8/3/2019 A Medical Students Perspective

1/3December 2011

LEADERSHIP IN MEDICINE:

A MEDICAL STUDENTS

PERSPECTIVE

In my various medical rotations, I have had

the privilege to work with many doctors

on different teams and to approach thingsfrom an outsiders view. The doctors that

embody medical leadership are those that

have picked up areas for improvement in

systems, made the extra effort to execute

effective change and advocated for the

patient beyond the medical/disease

paradigm. For me, these have been the

clinical experts whose foci were also on the

broader social determinants of health.

A word that I seem to hear with increasing

frequency in medical education is

professionalism. A recent LancetCommission (1) on the education of

health professionals in the 21st century

has emphasised the need to develop

leadership attributes using a new

paradigm of transformative learning. In the

report, the authors advocated for a new

professionalism with the outcome of health

professional education to develop change

agents for society.

By Philip Pinhao Chao5th Year Medical Student

The University of Auckland

8/3/2019 A Medical Students Perspective

2/3December 2011

There are examples of extracurricular

for medical students (2), including the

International Federation of Medical

Training New Trainers (TNT) programme.

Some extracurricular streams havebeen well supported by Universities and

involve engagement with the community

(3). There is an increasing trend to

integrate leadership curriculum into

medical education. Examples include a

novel selective leadership course at the

University of North Carolina Chapel Hill

(4) and integration with gross anatomy

dissection groups at the Mayo ClinicCollege of Medicine (5).

Currently at the University of Auckland, there

is a 2-day Quality and Safety Symposium

that third year medical students participate

in, together with colleagues from nursing

and pharmacy. I found this to be a valuable,

albeit brief insight into leadership in health

with inspiring keynote presenters. The

weeklong Population Health Intensive in

the development of leadership amongst

medical students. The experiential teamwork,

engagement with community organisations,

real-world needs analysis and problem solving

provided a pertinent demonstration of the

potential for integrated leadership development

in the curriculum.

However two initiatives in a 6-year long

features so prominently in the role of a

doctor. As a medical student, I would like

to hear more from health professionals at

the forefront of making decisions that will

affect my future practice: Clinical leaders

who are tasked with addressing workforce

issues in New Zealand; policy advisors

who shape decisions; and global healthleaders who make an impact on a world

scale. In the same vein that researchers

involve students early in research to

inspire a lifelong pursuit of research,

clinical leaders may provide opportunities

for students to get involved in advocacy

projects in our undergraduate years.

It is not uncommon as a medical student

in social gatherings to be asked our

opinions about health policies and the

health situation de-jour. Society expects

doctors to have an opinion on health

issues and a criterion for successful

admissions interviews requires some

knowledge and demonstration of critical

analysis of the current health environment.

Yet when we go through medical school,

this critical analysis of topical health issuesis somewhat lacking. We learn more of

historic events and facts than engaging in

the discussions of today.

There is a move at both New Zealand

universities to involve more small-group

teaching. I believe this would be an opportune

avenue to facilitate the development of

leadership traits. Through more experiential

learning, being involved in either real-life

projects or by simulation, students can develop

stead into the workforce.

The current revision of the undergraduate

curriculum in Auckland, the foundation of

the New Zealand Centre of Excellence in

Health Care Leadership, and the launch of the

Counties Manukau District Health Board Ko

Awatea Innovation Centre all indicate that thetime for change is now.

Leadership in medicine is required to

address inequalities that exist in health

today (1). Medical students can develop the

skills to become effective clinical leaders,

even with our limited clinical experience.

Leadership training should start in the

undergraduate medical curriculum. In an

environment that is increasingly dependent

on multidisciplinary teams, medical

8/3/2019 A Medical Students Perspective

3/3December 2011

students can and have played a role in

promoting inter-professional learning and

have been found to be a key element in its

success (6,7).

Change in medical education takes time

as it needs to go through many essential

processes. However medical students are

able to develop effective programmes (2) and

address local inequalities (8). Extracurricular

activities have been associated with

leadership styles and should be encouraged(9). In addition, medical students involved in

community leadership initiatives chose to

specialise in family medicine at rate more than

three times that of their colleagues (3).

I believe that the age-old adage in

medicine of see one, do one, teach one

also applies to leadership skills. We are

increasingly seeing the importance of

leaders on the wards and in policymaking

taking on a more prominent role. Medical

students do not have to wait for new

education reforms to get involved in

leadership opportunities through student

groups or self-generated projects.

The next step will be teaching and

disseminating the many combined years

of experience from student leaders in New

Zealand to an upcoming generation of

medical students.

One recent initiative is the Leadership

and Global Health Workshop - a

multidisciplinary, shared collaborative

between the New Zealand Medical

Students Association (NZMSA) and

Medical Students for Global Awareness

(MSGA) across New Zealand. It makes useof the Institute for Healthcare Improvement

(IHI) Open School and the experiences of

recent alumni to address the perceived

gap in training in the these two subjects in

the undergraduate curricula.

There is no easy solution, but judging

from the enthusiasm displayed by

many medical students, the outlook is

positive. Leadership initiatives that buildsuccessful change agents must act locally

in collaboration with our communities to

executive sustainable change.

References

1. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al.

Health professionals for a new century: transforming education

to strengthen health systems in an interdependent world. Lancet.

[Consensus Development Conference Research Support, Non-U.S.

Govt]. 2010 Dec 4;376(9756):1923-58.

2. Hedgecock J, Steyer TE. The American Medical Student

Associations contributions to advancing primary care. Acad

Med. [Historical Article Research Support, Non-U.S. Govt]. 2008

Nov;83(11):1057-9.

3. Carufel-Wert DA, Younkin S, Foertsch J, Eisenberg T, Haq CL,

Crouse BJ, et al. LOCUS: immunizing medical students against

the loss of professional values. Fam Med. [Research Support, U.S.

Govt, P.H.S.]. 2007 May;39(5):320-5.

4. Goldstein AO, Calleson D, Bearman R, Steiner BD, Frasier PY, Slatt

L. Teaching Advanced Leadership Skills in Community Service

(ALSCS) to medical students. Acad Med. [Research Support, U.S.

Govt, P.H.S.Review]. 2009 Jun;84(6):754-64.

5. Pawlina W, Hromanik MJ, Milanese TR, Dierkhising R, Viggiano TR,

Carmichael SW. Leadership and professionalism curriculum in theGross Anatomy course. Ann Acad Med Singapore. [Comparative

Study]. 2006 Sep;35(9):609-14.

6. Stigler FL, Duvivier RJ, Weggemans M, Salzer HJF. Health

professionals for the 21st century: a students view. Lancet.

[Comment]. 2010 Dec 4;376(9756):1877-8.

7.

implications for educators, researchers and policymakers. Med

Educ. 2008 Jul;42(7):654-61.

8. Hsu LD, DeJong W, Hsia R, Chang M, Ryou M, Yeh E. Student

leadership in public health advocacy: lessons learned from the

hepatitis B initiative. Am J Public Health. [Research Support, Non-

U.S. Govt]. 2003 Aug;93(8):1250-2.

9. Sriratanaban J, Chiravisit M, Viputsiri O. Predictors of leadership

styles of medical students: implications for medical education. J

Med Assoc Thai. 1999 Sep;82(9):900-6.