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Assessing leadership behaviours is not easy. Our ideas about who leaders should be and what they should do is very subjective, highly personalised and prone to bias (unconscious or conscious). Power dynamics mean that trainees might not behave as they would in everyday situations when they are not being ‘assessed’. Therefore a combination of…
Self-assessment
Leadership development and practice is grounded in how a person analyses and approaches situations and communicates with others. It is therefore highly individual and involves the continuing development and refinement of personal and professional identity. Because of this, leadership development involves developing a deep understanding of yourself, your strengths, preferences and ways of working, and your limitations. We can learn this through undertaking a range of self-development activities, engaging in self-reflection and reflective conversations, observing how others respond and react to you, and asking for feedback. It is important to obtain feedback and information from a range of internal and external sources and not just rely on our own self-assessment as this can be flawed.
For help and support in times of transition or career change, a coach might be useful and for helping you to adjust to a new role or organisation, a mentor can be invaluable. Both coaches and mentors help us ‘hold up a mirror’ to see how others see us and how we might be more effective. Over time, we should develop our own understanding of our self-efficacy and effectiveness and how we function as a leader/manager in various situations.
Feedback
Assessments of leadership ideally happen daily as you practice leadership skills and receive feedback from a range of people. There are many ways of doing this, for example:
- getting into the habit of ‘learning leadership on the run’ – offering to lead on an agenda item in a meeting; observing how colleagues tackle difficult challenges or situations or the purposeful noticing of the dynamics of a conversation between people of different status;
- asking for ‘in the moment’ feedback – a quick ‘how did I do?’ question on an activity you have just led or managed; asking how you might have done things differently or better
- for people to observe you carrying a leadership or management activity eg asking your supervisor to observe you leading a ward round and give you feedback on time management and inter-disciplinary communications
- having reflective conversations with colleagues and peers – getting in the habit of initiating conversations based around leadership in clinical and non-clinical situations – ‘how do you think we managed that?’; ‘could we have done things differently’, ‘when I … I felt that … what do you think?’.
Workplace assessment
While self-assessment can support learning through reflection, consensus from experts consulted during this project is that if medical leadership development is to be improved, more robust forms of assessment need to be introduced with a focus on equipping trainers (and trainees) for high quality workplace leadership development closely tied to learning goals at each stage of career.
Assessment aims to evaluate an individuals’ performance (competence or capabilities) against expected outcomes; it can be formal and informal. Assessment is important both guiding trainees’ learning and for quality assurance of training programmes.
The peer-reviewed literature on medical leadership development is scarce in relation to workplace assessments on leadership. However many formal assessments are available in postgraduate training which include proxies for assessment of leadership such as professionalism, teamworking and communication. For example, annual review of competency progression (ARCP), mini-clinical evaluation exercise (MiniCEX), situated learning events (SLEs), objective structured clinical assessments (OSCE), multi-source feedback (MSF), case based discussion (CBD) and written reflections for the portfolio are all opportunities where leadership can be observed and assessed. For the most part however, leadership is still assessed as part of teamworking or leadership in specific clinical situations. Whatever assessment methods are used, all assessment should have a developmental component so that learning occurs as a consequence of assessment, not that learning is undertaken simply to pass an assessment.
Whilst leadership requires some knowledge components (e.g., organisational structures and functions, professional requirements and standards and legal rules), most of the learning (and therefore any associated assessment) involves demonstration of professional skills and behaviours. This is one of the more challenging aspects of assessment, with the main aim to make what are often subjective judgements as reliable and valid as possible. Alongside all aspects of professionalism, leadership assessments therefore need to be programmatic (part of a longitudinal development programme), carried out in multiple contexts by multiple people on multiple occasions (multi-source feedback), and include self-reflection. Programmatic assessment typically involves lots of workplace-based low-stakes assessments, reflections and observations which are brought together in a portfolio at each assessment hurdle. Ideally, if learners are given time, constructive feedback, and remediation opportunities, they should not fail a programmatic assessment.
More recently, attention is being paid in determining how a learner’s trustworthiness to complete clinical tasks that integrate different skills and knowledge independently can be assessed. These types of assessments involve defining entrustable professional activities (EPAs). An EPA defines a unit of professional practice (typically a competency) that can be fully entrusted to sufficiently competent professionals. Learners must become proficient in these before undertaking them independently and supervisors must be confident that the learner can undertake these before delegating an activity to them.
A final note for trainers, educators and supervisors
As with many aspects of developing ‘professionalism’, leadership development can often feel hard to undertake and even harder to assess progress. Developing leadership and management skills involves a combination of skills and knowledge acquisition, developing and maintaining effective relationships and purposeful observation and reflection. A huge range of resources is available to help everyone ‘learn leadership’ and these web pages and additional resources provide signposting to resources you should find useful and helpful. Leadership development is a lifelong endeavour and grounded in understanding yourself, your influence on and relationships with others, and the wider organisation and systems in which you operate.
Building good relationships with colleagues you train, educate, and supervise is key for supportive and developmental conversations to flourish. This requires acknowledging and working through your own biases and expectations. Time is precious, and service pressures and training structures mean that the opportunities for forming meaningful relationships, carrying out more formal assessments and giving constructive feedback and follow up are limited. However, understanding your strengths, areas for development and career goals and aspirations will help you to spot opportunities that arise and be in a position to get the most out of these. Learn the ‘technical skills’ that good management requires and, as with any ‘non-technical’ skill based on professional capabilities, it is always useful to refer to GMC and College guidance.
Section Resources
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Berger, A. S., Niedra E., Brooks, S. G., Ahmed, W. S., Ginsburg, S. (2020). ‘Teaching professionalism in postgraduate medical education: a systematic review’, Academic Medicine, 95(6), pp. 938-946.
Burgess, A., van Diggele, C., Mellis, C. (2020). 'Feedback in the clinical setting', BMC Medical Education, 20(S2).
Forsythe, A. and Johnson, S. (2016). 'Thanks, but no-thanks for the feedback', Assessment & Evaluation in Higher Education, 42(6), pp. 850–859.
General Medical Council (2017). ‘Designing and maintaining postgraduate assessment programmes’, General Medical Council, London.
Hodges, B., Ginsburg, S., Cruess, R., Cruess, S., Delport, R., Hafferty, F., Ho, M.-J., Holmboe, E., Holtman, M., Ohbu,S., Rees, C., Ten Cate, O., Tsugawa, Y., Van Mook, W., Wass, V., Wilkinson, T., and Wade, W. (2011). ‘Assessment of professionalism: Recommendations from the Ottawa 2010 Conference’, Medical Teacher, 33(5), pp. 354–363.
Hodges, B., Paul, R., Ginsburg, S., and the Ottawa Consensus Group Members, the O. C. G. (2019). ‘Assessment of professionalism: From where have we come – to where are we going? An update from the Ottawa Consensus Group on the assessment of professionalism’, Medical Teacher, 41(3), pp. 249–255.
Jahan, F., Ahmad, N. and Burney, I.A. (2023). 'Teaching, learning and assessment of professionalism in medical education: A citation-based systematic review of literature’, International Journal of Life Science Research Archive, 4(1), pp. 006–016.
Leung, C., Lucas, A., Brindley, P., Anderson, S., Park, J., Vergis, A., and Gillman, L. M. (2018). ‘Followership: A review of the literature in healthcare and beyond’, Journal of Critical Care, 46, pp. 99–104.
Molloy, E., Ajjawi, R., Bearman, M., Noble, C., Rudland, J., Ryan, A. (2020). ‘Challenging feedback myths: values, learner involvement and promoting effects beyond the immediate task’, Medical education, 54(1), pp. 33-39.
Rosenman, E. D., Ilgen, J. S., Shandro, J. R., Harper, A. L., and Fernandez, R. (2015). ‘A Systematic Review of ToolsUsed to Assess Team Leadership in Health Care Action Teams’, Academic Medicine, 90(10), pp. 1408–1422.
Ryan, A., Hickey, A., Harkin, D., Boland, F., Collins, M. E., & Doyle, F. (2023). ‘Professional Identity Formation, Professionalism, Leadership and Resilience (PILLAR) in Medical Students: Methodology and Early Results’, Journal of Medical Education and Curricular Development, 10.
Stone, D., Heen, S. (2015). Thanks for the feedback: The science and art of receiving feedback well, Penguin, London.
Tavares, W., Eppich, W., Cheng, A., Miller, S., Teunissen, P.W., Watling, C. J., Sargeant, J. (2020). ‘Learning conversations: an analysis of the theoretical roots and their manifestations of feedback and debriefing in medical education’, Academic Medicine, 95(7), pp. 1020 - 1025.
Tay, K.T., Ng, S., Hee, J. M., Chia, E. W., Vythilingam, D., Ong, Y. T., Chiam, M., Chin, A. M., Fong, W., Wijaya, L., Toh, Y. P. (2020). ‘Assessing professionalism in medicine–a scoping review of assessment tools from 1990 to 2018’, Journal of medical education and curricular development, 7, pp. 2382120520955159.
Ten Cate, O. (2013). ‘Nuts and bolts of entrustable professional activities’, Journal of Graduate Medical Education, 5(1), pp. 157-158.
Ten Cate, O., Hart, D., Ankel, F., Busari, J., Englander, R., Glasgow, N., Holmboe, E., Iobst, W., Lovell, E., Snell, L. S., Touchie, C., Van Melle, E., Wycliffe-Jones, K., and International Competency-Based Medical Education Collaborators. (2016). ‘Entrustment Decision Making in Clinical Training’, Academic Medicine: Journal of the Association of American Medical Colleges, 91(2), pp. 191–198.
- Self assessment
More from Leadership and Management Development and Assessment
Part 1: What is leadership?
Part 2: Practical ways to develop leadership and management skills, experience and capabilities