Developing faculty to teach leadership
Lara Hazelton, MD, MEd
Leadership education is increasingly incorporated into the early stages of medical training, but it is not always clear who should teach and how they should be prepared. Teacher training (faculty development) must be responsive to the needs of a variety of instructors, including physicians who may be unfamiliar with the topic of leadership themselves. This article looks at the limited literature on faculty development for teachers of leadership and recommends approaches.
KEY WORDS: leadership teaching, leadership training, medical leadership, physician leadership
Teaching leadership to medical trainees
Physicians play an important role in the health care system and must possess strong leadership and managerial skills to contribute effectively.1,2 The value ascribed to leadership education is increasingly reflected in the accreditation requirements for programs in undergraduate medical education (UGME) and postgraduate medical education (PGME).3-5 Although this is an exciting trend for those involved in leadership education for physicians, the expansion of the curriculum at both levels raises the question of who is going to teach leadership to medical students and residents and how we can ensure that they are prepared to do so effectively.
Much of what physicians learn about leadership happens during clinical experiences through role modeling and informal instruction. In addition, the Future of Medical Education in Canada survey of Canadian medical schools in 2015 identified a range of approaches to leadership instruction, including seminars, service learning, and advanced degrees.4 At the PGME level, the most common methods are lectures, small group activities, case studies, projects, mentoring, and coaching.6 However, whether teaching occurs formally or informally, on the wards or in the classroom, there is the opportunity for teaching to be improved through faculty development.
Faculty development for physicians
Faculty development is a term used to describe teacher preparation for both faculty and non-faculty instructors. It can usefully be divided into training, educating, and developing teachers. Training focuses on the acquisition of skills required to fulfill a specific role, education produces a range of abilities generalizable across settings, and development encourages personal as well as professional growth.7
Faculty development can target specific competencies needed to carry out teaching activities. For example, a residency program director might decide to teach leadership to residents using a series of cases about transformational leadership.8 Implementing this would require knowledge of transformational leadership on the part of the person creating the curriculum, as well as objective-writing and case-writing abilities. Anyone using a case to teach must be skilled in facilitating small group discussions, evaluating learning, and providing feedback. On the other hand, if the program director decided to introduce a mentorship program, department supervisors might benefit from faculty development sessions on how to be good mentors.9
Faculty development is easiest when the teacher is already a content expert; for example, teaching a surgeon how to give feedback on suturing to a resident. However, in the area of leadership, depending on the instructor, it may be necessary to address content knowledge as well as teaching skills. Many physicians do not feel prepared to be leaders, let alone teachers of leadership.10 It is rare to find a teacher who combines knowledge of both leadership and medicine.
One approach to filling the gap is to is to identify change agents who can be equipped to develop curriculum and introduce new content to colleagues, who can then become teachers.11 An example of such a program is the Royal College’s Advancing Safety for Patients in Residency Education (ASPIRE) program, which prepares faculty to teach quality improvement.12 Physicians with an interest in leadership can become local experts, resource people, and role models for both learners and colleagues. These champions can then provide formal teaching, presenting content explicitly to learners through lectures and other didactic methods. Faculty development can be useful to help them develop their instructional skills or learn more about curriculum design.
Much of learning about leadership occurs informally. Yet, even when teachers think they are teaching leadership, learners may not perceive this to be the case, a reminder about the importance of making teaching explicit as well as implicit.13 Naming many of the activities in which physicians routinely participate (such as conducting ward rounds) as a means of displaying leadership can make these roles visible and allow for reflection on one’s leader identity. Faculty development should also address strategies to assist learners in meeting objectives (whether in a clinical or classroom setting) and provide training for clinical supervisors on the use of evaluation tools.14-16 Top
It has been suggested that faculty development should move beyond traditional approaches and focus on identity, growth, and empowerment.17 Becoming part of a community of practice can help facilitate this growth, and those with an interest in leadership development may choose to join groups like the Association of Leadership Educators or attend conferences, such as the Toronto International Summit on Leadership Education for Physicians (TISLEP). TISLEP has also developed Sanokondu (sites.google.com/site/sanokondu/), a free online resource with curriculum that can be used to teach residents and other learners about leadership.
In the area of didactic teaching, recruiting leadership teachers requires some combination of training physicians and looking outside of medicine.18,19 A review of the literature on leadership education in UGME found that the most commonly identified instructor type was clinical faculty (38%), but a significant number of nonclinical faculty were drawn from other departments (e.g., business schools) and the community.20 Top
In selecting leadership instructors, it is important to consider how they will be perceived by learners. Although concerns about credibility may be an issue for physicians who feel uncomfortable teaching new topics, physicians do bring a knowledge and experience of medicine that may be very influential with learners. Research has shown that learners make judgements about the credibility of feedback based on the instructor’s clinical ability, personal characteristics, and the quality of the “educational alliance.”21,22 The educational alliance is the relationship that exists between the student and the teacher, and it is influenced by interpersonal factors including whether or not the student believes the teacher is genuinely invested in helping foster their learning and development. Credibility in leadership education may also be influenced by whether the instructor has lived experience in leadership or comes from an academic background.23 Top
Unfortunately, we know little about how medical trainees view physician versus non-physician leadership instructors. For example, heavy reliance on non-physician instructors in resident teaching may send a hidden message that leadership is not core to what physicians do, or it may convey the useful concept that physicians can learn from others outside medicine. Until more is known about how credibility judgements are made in leadership education, instructors drawn from outside medicine may benefit from some insight into the culture of medicine as well as general faculty development on how to teach.
As the field of leadership education grows, we can hope to see more research asking not only whether interventions are successful, but also how they might be improved and what constitutes best pedagogical practices. As is frequently the case in medical education, we don’t know if interventions significantly impact leadership behaviour in practice; if they do not, does the fault lie with the curriculum, poor teaching, organizational barriers, or other factors? Top
From a faculty development point of view, more information should be included in publications about who teaches leadership and what is involved in their preparation. Those responsible for recruiting leadership teachers would benefit from knowing more about how learners make credibility judgements about instructors, and how these instructors serve as role models.
Faculty development has the potential to improve leadership education. The ultimate beneficiaries are not only the students, but also the patients and the health care system. However, faculty development should, ideally, give something back to the teacher, too. Fink writes, “Every time you teach, you have an opportunity to learn about teaching and about yourself as a teacher.”24 And, it might be said, every time you teach leadership, your own influence extends a bit further and you become more of a leader yourself.
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Lara Hazelton, MD, MEd, FRCPC, is an associate professor in the Department of Psychiatry and director of academic faculty development in the Faculty of Medicine at Dalhousie University.
This article has been peer reviewed.