Gaining exposure to medical leadership and management through shadowing

Medical leadership and management (MLM) is increasingly considered an integral part of being a doctor, regardless of our career stage. However, the teaching of MLM and associated opportunities to develop this integral skill has traditionally not equalled that of technical and academic competencies.

This is especially true for us Foundation doctors, who are unfortunately positioned at the nexus of leaving behind medical school MLM involvement, learning a new job every four months and figuring out our chosen career path. Trusts often fail to highlight MLM as a valuable asset for us, and do not provide adequate exposure to MLM learning or opportunities. This is compounded by the scarcity of MLM roles, which are almost universally targeted at post-Foundation trainees; however, to be effective, engagement needs to start earlier in medical training.

The NHS Medical Leadership Competency Framework (3rd Edition, 2010) first suggested shadowing senior managers as an example of MLM learning and development. This was supported by FMLM's junior doctor survey in 2017, where 81% of respondents thought shadowing a senior manager would be useful, and recommended that healthcare trusts work with medical directors to provide a mechanism for this shadowing to take place.

Shadowing healthcare leaders (both clinical and non-clinical) provides a unique insight to reflective, experiential learning around MLM and its relation to clinical practice, for example, managing patient flow and beds, organising theatre rotas and managing a budget. In addition, shadowing multiple leaders allows us to discover new leadership styles, improve our communication skills and understand the vision, mission and goals of our organisation.

I organised several shadowing days with various middle- and senior- managers at my trust during my FY1 year. Each day was an invaluable experience, opening my eyes to the contribution of leadership and management in healthcare. It took weeks of emails, calls and meetings to finally arrange each opportunity; as such, I have outlined a three-stage plan to help other trainees organise shadowing at their trusts, and have made it as painless as possible for all involved to get the most out of the experience.

Step 1 – Identifying

The first element is to identify the purpose of shadowing. Do you want to learn about the operational aspect of running a hospital, improve communication skills by listening to negotiations involving multiple stakeholders, consider a career in NHS management, or some combination of all these factors? Knowing why you are shadowing and what you want to get out of it will lead to a more informative and useful experience. For me, it was a combination of all these factors, and I made this clear to both human resources (HR) and the individuals I was shadowing, allowing them to tailor the day to my goals.

Linked to this is identifying people to shadow who could provide the experience you are looking for. I searched for a mix of clinical, non-clinical and previously-clinical-but-now-non-clinical managers, giving a more holistic view of leadership and the variety of opportunities available. LinkedIn is a great place to start, using keywords such as 'medical director', 'clinical director', 'service director', 'head of service', 'head of transformation/strategy', 'general manager', 'band 8/ 9', 'chief nurse' and even 'chief executive/operating/financial officer' in your location. Your hospital’s internal email may also have a useful search function so you can filter by job title, and trust websites will often have bios of the executive team and senior managers, along with their contact details. Lastly, leverage your network for warm introductions, which are far more likely to lead to a positive outcome. I used my start of placement meetings with my clinical supervisors to express my interest in MLM and outlined that I wanted to shadow that specialty’s head of service, as well as any non-clinical managers, and was fortunate that they were receptive and helpful in my requests.

It is worth making a list of all the individuals you would want to shadow and work your way down in clusters when reaching out. If people do not respond (very likely) or do not have the capacity for shadowing (likely) then you have many other individuals you can then reach out to. This also saves you from having too many positive replies and then yourself not having the capacity to fulfil every shadowing obligation. 

Step 2 – Reaching out

Once you have identified who you would like to shadow, the next (and probably the trickiest) step is to reach out to them. I had more success with ‘warm’ introductions through my mentor and clinical supervisor, but I did organise some shadowing through ‘cold’ emails/messages. My first goal was to build some rapport and initiate a dialogue, and later build up to requesting a shadowing experience. My initial message/email would be along the lines of:

“Dear x,

I am currently a FY1 at City Hospital, with a strong interest in NHS management. I see that you [one-liner about their career path] and would really appreciate hearing more about your career journey, especially because [why their career is relevant to you]. I appreciate you are extremely busy and so any insight/advice would be greatly appreciated.

Many thanks,

Raihan

NB. Watch out for LinkedIn connection requests - they have a 300 character limit. 

I researched each person I reached out to in detail, making sure to highlight a specific learning point I wanted to know. For example, how managers with a clinical background found the transition to non-clinical work, how a CEO navigated a complex trust merger and what challenges they faced or if the clinician/manager valued doing a MBA. Any ‘hits’ I received (for example, LinkedIn connection accepted, or an email response), I attempted to organise a brief call with them as this would be far more personal. In these conversations, I focused on them, their career journey, how they found it and any advice they had for myself, speaking only briefly about my experiences. This was not entirely insincere, as I was genuinely curious about their career path and it would allow me to make more informed decisions about my own journey. However, by placing them and their experiences at the centre of the conversation and by listening with an interested ear, it built rapport and demonstrated their importance to me. People enjoy talking about themselves and this can be leveraged to make them more open to your requests.

Depending on how the conversation went, at the end, I might tentatively suggest whether it was possible to spend some time shadowing them, or I would ask this in an email follow-up to thank them for their time/advice. My request emphasised I would not be a burden requiring constant supervision and I would be more than happy to just sit in meetings and see what they do day-to-day. I gauged my forwardness based on how receptive they were; most were happy to direct me to their PA to organise a mutually beneficial day/time, but be flexible and work around their schedules. I used my annual leave, study days and taster days for the shadowing experiences. For C-suite level shadowing expect a delay of one to two months before a suitable date, and this could be pushed further back if new meetings/business comes up. This is less likely to occur with mid-level management, but make sure to politely chase them up if it has been over a week without a response – your shadowing is (understandably) low on their list of priorities.

I started off shadowing middle-managers and specialty clinical directors, and used this experience to leverage shadowing C-suite level executives at my trust. It may also be worthwhile to reach out to managers at other trusts nearby, as they might be more responsive or give you introductions to managers at your own hospital.

Step 3 – Shadowing

Once you have finally organised a few days shadowing a variety of middle and senior managers, you need to prepare well to make the most of the experience and maintain professionalism. Logistically, make sure to receive any calendar invites to virtual meetings you will be attending, set up any video-conferencing on your/your trust laptop and email a day before to make sure everyone is expecting you and you have all the appropriate permissions to attend meetings (virtual and in-person).

On the day, turn up before the planned time to set up, and it is always nice to buy your host a coffee in the morning as a gesture of thanks. During the day, note the content of the discussions (eg Covid-19 contingency meetings, or sorting out consultant squabbles) and the communication skills displayed by attendees. Often, I did not get any opportunity to engage and contribute in meetings, but I did debrief where possible with whomever I was shadowing after each meeting. Try to reflect on what you saw, the content and what you learned, and especially comment on anything you thought they (whomever you are shadowing) did well.

Following the shadowing, it is courtesy to follow-up with an email of thanks and try to maintain a relationship with them going forward, as they will be an excellent network and resource. Depending on the experience and the individual, I continued to sit in certain monthly meetings to get a longitudinal view of MLM and the ongoing progress. On occasion, I requested to get actively involved in a project and contribute to the work, for example helping out with writing the business case, or further calls to learn more about the finance aspect.

Above all, be proactive and enjoy the shadowing. I found the experiences to be varied, intellectually stimulating and I learned much more about communication skills and managing people. As more trusts take up the FMLM Leadership Commitment for Junior Doctors, protected time for self-development and shadowing opportunities will hopefully become more common and encouraged.

If tomorrow’s doctors are going to engage in MLM, it is necessary to start with today’s Foundation doctors.