Clinical leadership behaviours in New Zealand medical students and new graduate doctors: Are we preparing medical students for their transition to clinical leaders?

Abstract

Introduction Leadership is key to the functioning of organisational teams and important for patient safety. Regardless of rank or specialisation all doctors, will at times, hold leadership roles in healthcare teams. Aim To identify the clinical leadership behaviours New Zealand medical students are developing and whether these behaviours prepare new graduates to become leaders in the clinical workplace. Methods This was a mixed methods study conducted using an online questionnaire, incorporating the Clinical Leadership Survey and free text questions. Fifth-year medical students and postgraduate year one (PGY1) doctors in New Zealand, during 2016, were invited to participate. Results Seventy-five medical students and 43 PGY1 doctors responded. Approximately a quarter received leadership training during medical school. Medical students and PGY1 doctors neither agree nor disagree that they are clinical leaders (5-point Likert Global Clinical Leadership Scale 3 vs 3; p = 0.275). Medical students neither agree nor disagree that they use clinical leadership behaviours, but PGY1 doctors agree that they do (5-point Likert Global Leadership Behaviour Scale 3 vs 4; p = 0.014). However, both groups use transformational leadership behaviours in their clinical environments (Total Clinical Leadership Score 60 vs 63 out of a maximum of 75; p = 0.174). A third of respondents could not give an example of being a clinical leader but almost all described leadership behaviours that they use in clinical practice. Five clinical leadership themes emerged, through thematic analysis: advocacy, collaboration, leading the way, individualistic and development. Observation of clinical leaders suggested that being the boss was related to seniority, with students holding the most inferior hierarchical position. Respondents believe that clinical leadership is a taught skill not an inherent trait and described a cycle of experiential learning. Conclusions Even though they may not be aware that they are learning leadership skills or acting as leaders, undergraduates are developing and practicing transformational leadership behaviours. Medical students and PGY1 doctors display similar behaviours but demonstrate these in different ways. Medical students feel that the medical hierarchy limits their leadership role. Leadership skills could be further developed with an explicit structured curriculum to acknowledge and focus learning.