It Is Time We Include Leadership Education and Experiences in MFM Training and Lifelong Learning

The recognition of the importance of leadership education and training has come late to medicine, especially academic medicine. Long adopted by military academies and Master of Business Administration programs of all types, leadership training in medicine has instead reflected a “just in time” approach. Academic faculty are often appointed to leadership roles having had little to no formal training in leadership, and they often have never considered themselves as leaders. The time has come to recognize that leadership is a core pillar of medicine, including subspecialty medicine. When many current leaders in medicine were medical students, leadership training was rarely mentioned, let alone included in the curriculum. Yet recently, accrediting and educational bodies such as the U.S.-based Association of Professors of Gynecology and Obstetrics (APGO) have included leadership principles in the medical school curriculum.1 In fact, leadership was a presidential initiative of one of the co-authors during his presidency of APGO in 2007-2008, and it has been embraced and its importance recognized since then. A co-author took a Harvard-based “department chair’s school” leadership course for associate professors and division chiefs, and since then it has been recognized that this leadership training needs to be introduced earlier, more broadly, and in more depth. The Society for Maternal-Fetal Medicine has responded to this need by offering courses on practice management, business skills, quality and safety, and leadership at its meetings and workshops.2,3 Similar leadership education has been developed to advance women in the academy, with the recognition that while beneficial, it must be developed in the context of leadership development in the medical profession more broadly. The American Association of Medical Colleges sponsors a “Group on Women in Medicine and Science” interest group, as well as hosting annual conferences focused on developing leadership potential in both early career and mid-career academic professionals.4 Every physician must have leadership training and lifelong upgrades as educational training for medical leadership advances. Leadership in medicine is important for more than just those with a formal leadership position. While it is clearly important for deans, department chairs, and division chiefs to have effective leadership skills, it is equally important for faculty to be able to provide effective leadership for their research, clinical, and educational teams. It is important for trainees–fellows, residents, medical students–to provide leadership to their peers and juniors. Just as there are many opportunities to lead, there are many different types of leadership (Table 1), and different situations require different types of leadership. Massive changes in health system financing and reimbursements may call for disruptive leadership that fosters new and innovative ways to do more with less. Yet if a life-threatening emergency presented itself in the operating room, an autocratic leader is likely preferable to one who seeks consensus before making a decision. Thus no single type of leadership can be considered ‘ideal’ in all contexts. Table 1 - Types of leadership. Type of leadership Definition Servant leadership Prioritizes the well-being of staff and customers over personal power or gain. Disruptive leadership Challenges the status quo and encourages innovation. Transformational leadership Inspires, motivates, and energizes others to maximize their potential. Visionary leadership Inspires change by providing a compelling vision of the future. Democratic leadership Leads through collaborative group input and decision making. Laissez-Faire leadership Empowers staff to work independently and make decisions, encouraging autonomy and creativity. Autocratic leadership Minimizes input from others when making decisions. Absent formal leadership training, several easily accessible books are useful primers on aspects of leadership, including time management,5 negotiation,6 and execution.7,8 These books are excellent for group discussions and journal clubs, both teaching methods familiar to MFM. Yet little is as powerful as learning about the principles of leadership, recognizing that many of the core competencies are already in hand, and practicing putting it all together. To that end, the China Medical Board has supported a joint effort between the Peking University Health Science Center and the University of Michigan called Preparing and Advancing Women for Leadership in the Health Sciences (PAWLHS).9 The PAWLHS program provides a year of mentored leadership training for young women in academic medicine from Peking University, supporting a year spent at the University of Michigan in Ann Arbor, MI, United States. In addition to a month of clinical immersion in their field of specialization, the fellows participate in a variety of leadership development activities, including mentored goal setting, assessment of strengths and leadership styles, and workshops focused on such issues as managing conflict, peer mentoring, and handling “crucial conversations.” Perhaps most importantly, fellows are challenged to identify and develop their own ‘leadership project’ that they can carry back with them to China. Developing leadership skills is a lifelong process. The exposure of Chinese women MFM to advanced leadership training9, as illustrated by Chen’s article10, has shown that leadership training focused on gender and subspecialty may be useful as a transitional step to universal subspecialty leadership education in the Chinese context and should be considered for local and national acceptance and adoption. While MFM as a specialty has relied heavily on technology, and some might argue that technology has overshadowed discussions about leadership training, high-quality clinical practice remains central to MFM. To that end, leadership training that focuses on aligning the specialty around the delivery of holistic, empathetic, and patient-centered care will serve the specialty well. Our experiences in low-resource settings indicate that having the most advanced technology does not, in fact, always result in the best patient experiences. Thus we encourage MFM to think carefully about balancing technical training with thoughtfully delivered leadership training. We also call for national medical education bodies to mandate leadership training as a core competency, with dedicated funding and evaluation frameworks to ensure its implementation.