Introduction
Leadership is a growing topic of interest in medicine and medical school education.
The Association of American Medical Colleges now identifies leadership as “the most
critical component for success”.
1
Some medical schools in the United States are introducing leadership curricula, but
there is a large gap that still needs to be filled.
2
The Uniformed Services University of the Health Sciences educates and trains health
professional leaders for the United States Army, Navy, Air Force, and Public Health
Service. Leadership education has long been a part of this university’s mission. Recently,
the university has expanded its Leader and Leadership Education and Development program
that is provided to all Uniformed Services University medical students at the F. Edward
Hébert School of Medicine.
3
The purpose of this paper is to describe the comprehensive program and its conceptual
framework that may be useful for other academic medical leader and leadership education
and development programs around the globe.
Leader and leadership education and development program
It is essential for leader and leadership education programs to define leadership;
identify which students should become leaders; base the program on a conceptual framework;
develop a curriculum consistent with the goals and conceptual framework; ensure that
the program has a sound scholarly basis and include appropriate assessments.
Medical students are introduced to leadership and its relevance to medical education
on their first day of medical school. Leadership is defined as influence on individuals
and groups by enhancing behaviors (actions), cognitions (perceptions, thoughts, and
beliefs), and motivations (why people act and think as they do) to achieve goals that
benefit the individuals and groups.
4
-
6
Leaders set the vision and inspire followers. The Uniformed Services University uses
these definitions and delivers a four-year, comprehensive program as a requisite part
of the undergraduate medical education of all medical students.
This program uses a variety of pedagogical techniques with emphasis on experiential
learning. The program strives to develop adaptive leaders who are prepared to perform
in volatile, uncertain, complex, and ambiguous environments.
7
-
9
The program content and assessments are based on the FourCe-PITO Leadership Conceptual
Framework. The four major elements of leadership (Four C elements or FourCe) are Character
(who the person is), Competence (what the person does), Context (when and where actions
occur), and Communication (how information is sent and received). These elements interact
with each other and operate across four levels of psychological and social interactions
– Personal (the individual), Interpersonal (between individuals), Team (small groups),
and Organizational (large groups and systems).
4
,
10
The curriculum is carefully woven throughout all four years of undergraduate medical
education focusing on the formation of professional identity, acquisition of relevant
knowledge and skills, and learning through experience. The topics of study pertain
to leadership, such as crisis communication, effective communication, followership,
the performance of individuals and teams under stress, personality and emotional intelligence,
self-assessment and peer support, and team building. Each session is based on at
least one element of the FourCe-PITO framework. A variety of pedagogical styles and
venues are used to deliver the curriculum, including interactive plenary sessions,
flipped classrooms, small group exercises, group discussions, applied clinical and
field settings. “Near peers” (more senior medical students) and core faculty facilitate
small group discussions about leadership in healthcare settings drawing from recent
and relevant experiences.
Leadership scholarship and research are foundational to this program. All concepts
of leadership, management, and followership taught to the students are based on principles,
theories, approaches, and techniques that have been developed by scholars and practitioners
of leadership.
6
,
11
,
12
The faculty conduct research and scholarship including evaluation of program effectiveness.
Medical and graduate students have the option to participate in research projects.
Current projects include gender and leadership; intergenerational leadership; development
of leadership assessment tools; innovative teaching strategies.
13
-
16
The program includes assessment of students’ knowledge and performance, faculty knowledge
and performance, and program effectiveness. Assessments of leadership are based on
quizzes; self-reflection; formative and summative feedback in applied settings; and
faculty, peer, self-assessments using the FourCe-PITO framework.
Quizzes and self-reflection questions are given after each session, and students provide
programmatic feedback. Results from the quizzes, self-reflection responses and feedback
are used to improve sessions. The program has developed a self-assessment and peer
support tool that is available as a smartphone app to help teach and promote self-awareness.
Students are provided with their own formative ratings in each of the leadership elements
as well as ratings based on input from several peers. This information enables students
to see how they rate themselves compared to how their peers rate them on elements
within the leadership framework. Additionally, all students participate in several
medical field exercises over the four years where faculty evaluates them in applied
settings.
All medical students in the program become physicians in the U.S. military or Public
Health Service for at least eight years after graduation (and typically remain in
these uniformed services for 10 - 25 years). Therefore, the program can assess performance
as medical leaders for many years after completion of the medical school’s leadership
program. This information is gathered and evaluated as part of the university’s Long-Term
Career Outcome Study.
15
,
16
Leadership elements in the database include student demographic information as well
as performance during pre-clerkship, clerkship phases of education, and beyond. The
merging of these data sets allows for evaluation of leadership performance in relationship
to individual differences and medical professional performance.
Conclusions
Leader and leadership education and development are essential aspects of medical education
and are gaining attention in the United States. Medical schools should determine whether,
who, how, when, and what should be taught about leadership. The Uniformed Services
University provides a comprehensive, four-year leader and leadership education and
development program for a medical student that may be valuable for other medical schools
around the globe.
Conflict of Interest
The opinions and assertions contained herein are the sole ones of the authors and
are not to be construed as reflecting the views of the Uniformed Services University
of the Health Sciences or the Department of Defense.