Special thanks to Glen Bandiera, MD, FRCPC, MEd, BASc(Engin), and Jamiu O. Busari, MB ChB, MD, PhD, MHPE,for developing this content.
Over the years, patients’ expectations of health care services have changed. As a result, health care providers have had to develop and demonstrate new competencies. In response, competencies in the physician Manager Role in the curricula of undergraduate and postgraduate medical training programs in several countries were examined as part of extensive curricular reform initiatives.1–5 In 2015, the CanMEDS Framework was revised to ensure it reflected the competencies that the next generation of physicians would need to acquire to fulfill the public’s expectations of them. In the process, the physician role of Manager was changed to the role of Leader; four key competencies and 11 enabling competencies defined what this role would look like.1
Authors writing in both the academic and business spheres have identified the importance of formalized training in leadership skills as well as the lack thereof in standard medical curricula.6–8 In making the nomenclature shift from Manager to Leader, the CanMEDS 2015 Framework makes an important statement about the necessity of key attributes commonly associated with leadership.
Leadership competencies can be distinguished from management skills in several ways, such as in the role played by long-term versus short-term thinking, the importance of establishing a vision rather than goals, the emphasis on refining perspectives and approaches versus refining skills, and the use of motivation by inspiration versus motivation by authority and processes. Blumenthal and colleagues state, “For physicians in the modern practice environment, leadership and management skills are vitally important to health care quality and organizational performance because individual physicians can no longer achieve optimal patient outcomes on their own.”6 Rotenstein and colleagues write about the fact that physicians need both “interpersonal literacy” and “systems literacy” to be effective leaders in today’s complex health care environment.7
Both the Institute of Medicine and the Association of American Medical Colleges have articulated the rationale for leadership training, particularly related to systems change, and they have linked physician leadership to better patient outcomes.9–11 As the literature expands in these key areas, it is becoming clear that the old assumption that future doctors will be adept as leaders without formal training no longer holds; leadership skills must be taught and assessed.
There are two reasons for optimism when considering approaches for residency programs. The current generation of medical learners are primed for leadership training and in fact expect it. As a broad generalization, the current cohort of residents belong to a generation that accepts its role in leading change and does so in a collaborative manner.12 Furthermore, today’s residents tend to seek and rely on feedback more than previous generations of residents did, and thus faculty can expect that they will welcome feedback on key leadership behaviours: “While members of the Greatest Generation [Boomers] revere the institution of education as the source of all knowledge, conform to rules and regulations and tend to experience having failed if and when feedback is offered, members of the Millennial generation, and to a lesser degree the Gen Xers, thrive on immediate and continuous feedback, feel insecure without it and expect to be acknowledged based on how big their social network followers are.”13
As work evolves to address the existing gaps in leadership training, a number of examples and guidance documents for fundamental curricula (i.e., materials that are applicable to all residents rather than boutique offerings for the motivated few who have a specific interest in leadership) have emerged, been implemented and found to be feasible and valuable in many residency programs.14–16
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