A first-year leadership programme for medical students.

BACKGROUND: The established medical hierarchy, dramatic expansion of scientific knowledge and emphasis on value-based health care means that graduating physicians need to know how to manage and lead positive change. There is a critical gap in the teaching of these skills in undergraduate medical education.
METHODS: Our medical school developed a first-year medical student competency-based leadership curriculum that focused on: leading yourself; teams and teamwork; influence and communication; problem solving; and systems thinking. The course used four methods of teaching leadership: experiential learning; targeted development; reflection; and feedback. The formal curriculum included topics such as developing a leadership agenda, challenging conversations and negotiations. The informal curriculum (learning outside of the structured curriculum) included applying leadership in co-curricular and extracurricular activities (e.g. in a student-run free clinic). Students recorded leadership experiences using a novel reflective assessment tool, obtained multi-source feedback and then articulated a plan for improvement.
RESULTS: Course evaluations noted that only one-third of first-year students responded that the curriculum developed skills in communication, and the ability to problem-solve, apply systems thinking and build teams. Students self-reported that they were often building, leading and managing productive teams, and applying influence and communication. The multi-source feedback assessment revealed that students, on average, were rated as competent to proficient. DISCUSSION: Creating a robust curriculum for medical students in the first year is challenging. Student reactions ranged from affirming to critical. The next steps will focus on increasing interactive teaching and on helping students understand why, where and how leadership is important.