

At certain institutions, learner participation in meetings is more supported; at others, the culture of the program or clinical care site makes it very difficult for a learner to feel comfortable asking for time to participate. It is important to acknowledge that these constraints affect not only learners; the same challenges are also reported by faculty.

 

In contrast, students are actively encouraged and supported to engage in academic research. School policies often allocate “x” days for students to attend conferences where they are presenting research, and some schools have a formal research curriculum or certificate programs that further “legitimize” these pursuits, unlike leadership endeavours. For example, as part of its curriculum, Dalhousie has a research in medicine program, which supports students to do a research project during their pre-clerkship training. Students are eligible to receive scholarship support for these efforts. Other schools have research certificate programs; for example, the University of Alberta’s Special Training in Research program recognizes research endeavours outside the formal curriculum.

 

These research programs are supported and sanctioned by their faculties, meaning formal mentorship, recognition on the student’s performance record or transcript, support to present research and attend associated conferences, and more. In contrast, no leadership training certificate programs or integrated leadership development and project support within undergraduate medical education currently exist in Canada. Top

 

Supporting those on national learner organizations

 

National organizations have traditionally expressed concern with the lack of learner representation at important decision-making tables. Although this has improved significantly, the lack of institutional support for learners to actively participate in such activities continues to have many consequences. Consequences include missing the learner perspective entirely, frequent turnover in the learner representative on committees, and overrepresentation of specialties and institutions whose culture is more supportive of this involvement, limiting the diversity of viewpoints. Although such national organizations as the Association of Faculties of Medicine of Canada have expressed the desire to have the learner perspective as part of decision-making, this will not be achieved unless concurrent policies are implemented to support this ideal.

 

It is important to acknowledge that staff physicians are also often asked to join committees and take on certain leadership-type roles “off the side of their desk” without formally allocated full-time equivalents (FTEs) and, thus, often requiring work to be done on weekends and evenings. Further, even those with formal roles and allocated FTEs are often required to spend much more than the allocated time on leadership roles. This issue is not isolated in medical education, but is systemic in medicine in general. In recognizing this, though, medical education should not continue to perpetuate this phenomenon, but rather build a medical culture where these roles are valued, where faculty and learners are supported with mentorship and professional development to prepare and foster satisfaction and success. Top

 

Defining leadership in medical education

 

One of the difficulties of making progress in advancing leadership development in medical education is the lack of a shared definition of medical leadership on which a national curriculum could be based. Although CANMEDS describes the Leader role,4 a multitude of different leadership theories, models, and definitions continue to evolve as our insight into the competencies required to navigate our health care system continues to advance.

 

Studies have outlined learner and faculty perspectives on leadership development in medical education, important topics to cover, and approaches to teach these competencies.8-10 It may be time for a renewed collaborative effort by learners and educators across the medical education spectrum to commit to reviewing the definitions, competencies, delivery methods, and other aspects of medical training focused on a leadership curriculum. The aim of this should not be defining and teaching leadership for the sake of “teaching leadership,” but rather we should closely link our work with how we can influence health outcomes. Top

 

Leadership skills for all trainees

 

With all the discussion regarding leadership, one may ask, “what if I never want to be in a formal leadership role?” This highlights another misconception that is often associated with the conversation around leadership development and competencies. Physicians need not be in formal leadership roles to display outstanding leadership skills. Medical students, residents, and staff physicians must use leadership competencies every day. As we further explore the definitions of leadership and how we develop it in learners throughout the career spectrum, we must also take time to consider how the renewed focus and influences of physician well-being, equity, diversity, inclusivity, and other emerging areas of focus affect theories of leadership.

 

Ward senior resident, for example, whether regarded as a leadership role or not, requires significant leadership skills. Senior residents have an untold amount of influence on patients, other medical trainees, and allied health members of care teams. Their knowledge of how to support others in reaching their greatest potential, foster a health-promoting environment, model patient care with dignity and respect, and much more make it a very difficult job to do well, even if one is very competent in the Medical expert role.

 

The urgency of this work is important to recognize. The medical education community has the potential to significantly improve physician training by optimizing how we development leadership skills. Top

 

Taking collective action

 

Making meaningful progress in integrating leadership development into medical education will require the following steps.

 

  1. Organize a virtual summit attended by medical education stakeholders across the trainee spectrum, including undergraduate and postgraduate deans and learners, to initiate development of a strategic framework to implement the FMEC’s recommendation 8, Foster leadership development.3 Implementation should include an oversight group comprising undergraduate and postgraduate medical education leadership and learners to monitor progress and ensure accountabilities.
  2. Develop a formal undergraduate and postgraduate Canadian medical leadership curriculum framework aligned with the FMEC objectives. The oversight group may be able to play a role in helping the many different initiatives at different institutions connect and collaborate.
  3. Residency programs and undergraduate medical programs should re-evaluate how their curricula, policies, and culture support leadership development among learners in the program.
  4. Ensure that the learner perspective is represented in discussions on policy changes in leadership development.
  5. Medical schools must commit to improved continuing professional education in leadership competencies for faculty.
  6. Undertake ongoing leadership development program evaluation and reform. This should be supported by multi-institutional academic research to study the effects of this progress and work on medical student and resident leadership competencies.

 

Medical students, residents, and their representative learner organizations are ready and eager to make meaningful progress toward these goals. Through collaboration and commitment, transforming leadership development for physician trainees can make a substantial difference in health care delivery. Improved physician leadership competencies will allow physicians to more effectively integrate patient perspectives, foster collegiality and a renewed positive culture, and navigate the challenges that technology poses regarding how we practise among a host of other opportunities in 2020 and beyond. Top

 

References

 

1.Benrimoh D, Hodgson E, Demko N, Chen BY, Habte R, Dandurand-Bolduc C, et al. Advocacy and leadership in Canadian medical student curricula. Policy paper. Ottawa: Canadian Federation of Medical Students; and Montréal: Fédération médicale étudiante du Québec; 2016. Available: https://tinyurl.com/y3ap72y8

2.Academic roundtable student surveys. Ottawa: Canadian Federation of Medical Students; 2018–2020. Unpublished.

3.The future of medical education in Canada: a collective vision for postgraduate medical education in Canada. Ottawa: Association of Faculties of Medicine of Canada; 2012. Available: https://tinyurl.com/yyxntde8

4.Frank JR, Snell L, Sherbino J (editors). CanMEDS 2015: physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. Available: https://tinyurl.com/j53ulbz

5.Ginzburg SB, Schwartz J, Gerber R, Deutsch S, Elkowitz DE, Ventura-Dipersia. Assessment of medical students’ leadership traits in a problem/case-based learning program. Med Educ Online 2018;23(1):1542923. https://doi.org/10.1080/10872981.2018.1542923

6.Busari JO, Yaldiz H, Verstegen D. Serious games as an educational strategy for management and leadership development in postgraduate medical education — an exploratory inquiry. Adv Med Educ Pract 2018;9:571-9. https://doi.org/10.2147/AMEP.S171391

7.Richard K, Noujaim M, Thorndyke LE, Fischer MA. Preparing medical students to be physician leaders: a leadership training program for students designed and led by students. Med Ed Portal 2019. https://doi.org/10.15766/mep_2374-8265.10863

8.Rouhani MJ, Burleigh EJ, Hobbis C, Dunford C, Osman NI, Gan C, et al. UK medical students’ perceptions, attitudes, and interest toward medical leadership and clinician managers. Adv Med Educ Pract 2018;9:119-24. https://doi.org/10.2147/AMEP.S151436

9.Sultan B, Torti J, Haddara W, Inayat A, Inayat H, Lingard L. Leadership development in postgraduate medical education: a systematic review of the literature. Acad Med 2019;94(3):440-9. https://doi.org/10.1097/ACM.0000000000002503

10.Karpinski J, Samson L, Moreau K. Residents as leaders: a comprehensive guide to establishing a leadership development program for postgraduate trainees. Med Ed Portal 2015;Aug. https://doi.org/10.15766/mep_2374-8265.10168

11.Kiesewetter J, Schmidt-Huber M, Netzel J, Krohn AC, Angstwurm M, Fischer MR. Training of leadership skills in medical education. GMS Z Med Ausbild 2013;30(4):Doc 49.

 

Author

Victor Do, MD, is an R1 pediatrics resident at the University of Toronto. Previously, he was at the University of Alberta, Edmonton.

 

Correspondence to: vdo@ualberta.ca

 

This article has been peer reviewed.

 

Top

PERSPECTIVE: Leadership in medical education: call to action

Victor Do, MD

https//doi.org/10.37964/cr24731

 

 

Leadership development in medical trainees is a frequent topic of discussion as we continue to grapple with better equipping physicians for the realities of “modern medicine.” Leadership is a critical competency for physicians to foster. Ironically, medical education rarely integrates leadership development into formal curricula. The conversations and formal policies around leadership development are relegated to the “hidden curriculum” of medical education. This paper describes the experience of Canadian medical trainees who pursue leadership opportunities and further training to develop leadership competencies in the context of relevant literature on leadership development. As leadership is a crucial competency to prepare physicians for medicine in 2020 and beyond, promotion of early leadership development in medical training is urgently required.

 

KEY WORDS: leadership development, medical education, policy, national learner organizations

 

CITATION: Do V. Leadership in medical education: call to action. Can J Physician Leadersh 2020;7(2):72–76.

 

Current perspective of learners in undergraduate medical education

 

At their spring general meeting in 2016, Canadian Federation of Medical Student (CFMS) members wrote and endorsed a comprehensive policy paper: Advocacy and Leadership in Canadian Medical Student Curricula.1 The document was meant to serve as a resource for local schools to develop leadership and advocacy curricula. This effort highlighted the passion that medical students have for formal training in these skills. Unfortunately, little progress has been made on its recommendations.

 

As junior trainees, medical students in 2020 recognize and understand the importance of thoughtful, effective, collaborative leadership. Although physicians are often expected to take on formal or informal leadership roles, medical schools and residency continue to lack formal leadership training to prepare future physicians for these roles. At the time of writing, I was unable to find a review that provides direct comparison between leadership curricula at Canadian medical schools.

 

Where there are leadership threads in undergraduate medical programs in Canada, they exist primarily as free-standing lectures or workshops that are not thoroughly integrated into the curriculum map.2 A survey of such curricula conducted by CFMS also found that many programs omitted important concepts, such as integration of health promotion, equity, diversity, and inclusivity, as core leadership principles.2

 

As a result, there is a significant student-led effort to increase leadership education exposure, including student-organized after-hours activities and students pursuing opportunities independently through certificate programs and other course-based education.

 

Leadership development in medical education: a broader view

 

The broader medical education community has recognized the importance of leadership development in medical education for many years now. Recommendation 8 of the 2012 Future of Medical Education in Canada (FMEC) postgraduate education report3 notes the need to “Foster the development of collaborative leadership skills in future physicians, so they can work effectively with other stakeholders to help shape our healthcare system to better serve society.” Although several steps to promote progress were outlined, there has been a paucity of action on this recommendation.

 

In 2015, the CANMEDS physician competency framework4 changed the previous Manager role to Leader, which is defined: “As Leaders, physicians engage with others to contribute to a vision of a high-quality health care system and take responsibility for the delivery of excellent patient care through their activities as clinicians, administrators, scholars, or teachers.” An accompanying list of key and enabling competencies touches on other aspects of health care management, including quality improvement. Efforts have been made to develop resources to integrate this CANMEDS role into residency curricula, and a number of scholarly articles have been published detailing school- or program-specific approaches to developing formal and informal residency leadership curricula/activities.5-7

 

However, data on learner perceptions and confidence in leadership training are currently lacking. Future specific evaluations of this aspect are necessary to allow us to better understand curricular gaps and assess the effectiveness of current teaching. Top

 

Beyond the curriculum: other barriers to leadership development

 

Students who have formal peer-elected leadership positions commonly experience significant difficulty getting time off from rotations and/or rescheduling other educational activities to fulfill their commitments. Many meetings are held during regular weekday working hours and, although participating faculty may have protected time for the meetings if this work is part of their academic appointment, learners face additional barriers, even when they are “excused” from duties. To fulfill training requirements, learners report being required to work additional weekends and/or additional call, making their schedules difficult to navigate. This is a disincentive to participate in leadership.

 

Mentorship and professional development to prepare learners for these roles are often lacking. Participating in formal leadership roles is a significant time commitment and, without support from faculties, may contribute to distress among these learners. Anecdotally, many learners who participate in formal leadership roles have experienced this barrier and often remark at the end of their term that, although they appreciated the opportunity, they feel completely exhausted and would not do it again. Top

 

At certain institutions, learner participation in meetings is more supported; at others, the culture of the program or clinical care site makes it very difficult for a learner to feel comfortable asking for time to participate. It is important to acknowledge that these constraints affect not only learners; the same challenges are also reported by faculty.

 

In contrast, students are actively encouraged and supported to engage in academic research. School policies often allocate “x” days for students to attend conferences where they are presenting research, and some schools have a formal research curriculum or certificate programs that further “legitimize” these pursuits, unlike leadership endeavours. For example, as part of its curriculum, Dalhousie has a research in medicine program, which supports students to do a research project during their pre-clerkship training. Students are eligible to receive scholarship support for these efforts. Other schools have research certificate programs; for example, the University of Alberta’s Special Training in Research program recognizes research endeavours outside the formal curriculum.

 

These research programs are supported and sanctioned by their faculties, meaning formal mentorship, recognition on the student’s performance record or transcript, support to present research and attend associated conferences, and more. In contrast, no leadership training certificate programs or integrated leadership development and project support within undergraduate medical education currently exist in Canada. Top

 

Supporting those on national learner organizations

 

National organizations have traditionally expressed concern with the lack of learner representation at important decision-making tables. Although this has improved significantly, the lack of institutional support for learners to actively participate in such activities continues to have many consequences. Consequences include missing the learner perspective entirely, frequent turnover in the learner representative on committees, and overrepresentation of specialties and institutions whose culture is more supportive of this involvement, limiting the diversity of viewpoints. Although such national organizations as the Association of Faculties of Medicine of Canada have expressed the desire to have the learner perspective as part of decision-making, this will not be achieved unless concurrent policies are implemented to support this ideal.

 

It is important to acknowledge that staff physicians are also often asked to join committees and take on certain leadership-type roles “off the side of their desk” without formally allocated full-time equivalents (FTEs) and, thus, often requiring work to be done on weekends and evenings. Further, even those with formal roles and allocated FTEs are often required to spend much more than the allocated time on leadership roles. This issue is not isolated in medical education, but is systemic in medicine in general. In recognizing this, though, medical education should not continue to perpetuate this phenomenon, but rather build a medical culture where these roles are valued, where faculty and learners are supported with mentorship and professional development to prepare and foster satisfaction and success. Top

 

Defining leadership in medical education

 

One of the difficulties of making progress in advancing leadership development in medical education is the lack of a shared definition of medical leadership on which a national curriculum could be based. Although CANMEDS describes the Leader role,4 a multitude of different leadership theories, models, and definitions continue to evolve as our insight into the competencies required to navigate our health care system continues to advance.

 

Studies have outlined learner and faculty perspectives on leadership development in medical education, important topics to cover, and approaches to teach these competencies.8-10 It may be time for a renewed collaborative effort by learners and educators across the medical education spectrum to commit to reviewing the definitions, competencies, delivery methods, and other aspects of medical training focused on a leadership curriculum. The aim of this should not be defining and teaching leadership for the sake of “teaching leadership,” but rather we should closely link our work with how we can influence health outcomes. Top

 

Leadership skills for all trainees

 

With all the discussion regarding leadership, one may ask, “what if I never want to be in a formal leadership role?” This highlights another misconception that is often associated with the conversation around leadership development and competencies. Physicians need not be in formal leadership roles to display outstanding leadership skills. Medical students, residents, and staff physicians must use leadership competencies every day. As we further explore the definitions of leadership and how we develop it in learners throughout the career spectrum, we must also take time to consider how the renewed focus and influences of physician well-being, equity, diversity, inclusivity, and other emerging areas of focus affect theories of leadership.

 

Ward senior resident, for example, whether regarded as a leadership role or not, requires significant leadership skills. Senior residents have an untold amount of influence on patients, other medical trainees, and allied health members of care teams. Their knowledge of how to support others in reaching their greatest potential, foster a health-promoting environment, model patient care with dignity and respect, and much more make it a very difficult job to do well, even if one is very competent in the Medical expert role.

 

The urgency of this work is important to recognize. The medical education community has the potential to significantly improve physician training by optimizing how we development leadership skills. Top

 

Taking collective action

 

Making meaningful progress in integrating leadership development into medical education will require the following steps.

 

  1. Organize a virtual summit attended by medical education stakeholders across the trainee spectrum, including undergraduate and postgraduate deans and learners, to initiate development of a strategic framework to implement the FMEC’s recommendation 8, Foster leadership development.3 Implementation should include an oversight group comprising undergraduate and postgraduate medical education leadership and learners to monitor progress and ensure accountabilities.
  2. Develop a formal undergraduate and postgraduate Canadian medical leadership curriculum framework aligned with the FMEC objectives. The oversight group may be able to play a role in helping the many different initiatives at different institutions connect and collaborate.
  3. Residency programs and undergraduate medical programs should re-evaluate how their curricula, policies, and culture support leadership development among learners in the program.
  4. Ensure that the learner perspective is represented in discussions on policy changes in leadership development.
  5. Medical schools must commit to improved continuing professional education in leadership competencies for faculty.
  6. Undertake ongoing leadership development program evaluation and reform. This should be supported by multi-institutional academic research to study the effects of this progress and work on medical student and resident leadership competencies.

 

Medical students, residents, and their representative learner organizations are ready and eager to make meaningful progress toward these goals. Through collaboration and commitment, transforming leadership development for physician trainees can make a substantial difference in health care delivery. Improved physician leadership competencies will allow physicians to more effectively integrate patient perspectives, foster collegiality and a renewed positive culture, and navigate the challenges that technology poses regarding how we practise among a host of other opportunities in 2020 and beyond. Top

 

References

 

1.Benrimoh D, Hodgson E, Demko N, Chen BY, Habte R, Dandurand-Bolduc C, et al. Advocacy and leadership in Canadian medical student curricula. Policy paper. Ottawa: Canadian Federation of Medical Students; and Montréal: Fédération médicale étudiante du Québec; 2016. Available: https://tinyurl.com/y3ap72y8

2.Academic roundtable student surveys. Ottawa: Canadian Federation of Medical Students; 2018–2020. Unpublished.

3.The future of medical education in Canada: a collective vision for postgraduate medical education in Canada. Ottawa: Association of Faculties of Medicine of Canada; 2012. Available: https://tinyurl.com/yyxntde8

4.Frank JR, Snell L, Sherbino J (editors). CanMEDS 2015: physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. Available: https://tinyurl.com/j53ulbz

5.Ginzburg SB, Schwartz J, Gerber R, Deutsch S, Elkowitz DE, Ventura-Dipersia. Assessment of medical students’ leadership traits in a problem/case-based learning program. Med Educ Online 2018;23(1):1542923. https://doi.org/10.1080/10872981.2018.1542923

6.Busari JO, Yaldiz H, Verstegen D. Serious games as an educational strategy for management and leadership development in postgraduate medical education — an exploratory inquiry. Adv Med Educ Pract 2018;9:571-9. https://doi.org/10.2147/AMEP.S171391

7.Richard K, Noujaim M, Thorndyke LE, Fischer MA. Preparing medical students to be physician leaders: a leadership training program for students designed and led by students. Med Ed Portal 2019. https://doi.org/10.15766/mep_2374-8265.10863

8.Rouhani MJ, Burleigh EJ, Hobbis C, Dunford C, Osman NI, Gan C, et al. UK medical students’ perceptions, attitudes, and interest toward medical leadership and clinician managers. Adv Med Educ Pract 2018;9:119-24. https://doi.org/10.2147/AMEP.S151436

9.Sultan B, Torti J, Haddara W, Inayat A, Inayat H, Lingard L. Leadership development in postgraduate medical education: a systematic review of the literature. Acad Med 2019;94(3):440-9. https://doi.org/10.1097/ACM.0000000000002503

10.Karpinski J, Samson L, Moreau K. Residents as leaders: a comprehensive guide to establishing a leadership development program for postgraduate trainees. Med Ed Portal 2015;Aug. https://doi.org/10.15766/mep_2374-8265.10168

11.Kiesewetter J, Schmidt-Huber M, Netzel J, Krohn AC, Angstwurm M, Fischer MR. Training of leadership skills in medical education. GMS Z Med Ausbild 2013;30(4):Doc 49.

 

Author

Victor Do, MD, is an R1 pediatrics resident at the University of Toronto. Previously, he was at the University of Alberta, Edmonton.

 

Correspondence to: vdo@ualberta.ca

 

This article has been peer reviewed.

 

Top

At certain institutions, learner participation in meetings is more supported; at others, the culture of the program or clinical care site makes it very difficult for a learner to feel comfortable asking for time to participate. It is important to acknowledge that these constraints affect not only learners; the same challenges are also reported by faculty.