Structured leadership reflections support leadership development for junior doctors

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  • Structured leadership reflections support leadership development for junior doctors
  • Professor Judy McKimm
  • Menna Brown
  • Paul Jones
  • International Reflective Practice Conference
  • 10 September 2013
  • Swansea

Leadership for Foundation Doctors

  • Foundation training in UK - first two years post graduation
  • ‘Academic’ foundation programme including clinical leadership and management training established in 2007
  • Collaboration between medical schools, NHS hospital Trusts and postgraduate deaneries

Developing understandings of junior doctors as leaders

  • Research study aligned with the academic programme
  • Involves students as co-researchers
  • Exploring lived experience of developing leadership role, knowledge, skills and behaviours
  • Methods include: survey (based on MLCF); interviews; focus groups; reflective narratives

Becoming and being a medical leader

  • Reflection on, in and for action

Participants – 4 cohorts

  • 46 F2 doctors
  • Competitive selection via application and interview
  • Four had previous experience/study in management (one had BSc)
  • None had studied leadership
  • World view
  • “before the start of the programme, I was very naive to the idea of clinical leadership. The idea had never been discussed in medical school. Once I had graduated and started working, the idea was rarely discussed. When it was discussed, it was not for my benefit” (C1)

Programme structure

  • 12 months integrated
  • Two thirds time gaining Foundation competencies in Emergency Department/Medical units/ICU
  • One third gaining postgraduate certificate in clinical leadership and management
    • Modelled on successful national programme for healthcare education leaders
    • 8 contact days throughout year (including 2 residentials)
    • Largely work based learning: theory to practice, theory in use

Programme outcomes

  • Programme outcomes mapped onto generic masters programmes and national competency frameworks:
    • Medical Leadership Competency Framework
    • Academic Foundation competencies in leadership & management
  • Synthesis of leadership and management; acquisition of academic writing and analytic skills; focus on personal development, reflective practice, group/team working, organisational awareness, policy and health systems.

Benchmark self assessment domains of Medical Leadership Competency Framework

  • Personal qualities
  • Working with others
  • Managing services
  • Improving services
  • Setting direction

Key themes

Written assignments linked to workplace/service

  • Essay on contemporary issues for healthcare leaders
  • Management report on individual projects
    • Change management in clinical service
  • Portfolio assessment
    • Reflective commentary, significant event analyses, critical literature reviews, PDP, self analysis

The ‘learning leaders’’ narrative (after Launer)

    • Focus on listening – respect, ground rules, attention
    • Circular and open questioning – learn techniques
    • Exploring the whole context – PDPs, whole life, career
    • Using models to help understand the context – leadership ‘lens’
    • Developing a shared story – developing the narrative, leadership journey
    • Shifting balance of power to the learner – it’s their journey and story

Developing reflective practice

Developing reflective practice

  • Learn from one another
  • using guided reflection
  • Role modelling, creative thinking
  • Self insight, TA, EI
  • Reflective models, practice and feedback
  • Tools/lenses for viewing the world
  • Tools and techniques
  • Structured narratives

Action learning sets

  • Work in self-selected group for 1.5 hours each contact day (and more often if they wish)
  • Introduced to ALS model as a means of enabling reflection on and for action
  • Peer group important, tutors aren’t involved
  • All take turns to bring a ‘problem’ or ‘issue’
  • Opportunity for guided reflection

Group exercises

  • Group check-ins, role modelling
  • ‘What is reflection?’ session – models of reflection (e.g. Gibbs, Moon, Johns, Rolfe, Schön, Bolton)
  • De Bono’s ‘Thinking hats’, ‘what if?’ – reflecting in action, ways of thinking, metacognition
  • Involvement in co-researching ‘what is junior doctor leadership?’ – reflecting on practice
  • Developing self insight: Emotional intelligence, Transactional Analysis, resilience, stress management – tools for reflecting on self development and behaviours

Leadership theories and models

  • Adaptive leadership
  • Engaging leadership
  • Affective leadership
  • Followership
  • Authentic leadership
  • Leader-member-exchange (LMX) theory
  • Charismatic leadership, narcissistic
  • Ontological leadership
  • Phenomenological leadership
  • Complex adaptive leadership
  • Relational leadership
  • Collaborative leadership
  • Servant leadership
  • Contingency theories
  • Situational leadership
  • Dialogic leadership
  • Trait theory, ‘Great man’ theory
  • Distributed, dispersed (shared) leadership
  • Transactional leadership
  • Eco leadership
  • Transformational leadership
  • Emotional intelligence (EI)
  • Value led, Moral leadership

Using theory to underpin reflection

  • Three domains:
  • Theories that focus on the personal qualities or personality of the leader as an individual
  • Theories relating to the interaction of the leader with others
  • Theories which seek to explain
  • leadership behaviours in relation
  • to the environment or system

Reflective writing

  • Formative paired work – specific session on ‘writing reflectively’ with practice and feedback
  • Summative portfolio: reflective commentary (3-4000 words); significant event analysis; reflection on group working, use of models/concepts in practice and on leaders’ behaviour – reflection on and for action
  • Personal development plan – reflection for action
  • Feelings
  • Description
  • Evaluation
  • Analysis
  • Conclusions
  • Action plan

Reflective commentary

  • Started as an open commentary on their leadership journey – students found this difficult
  • Now more structured based on cyclical models:
    • Series of trigger questions to answer (issues/challenges; role models; how you have changed; relationships with others; messages and next steps)
    • at least 20 references needed to support points made
  • Supported by embedded activities around reflection throughout course

What have we learned?

  • “Reflective thinking has formed the basic foundation of my leadership journey and development throughout this program. My learning has been characterized by a heightened awareness and evolving understanding of my own self, what drives and motivates me, and my own unique leadership styles and behavior. This learning has influenced not only my views on leadership and management, but also my behavior and interpersonal interactions within my leadership roles and clinical context” (C4)


  • Although medical students and junior doctors ‘learn reflection’ and have to reflect on clinical practice - their skills are relatively poor, especially in written reflection
  • The group and individuals need to feel safe
  • A highly structured approach in which reflection is embedded, practised and reinforced works well – assignments are higher quality, group work is richer
  • Students report that they feel much more skilled in using reflection purposefully in all areas of life

Thank you! Any questions?


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