Faculty Development for Leadership

Special thanks to Deepak Dath, HBSc MD MEd FRCSC FACS, for developing this content.

The introduction of the Leader Role in the 2015 revision of the CanMEDS framework has generated a burst of activity around leadership in medical education. With the realization that leadership as a competency can be understood, parsed and taught, there is now a need to prepare faculty, educators and administrators to do this teaching.

Our learners may be primed to learn about leadership, but how ready are our faculty to teach leadership explicitly? Most faculty have not received leadership training themselves. This has not stopped them from performing as leaders in a wide range of activities and at all levels of leadership, but they may not be sufficiently familiar with the jargon and techniques of leadership and the ways of teaching it to develop the next generation of doctors with the defined leadership skills they will need to achieve excellence. In this section we describe very briefly some concepts about faculty development in leadership and provides some examples of leadership training for faculty.

In recent years, leadership training for faculty and residents has increased. However, if this is to translate into dedicated and meaningful attention to leadership in physician training, faculty development that prepares academic physicians to be active teachers of the Leader Role must become an organized effort.

Faculty development in leadership itself requires some leadership. The use of techniques and processes from other areas of medical education has the potential to increase success. (Frank et al).¹ The five core components of competency-based medical education described by van Melle and colleagues (2017 Academic Medicine)² are outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction and programmatic assessment.

Iobst and Holmboe describe programmatic assessment of learners as a subsystem of the CBME system.³ This subsystem includes the people who collaborate to perform appropriate assessments, the overall goals of the system; the assessment techniques and a focus on the outcomes of interest. Similarly, a programmatic approach should be taken to faculty development to ensure that the offerings and initiatives to develop faculty’s leadership knowledge and skills are knit together with other themes in faculty development. The programmatic approach should align with the vision, mission and goals of the faculty. Faculty members should lead the effort to design the overall faculty development program on the basis of what they and their colleagues want to achieve over time. Programmatic development is not a new technique. It is touted as the way forward in medical education, in assessment and even in the business world.

Why does Competence by Design (CBD) require programmatic faculty development? To begin with, clinicians do complex work in chaotic systems.⁴ Leadership, in general, is a complex competency that requires different skills to be demonstrated by different clinicians at different levels at different times. For instance, consider some of the situations physicians might have to navigate in three different types of roles. First, a clinician, may require negotiation skills to acquire resources at the postgraduate medical education (PGME) table, conflict resolution skills to sort out a call schedule problem in her program and teamwork skills for distributive leadership during a discharge planning meeting for a complex patient. Second, while working on CBME changes, an educational leader may need to develop and use skills of effective time management and may be called upon to employ a more transactional leadership style to force a project to completion. Third, teaching faculty may need to demonstrate coaching styles and exemplify working together in teams, and they are expected to always be authentic leaders. In addition to the complexities of different roles, there are complexities associated with faculty with different mixes of experience functioning at different levels and new faculty constantly being recruited.

For programmatic leadership to be programmatic, faculty development in leadership must be longitudinal, it must be recursive and it must offer diverse opportunities for faculty. It will need to occur not only in the classroom or virtually but also in the workplace.⁵ Didactic efforts will provide theory and knowledge, but workplace efforts will give faculty the experience and real-world feedback they need to develop the leadership skills they are learning about. Workplace faculty development programs have the benefit of providing faculty with real-time coaching. Ahn and colleagues began a Career Development and Research Office, which is essentially a way to use coaching to support faculty leadership development in a department of psychiatry.⁶ Craighead and colleagues developed a coaching program for leadership at many levels.⁷

Mentorship for junior faculty is an important part of a programmatic approach that has been successfully implemented at some medical schools. In a recent review, Geerts and colleagues found that mentoring increased performance and enhanced self-awareness in some studies.⁸ Faculty in all programs have a spectrum of abilities and needs when it comes to leadership capacity. Programs of faculty development will also have to cater to audiences ranging from educational leaders, educational researchers and front-line champions of educational leadership to clinicians who practise everyday leadership and teach in the clinical workplace. Faculty development costs money; layered cost structures will see the school, the program, the hospital, institutions and the clinicians themselves sharing the cost of development.

In summary, faculty development for leadership in medical education adds another facet to the already complex and difficult responsibilities of medical educators. To expect each faculty member to find and participate in faculty development initiatives for leadership is a tall order. Divisions, departments and faculties need to help by organizing these initiatives in a programmatic process that considers the people, goals, techniques and desired outcomes of those they serve.

Several types of faculty development initiatives are available. Most off-the-shelf offerings consist of courses or workshops. National and international bodies, professional and specialty organizations, educational communities, university business schools and faculties of medicine have developed courses and workshops. Some examples of leadership training that are widely available are listed below; local solutions exist too, but it is not possible to collate them here because of space constraints.

References

1. Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32(8):638-645. doi:10.3109/0142159X.2010.501190
2. Van Melle E, Gruppen L, Holmboe ES, et al. Using Contribution Analysis to Evaluate Competency-Based Medical Education Programs: It's All About Rigor in Thinking. Acad Med. 2017;92(6):752-758. doi:10.1097/ACM.0000000000001479
3. Iobst WF, Holmboe ES. Programmatic assessment: the secret sauce of effective CBME implementation. J Grad Med Educ. 2020;12(4):518–21. doi:10.4300/JGME-D-20-00702.1
4. Fernandez N, Audétat MC. Faculty development program evaluation: a need to embrace complexity. Adv Med Educ Pract. 2019;10:191-199. Published 2019 Apr 16. doi:10.2147/AMEP.S188164
5. Steinert Y, Naismith L, Mann K. Faculty development initiatives designed to promote leadership in medical education. A BEME systematic review: BEME Guide No. 19. Med Teach. 2012;34(6):483–503. doi:10.3109/0142159X.2012.680937
6. Ahn MS, Ziedonis D. Coaching Health Care Leaders and Teams in Psychiatry. Psychiatr Clin North Am. 2019;42(3):401-412. doi:10.1016/j.psc.2019.05.010
7. Craighead PS, Loewen SK, Verma S. The Role of Coaches within Academic Medical Departments: Is There Value to Integrating This into Academic Mentorship Programs?. Healthc Q. 2019;22(3):68-72. doi:10.12927/hcq.2019.26013
8. Geerts JM, Goodall AH, Agius S. Evidence-based leadership development for physicians: a systematic literature review. Soc Sci Med. 2020;246:112709. doi:10.1016/j.socscimed.2019.112709