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Abstract
Background There is increasing recognition of the importance of leadership development within undergraduate medical training. One method of doing this is through student-selected components (SSCs), optional modules that allow students to explore an area in greater depth than in the core curriculum. An SSC in medical leadership has been offered at the University of Glasgow since 2015. We evaluated students’ perceptions of this SSC.
Methods Students are required to submit a written reflective report on the SSC. These were analysed thematically to determine students’ lived experience. Respondent validation and independent anonymised feedback to the university were used for triangulation.
Results Students reported that the SSC allowed them to experience aspects of healthcare not encountered elsewhere in their training. Three themes were derived from the analysis, relating to SSC structure, areas of learning and personal development/impact. Students recognised that leadership development is important within the curriculum and felt that it should be available to all medical students.
Conclusion This evaluation of students’ perceptions of a leadership SSC identified characteristics of the module that were felt by students to be valuable in leadership development and will support development of similar leadership modules at undergraduate and postgraduate levels.
- medical student
- medical leadership
- development
- curriculum
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Introduction
It is now accepted that medical undergraduate curricula should include training in leadership.1 2 However, progress has been slow due to the challenges of limited teaching time and availability of suitable faculty.3 4 At the University of Glasgow, a student-selected component (SSC) in medical leadership was established in 2015. This 5-week module, based on the undergraduate Medical Leadership Competency Framework,5 is offered to third-year and fourth-year students by two consultant physician supervisors (ALNC and HM), with one or two students taking the module at a time. Students shadow NHS leaders, attend meetings and undertake self-directed study supported by educational supervision and a resource pack.6 Students also undertake a quality improvement (QI) project. On completion, students are required to submit a reflective report.
We were keen to explore students’ perspectives of the SSC to support expansion of the programme. This paper describes a qualitative thematic analysis of students’ written reports.
Methods
Written consent was obtained from SSC students to include their reports in this study.
Reports were analysed using an inductive approach. Data from reports were organised into codes, which were then combined and contrasted to develop themes.7 This was done independently by two of the authors (ALNC and RC), who then compared and discussed their outputs and reached consensus regarding the final themes.
Five students who had undertaken the SSC expressed interest in further involvement in the evaluation. These students were asked to contribute to respondent validation.8 9 They provided structured feedback on the results section in response to a series of questions:
Do you agree with the themes and subthemes derived from the data?
Are any themes surprising, overstated or missing?
Do you agree with the positive tone of the themes and subthemes?
Can you think of any negative aspects of the SSC that haven't been mentioned?
The university requests anonymised feedback on SSCs for quality assurance. Data on the medical leadership SSC were evaluated as a further method of triangulation.
Results
Qualitative analysis
Eleven students undertook the SSC between April 2015 and June 2018 and all gave permission for their reports to be included. We summarise here the key findings; qualitative data supporting these findings are provided as online supplementary data.
Supplemental material
All students wrote positive comments about the SSC as a whole. Many commented that the SSC provided an opportunity to see aspects of healthcare provision not covered elsewhere in the curriculum.
Students reported that leadership training is not generally included in undergraduate curricula and felt that it should be offered to all medical students. However, they recognised that impact may be limited by student engagement. Staff engagement was a further limitation: students reported feeling supported and welcomed by teams who participated regularly in the SSC but less so by other teams.
Three further specific themes were derived from the analysis (table 1).
Themes and subthemes derived from analysis
SSC structure
Most students appreciated having access to many leaders of varied professional roles across the organisational hierarchy and the opportunity for one-to-one sessions with leaders.
The resource pack was regarded as informative and helpful in supplementing experiential with theoretical learning. Students felt that the resources supported their personal development and allowed them to ask more meaningful questions.
Students were given the opportunity to undertake a short QI project, and it was apparent that they appreciated the opportunity to participate actively.
Finally, several students highlighted the benefit of being embedded in a management team: this gave them the sense of ‘belonging’ and empowered them to ask questions and volunteer views.
Learning
All students reported increased understanding of operational hospital management. However, students were also encouraged to observe leadership behaviours, and it was evident that students had benefited from this. Students reported improved awareness and understanding of factors contributing to team effectiveness, and some reflected on their own teamworking skills and development needs. They also reported learning about leadership styles, describing examples of effective and less effective leadership. They appreciated the opportunity not only to learn about leadership in theory but also to observe leaders in real situations and to apply this to their own personal development.
Finally, students gained understanding of QI methodologies and insights into the challenges of managing change, including recognising and acknowledging different perspectives.
Personal development and impact
Most reports emphasised the impact of the SSC on individual students’ personal development. Meaningful reflection was actively encouraged throughout the SSC. Students gained understanding of the benefits of reflective practice and felt their reflective skills had improved. Some began to assess their own strengths and weaknesses. Several students described situations which made them uncomfortable and reported that reflecting on these scenarios had allowed them to become better prepared for the future.
Participation in the SSC also gave a sense of empowerment. Students welcomed the opportunity to contribute to discussions and also to meaningful QI initiatives.
The combination of self-reflection, recognition of strengths and weaknesses and opportunities for participation appeared to support students in action planning their further development.
Respondent validation
Five students contributed to respondent validation. All agreed that the themes derived from the analysis were accurate and that the generally positive nature of themes was consistent with their personal experiences. They did not feel that any themes were missing.
Two students commented on the prominence of reflective practice in the analysis. Both had assumed that the focus on reflective practice was to support their development during the SSC. However, after reading the analysis, one commented that she/he could now see that the SSC had given him/her valuable skills for reflecting on and managing difficult situations subsequently. Other students agreed with the analysis that reflective practice and personal development were important aspects of the SSC.
One respondent was surprised that students reported varying attitudes among leaders, commenting that most leaders had been welcoming and open. However, another student agreed with the analysis that, although most leaders were positive, a small number were reluctant participants.
Finally, all respondents agreed with the view that undergraduate leadership development is important and currently under-represented in the curriculum.
Anonymised student feedback to the university
The university received anonymous feedback from four students. All students stated that they would recommend the SSC to other students and that it had been useful for personal development. They were positive about the level of supervision and clarity of objectives. There was consensus that the SSC was intellectually stimulating and that they were fully occupied throughout. Students valued access to resources and learning opportunities. The single critical comment related to difficulty with IT access.
Discussion
Key findings
We describe a qualitative analysis of student perceptions of a medical leadership SSC. Three key themes were derived. First, the analysis identified aspects of SSC structure that students felt contributed to a positive learning experience. A placement-based SSC with experiential learning, supported by theoretical resources, was viewed positively, as has been identified previously.10–12
The second theme relates to students’ perceptions of key areas of learning. Students reported learning in operational management, leadership styles, teamworking and QI. Although most medical curricula include opportunities for QI involvement, students generally have little experience of operational management. Furthermore, the move away from apprentice-style ward training to more formal timetabled clinical placements may limit opportunities for students to observe teamworking and leadership.13 Placements such as this SSC allow students to experience these aspects of leadership.
The third theme relates to personal development and impact. The one-to-one nature of the SSC, coupled with training in reflective practice, allows a focus on the student as an individual, making the SSC a powerful tool for personal development and empowerment.
A further finding was that students perceived leadership development as an important element of undergraduate medical training, which should be available for all students.3 11 Several stressed the importance of ensuring that contributing leaders are engaged and enthusiastic; this may otherwise limit provision of leadership training routinely for all students.6
Strengths and limitations
Themes were identified inductively from student reports of their SSC experience. The reports were relatively consistent, and although only 11 reports were included, the authors were confident that data saturation was achieved.14 The use of respondent validation and anonymised feedback improved validity.
However, there are some limitations. Most importantly, students wrote reflective reports for assessment purposes and may have been more likely to write positively about the SSC; however, students did report some negative perceptions, suggesting that they felt able to write openly about their experiences. Furthermore, triangulation through respondent validation and anonymised feedback confirmed that students perceived the SSC as a positive and beneficial experience.
One further potential limitation is that the analysis was conducted by an SSC supervisor and student. The possibility of reflexivity15 is acknowledged, but its impact was mitigated by respondent validation. Finally, it is likely that the students who selected this SSC had a particular interest in leadership. The results therefore may not be generalisable to larger numbers of students with variable engagement.
Conclusions
This evaluation has identified features of a leadership SSC that were found beneficial to students. Students found the SSC effective in delivering learning in medical leadership and supporting their personal leadership development. However, it remains to be seen whether such programmes translate into more effective leadership and improved service outcomes in students’ subsequent careers. It is important that undergraduate leadership development coordinates with postgraduate programmes to maximise future impact.
Acknowledgments
The authors would like to acknowledge all students who contributed their written reports for analysis, and the clinical and non-clinical leaders who support this student-selected component programme.
Footnotes
Contributors ALNC and RC devised the study and conducted the qualitative analysis. RL, ML, LT, FT and MA provided respondent validation. All authors contributed to the preparation of the manuscript for submission. ALNC and HM are guarantors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was deemed unnecessary.
Provenance and peer review Not commissioned; externally peer reviewed.