We sought to explore the leadership qualities and styles identified by students during a large scale, small team interprofessional learning activity, using Situational Leadership Theory as a conceptual framework [15]. The most common leadership styles identified were ‘Delegating’ (36%) and ‘Supporting’ (31%). Fewer responses were identified as ‘Directing’ (19%), and ‘Coaching’ (14%). The need for improvement identified by students included the need for more active contributions to teamwork and clearer communication, including listening to others, demonstrating a greater awareness of interprofessional patient-centred care, and contributing to teamwork by sharing one’s own disciplinary knowledge.
A key task of leadership is utilising appropriate skills and adapting an appropriate style for the given situation in supporting effective team function [20]. Peer feedback provided during team activities, suggests that some students performed their own tasks accurately and efficiently using task-oriented leadership behaviours. Students using relational-oriented behaviours focused on communicating support and appreciation for others. Both types of behaviours are core to basic leadership and are learned behaviours. Behaviours traditionally associated with leadership, such as ‘Directing’ were not always perceived favourably by peers. In line with current literature, student feedback to peers highlighted the importance of listening to others, and considering all viewpoints. Oates (2012) suggests that a key characteristics of tomorrow’s clinical leaders is “being a team player as well as a team leader” [4]. Good team leaders value the opinions of others, and display respectful communication, acknowledging the strengths and ideas of others [4]. Yet if some team members in the group are less confident, capable or willing, a ‘directing’ or ‘coaching’ approach may be appropriate [15, 21]. For example, ‘directing’ will be appropriate in their future workplace context, such as during patient treatment and management during a medical emergency.
A collective leadership style is essential to support excellence in patient care [22]. Our findings align with literature emphasising the importance of cultivating clinical leaders with qualities that include clear and concise communication; the sharing of disciplinary knowledge and willingness to learn from others; collaborative interprofessional practice, whereby team members are encouraged to contribute, and support input from the patient; and active contribution from all team members towards the task and team discussion [4]. A recent systematic review by Sfantou and colleagues (2017) identified a correlation between effective leadership and patient outcomes, finding that effective leadership fosters a high-quality work environment leading to positive patient outcomes, while failure to create a quality workplace ultimately harms patients [23].
While some attempts have been made within the university sector to embed leadership in health professional curricula, there is an identified need for explicit training and development in this area [24]. Rather than being taught informally, skills such as communication and teamwork should be identified as leadership competencies and reinforced throughout a vertically integrated, interprofessional curricula. Steps could be taken to make leadership behaviours more explicit in practice, by creating an awareness of the importance of leadership and how their work environment (and clinical placement) is influenced by good leadership. Leadership in team settings should be specifically identified, trained, rewarded, and encouraged at all levels of a health professional students’ degree.
West et al. (2015) suggest longitudinal leadership development is essential, noting shared and collaborative leadership to be the most effective [22]. Our results indicate that while most students contributed effectively to team goals, they may benefit from training in leadership skills. Furthermore, there is an identified need to promote consistency in leadership training approaches across health professional degrees [25]. Although concerns surround the place of leadership training within crowded healthcare curricula [26], our study suggests that interprofessional learning activities provide an opportunity to frame and embed leadership skills training, practice and assessment for a range of health professional degrees. Interprofessional team learning is increasingly used as a teaching and learning method in health professions education [27]. The interprofessional setting provides the opportunity for faculty to meaningfully address the topic of leadership both in university and clinical practice settings.
Importantly, given the high number of student feedback comments regarded as unconstructive, training in how to provide feedback will likely assist in the growth of students’ leadership skills. A recent study on peer review using a specific rubric to assess the quality of medical student peer feedback during a team exercise highlighted the need for training in this area. Common breaches in professional feedback included ‘cutting and pasting’, as well as banal feedback [28]. This study found that while students were comfortable identifying positive learning behaviours of their peers, they were less able to identify needs for improvement (gap) and detail a plan for improvement (action) [28].
Limitations
To our knowledge, this study is one of the first qualitative studies to explore the leadership qualities of health professional students identified by team members during a large scale interprofessional learning activity. Findings of this study may not be generalisable to other educational settings.
