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Leadership Training In Med School: Learning When To Follow

bf84ab9b24e1ee5737779dc8ee2123f6-huge-deMedical students across the country are calling for their institutions to provide leadership training. But once that training became a reality at Brown, these two med students learned that community leadership isn't as straightforward as it may seem. 

By Denise Marte and Matthew Perry

Our first week of classes at Brown Medical School was a whirlwind introduction to the social determinants of health. Before diving into the basic science curriculum, we gave our attention to systemic healthcare problems such as insurance gaps, spiraling costs, and health inequality. One lecture ended with a particularly memorable line, “Our healthcare system is a mess, but you all are going to fix it.” No pressure though.
Medical education doesn’t typically include leadership training sufficient to take on this mandate. But as the system has become more complex, medical schools have begun to implement important and necessary new strategies to equip students to tackle structural problems in the field. Here at Brown, the Primary Care-Population Medicine MD-ScM program and its Leadership in Healthcare course are two examples. We value these courses and the opportunity they provide to build an important skillset, but translating these skills into community work is complicated. As our faculty create these programs and students begin to complete the courses, we must stop and challenge the assumptions of what it means to learn leadership as students in a new place.
Our medical school employs an active learning model. That means that much of our learning is hands-on and takes place in a community setting. But are we mindful of the possible consequences of learning and practicing a lead-first mentality in those environments? Doctors have a specialized set of skills and knowledge which can be a powerful resource in any setting. But when we step out of the hospital, those skills may be more useful when they are guided by the expertise of those who live in the communities in which we are learning, working, and presumably leading. For that to be possible, we need to reconsider our default position as leaders. More generally, our leadership training should involve fostering accountable relationships in which we see ourselves as partners first.
If medical schools are to teach leadership, we must consider the context of that education. At Brown, as must be the case at many universities, many students are new to the area and unfamiliar with the values, needs, and challenges of the people living there. Yet healthcare leadership training encourages students to take the lead at the local level. While we are learning to study structural problems and propose interventions, are we sure that we’re identifying the issues our communities consider most important?
Leadership training in medical school teaches students to bridge medicine and social services with an eye toward preventive care. As such, the subjects and environments of student activities are broadening. For students at Brown, research themes range from food security and addiction intervention to healthcare in prisons. These themes often play out in work with vulnerable communities. But the power dynamics involved in such interactions are complicated. While in school, through academic guidance and mentoring, we are learning methods and best practices as we go. But this new work takes many of us outside of traditional healthcare settings, where we are often unsupervised. To uphold our ethical principles, we must ask ourselves if increased community involvement within the framework of leadership training requires new mechanisms of accountability.
For example, as we work on these projects, it is not always feasible for community members to give us feedback. As a result, measures to ensure we are doing no harm are limited. What happens if our projects are having unintended consequences in a community with no routes of access to our administration? Conversely, if student projects are having a positive impact, how do we lend them continuity after we graduate?
What we are learning through our coursework is that teaching leadership in med school is still uncharted territory. It’s a work-in-progress and, fortunately at Brown, a collaborative process with our faculty.
In partnership with student-led efforts, our administration is taking steps to create structures of accountability and continuity. As our Office of Diversity and Multicultural Affairs expands, community oversight is becoming part of its mandate. An upcoming community advisory board aims to bring together different voices from Rhode Island with various non-medical backgrounds. Our administration is considering how existing student projects, whether they involve leadership, community service, or both, can be incorporated into the curriculum for credit, lending those projects continuity and oversight.
One novel idea is the creation of ‘interest clusters,’ whereby before initiating our own projects, students join pre-existing groups that align them with relevant community organizations and services. Within these clusters, students can engage in clinical work, service-learning, or activism. This structure would ultimately help them understand the self-defined values, needs, and challenges of their population of interest before designing their research. They can lend their energy to continuing and improving existing efforts, with oversight from students who are further along in their training and from non-medical organizations. Still, it remains a challenge to foster these structures without burdening our community partners – a longstanding challenge of service-learning models.
Still, continuing to work toward creating best practices is important. If medical students forge into unknown communities with a lead-first mentality before we learn about the people we claim to lead, we will lose the trust of our patients before we even become doctors. It is vital for medical students and healthcare professionals to handle leadership with care. We must be intentional about when and how we see ourselves as leaders and be humble enough to take a backseat when appropriate.
Denise Marte is a third-year medical student at the Warren Alpert Medical School of Brown University. She is interested in primary care and emergency medicine. Born and raised in the Bronx, NY, she plans to return one day and join the leaders transforming New York City’s healthcare system.
Matthew Perry is a third-year medical student in the Primary Care-Population Medicine program at the Warren Alpert Medical School of Brown University. He hopes to practice in primary mental healthcare and to join in the work of dismantling structural barriers to health and well-being.

Read more about medical school leadership training. 
Posted by Sonya Collins on Jun 15, 2017 11:57 AM America/New_York
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