Leadership development for doctors: Are we turning a corner?
The development of leadership skills in trainee doctors is an issue which has been debated over many years, but may have taken a decisive turn recently.
In the past leadership was often considered alongside, or one of, several ‘non-clinical’, or ‘non-technical’ skills, or more generally under the banner of ‘professionalism’. In 2017 the GMC published the Generic Professional Capabilities framework (GPC) and requires that it is reflected in revised postgraduate curricula by 2020, although this process may be delayed by the Covid-19 pandemic.
The GPC framework includes generic clinical and non-clinical skills, and includes the domains of leadership and team working, and patient safety and quality improvement. Although the GMC in its role as professional regulatory body has promoted leadership and teamwork for many years, the revised curricula require that leadership, teamwork, patient safety, and quality improvement formally become part of all postgraduate medical training and will be assessed alongside other clinical and non-clinical skills and knowledge. Guidance published by the GMC and the Academy of Medical Royal Colleges says that the 'inclusion of generic professional capabilities within the new standards for curricula is a significant change in the approach to formalising professionalism within training’.
There is a long road from making the regulatory changes to the actual delivery of improved leadership development opportunities for all trainee doctors, as part of training programmes, and assessed as a key generic capability. Leadership is only one element of the Generic Professional Capabilities framework, and all parts of the system are struggling with workload demands. The GMC’s recent report Caring for doctors, caring for patients paints a bleak picture:
'The doctors in training we spoke to described challenges that have the combined effect of significantly reducing autonomy/control, belonging and competence. Indeed, the role of doctors in training seems perversely designed to prevent the fulfilment of all three needs.'
A new approach in the South-West
Health Education England in the South West (Peninsula and Severn Deaneries) developed a Clinical Leadership Mentor (CLM) scheme in 2018, appointing Mentors in 19 Trusts. These part time medical appointments (2 hours a week in the initial phase) were made to support the leadership development of junior doctors, by working directly with them and with Trust and education leaders. The Centre for Health and Social Care Leadership at the University of Birmingham worked with the mentors and an external facilitator to evaluate their work, and the evaluation report is published today. The evaluation was supported by the NHS Leadership Academy.
We surveyed and interviewed CLMs, trainees, educational supervisors, and Trust Leaders. There was significant variation within the CLM group, regarding their roles and experience, and the size and context of Trust. For example some CLMs worked mainly with individual trainees, and some worked with colleagues who supported trainees, such as educational supervisors. Across the group, CLMs:
- Signposted leadership development opportunities to trainees and trainers
- Developed shadowing schemes for trainees and Trust leaders
- Developed and delivered training sessions
- Built informal support teams for leadership development, including, for example Chief Registrars and Leadership Fellows
- Mentored individual trainees
- Attended induction sessions
- Supported trainees involvement in Quality Improvement initiatives
The role of CLMs was welcomed by trainees and educational supervisors. Our survey showed that Educational Supervisors were engaged with leadership, although many suggested that they needed more information about the new curriculum to be able to support trainees (as is acknowledged in the implementation guidance).
Our evaluation also had other encouraging findings. Trainees embraced the idea of leadership as part of clinical practice with 78% considering themselves to be a leader, a higher figure than some other recent research. Eighty per cent of the trainees had undertaken a Quality Improvement project.
The final finding to highlight is variability in the environment for leadership development between Trusts: 86% of trainees surveyed reported variability, which suggests opportunities for improvement, and learning between Trusts. An example given was that some Trusts supported Quality Improvement projects in clinical teams, while other trainees received minimal support from the Trust, and little prospect of change. The Caring for doctors, caring for patients report reviewed a range of evidence that showed the quality of services improves when doctors, and particularly doctors in training, are well supported with high levels of wellbeing concern, and compassionate leadership in the Trust. With better support for leadership development it is likely that doctors in training will be more able to contribute to improvements in education and service.
Although difficult to demonstrate in purely financial terms, the cost of Clinical Leadership Mentor posts is likely to be recouped through service improvements. The new curricula will offer opportunities to Trusts and Trust managers, who have expertise in leadership and team working, and patient safety and quality improvement, to engage more fully with medical education. Clinical Leadership Mentors are well placed to lead and support improvement – are we turning a corner towards improved leadership development for doctors?
This viewpoint was written by Iain Snelling, Senior Fellow in the Health Services Management Centre.