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
World view
Scientific paradigm, hierarchical,
managers ‘dark side’, little experience of
leadership, ‘naive’ sense of leadership
‘Openness to experience’
Responses to experiences, insights
Action learning sets, group and paired
discussions, co-coaching, writing and
feedback, linking theory to practice
Reflection
on, in and
for action
Actively want to learn, engage in
activities/projects, willing to make
mistakes and learn from them
Experiences
Contact days and activities, workplace
based learning, project champions and
‘little l’ leaders, applying models in
practice
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
Action
learning
sets
Reflective
writing
Reflection
Theories
and
models
Group
exercises
Developing reflective practice
Tools and techniques
Structured narratives
Action
learning
sets
Learn from one another
using guided reflection
Reflection
Reflective
writing
Story telling
Group
exercises
Reframing
Reflective models, practice
and feedback
Tools/lenses for viewing the
world
Role modelling, creative thinking
Self insight, TA, EI
Theories
and
models
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:
1. Theories that focus on the personal
qualities or personality of the leader as
an individual
2. Theories relating to the interaction of the
leader with others
3. 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 (34000 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
Description
WHAT?
Observations,
insights,
feelings
Feelings
Action plan
Evaluation
Reflective
writing
NOW WHAT?
Actions, plans,
future
development
Conclusions
SO WHAT?
What does the
literature say?
What do others
think?
Analysis
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)
Summary
• 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?
[email protected]