Identifying informal leaders among medical residents as a basis for educational interventions.

backgroundLeadership skills training is not usually integrated into the curriculum of medical residents, contributing to variation in skills development. Hence, identifying the manifestations of residents’ informal leadership can guide educational interventions. It is unclear how theories of formal leadership can support the identification of informal leaders. PURPOSE: To propose an approach for identifying the manifestations of informal leadership among medical residents, using this information for proposing interventions.

methodsA social network analysis survey was conducted including 68 physicians (22 preceptors and 46 residents) from an internal medicine service of a university hospital using data on advice-seeking relationships, self-assessments of four leadership styles (transformational, relational, adaptive, resilient), and preceptors’ evaluations of the styles’ importance. For each participant, a leadership score was calculated by integrating four network metrics (in-degree, betweenness, in-closeness, and out-closeness) that were proxies of the leadership styles. This score reflected “leadership-as-done” (LAD). The responses to the self-assessment questions reflected “leadership-as-imagined” (LAI). The scores for both LAD and LAI were weighted by the importance of leadership styles. A scatterplot placed each participant by LAI and LAD scores, partitioned into four groups: established, humble, aspirational, and latent leaders. A residents-only network was additionally examined to compare group assignment when preceptors were excluded.

resultsConsidering the full network with residents and preceptors, which more accurately represents the service complexity, 15.2% of the residents were established leaders, 23.9% were humble leaders, 21.7% were aspirational leaders, and 39.1% were latent leaders. Established and humble leaders stand out as informal leaders. The former regard their skills well developed and play central roles in the network; the latter do not consider their skills well developed, while still being central.

conclusionsEducational interventions should focus on offering advanced training for established leaders, enhancing the leadership skills of humble leaders that match their real demand for advice, giving opportunities for increasing the network centrality of aspirational leaders, and providing supervised leadership experiences for latent leaders.