5.3 Leadership

By Manveen Puri, HBSc, MD, CCFP, MPA Candidate (Class of 2018)

Manveen works as a Medical Officer with the Canadian Armed Forces and is a Family Physician who also practices rural Emergency Medicine. He has taken on various leadership roles over the years and has served on University of Toronto’s Governing Council and as Chief Resident (Family Medicine) at Credit Valley Hospital in Mississauga. He has received both the Cressy Award and the Arbor Award for his continued leadership within the University of Toronto community.

Many national physician regulatory bodies establish a standardized set of competencies that a doctor must attain to be eligible for practice. In Canada, the Royal College of Physicians and Surgeons created the “CanMEDs” competency framework in the 1990’s. In 2015, CanMEDs underwent an update. Notably, the “manager” competency was updated to “leader.” This was the only competency to undergo a name change in the 20-year history of CanMEDs. In justifying this change, the Royal College emphasized the importance of leadership skills in delivering high quality care within an increasingly complex healthcare system. While leadership has been extensively studied within the business and military communities, this level of emphasis on developing leaders represents a paradigm shift for medical education. Although leadership skills were always viewed as a valuable asset, they now have become a necessity. It will take years for this change to permeate a profession that has traditionally looked at direct individual patient care as its chief responsibility, and has left “administration” to the reluctant few who were willing to take on the task. This change in Canada is in keeping with a global shift in expectations from medical professionals.

The fact that those leadership skills will even be more heavily scrutinized during the admissions process in the years ahead should come as no surprise to any premedical students. Nevertheless, there are many misconceptions about leadership, which persist. The following few paragraphs contain some leadership lessons that I have gathered along my journey.

1. Leadership is not an innate quality, but a skill
There is no doubt that some people have traits that make it easier for them to lead; however, like any skill, leadership can be improved with practice and effort. As premedical students, start developing those skills. Whether it is serving on the executive council of an extracurricular club or spearheading a new initiative, put yourself out there! Make mistakes and learn from them. Run for an elected position. It is okay if you lose! While there may be a role for formal leadership education (e.g. an MBA or courses through various physician executive and leadership organizations) at a later stage, you need to start somewhere. Leadership is more art than science, which means that it needs to be perfected with time.

2. Leadership can be developed in multiple settings
There are many different styles of leadership, and it helps to have a range of styles in your repertoire so that you can pick the right style to solve the problem at hand. It also means that it behooves you to seek out a range of leadership experiences, both formal and informal, to nurture those qualities. One of my most meaningful leadership experiences was being a one-to-one mentor to various high school students. It did not come with a fancy title, but the experience tremendously shaped how I have come to view myself as a leader. Many of you may already be good leaders after taking on significant responsibilities within a family or community setting while growing up. Do not let those skills fade just because you have moved away for university.

3. Seek out mentors and learn from them
There are excellent physician and non-physician leaders out there in healthcare and other related professions. Find out who these people are in your community and try seeking them out. You may be surprised to learn, as I was, that many of the best physician leaders are quite accessible and take it upon themselves to inspire and teach the next generation. Interacting with these individuals in person will at some level motivate you and can help you visualize what your career may look like. It is well known within the medical literature that you cannot teach the behaviours, values, and attitudes associated with becoming a physician through textbooks or lectures. Rather, these critical skills are transmitted from one generation to the next through role modeling and emulation.

While you may not always be able to access every desired mentor as a premedical student, you can nevertheless learn from their career paths through books, speeches, and talks. Below I have listed some books about physician career journeys and other resources that I found particularly useful.

1. “Lessons Learned: Reflections of Canadian Physician Leaders” and “Leading from the front: experiences of Canadian physician leaders.” These two books contain vignettes from 31 physician leaders in Canada that chronicle their career paths and distill key reflections and decision points from a myriad of experiences. A must read! ⁸
2. American Association for Physician Leadership: A one-stop shop for resources on physician leadership ranging from online modules to courses to opportunities for formal training. ⁹
3. Canadian Medical Association Physician Leadership Institute: This definitive Canadian database on physician leadership contains many free resources to get you started on your leadership journey. ¹⁰
4. When Clinicians Lead: This article explores the importance of physician leadership to improving healthcare systems and solving healthcare challenges around the world. ¹¹
5. Coaching Physicians to Become Leaders: This article delves into the typical challenges facing physicians looking to take on leadership roles, and suggests how to get around common barriers. ¹²

⁷ Royal College of Physicians and Surgeons of Canada. CanMEDs Framework.
⁸ “Lessons Learned: Reflections of Canadian Physician Leaders” and “Leading from the front: experiences of Canadian physician leaders”.
⁹ American Association for Physician Leadership.
¹⁰ Canadian Medical Association Physician Leadership Institute.
¹¹ When Clinicians Lead.
¹² Coaching Physicians to Become leaders.