Let’s veer to the vertical
by Lewis Peake
Just six months into my first year as a doctor, I was involved in the unexpected death of a patient. I harboured fears of personal liability, and I have no doubt that the incident and subsequent investigation left me a more anxious and defensive clinician. With the benefit of hindsight, I now realise that what I needed at the time was the ability to reflect, question the status quo and drive change from the learning that sad incidents like that can provide – all, unquestionably, leadership skills. Unfortunately I lacked those attributes; my undergraduate training perhaps underplayed their importance.
Vertical leadership development was a new concept to me when it was mentioned during the induction programme for the National Medical Director’s Clinical Fellow Scheme. I am certainly no expert on the topic now, but horizontal and vertical development has been nicely described elsewhere1 as the difference between adding new software and upgrading to a new computer. The former provides new tools for the job at hand, whereas the latter broadens perspectives and affords greater processing power for more complex tasks and ideas. In other words, horizontal development prepares you for now. Vertical development prepares you for the future.
In many ways, clinical practice epitomises vertical development. Core trainees look to develop the skills needed to manage the ‘acute take’ as a registrar, and registrar training aims to provide the depth of knowledge necessary to commence a consultant post. It’s this often-maligned conveyor belt of postgraduate training that can leave junior doctors (myself included) feeling paralysed and anonymous. It also fails to recognise the importance of non-clinical skills - such as self-awareness, team-working and improvement - that, as a foundation doctor, I was in desperate need of. Instead, these leadership and management skills still fall to the horizontal model of development, seemingly parked until such a time as they are made explicit in a job description.
But perhaps things are changing. I was certainly encouraged recently by the leadership insights demonstrated by the finalists of our recent FMLM student essay prize. The deep understanding these five undergraduates showed of ‘resilience’ and its relationship to clinical leadership, may be indicative of a cohort focused on vertical development in all aspects of their careers as doctors (and dentists, for our winner was a dental student), not just their clinical competence.
This push for vertical leadership development has featured prominently in my work this year. In the coming months, FMLM will be launching an indicative curriculum for undergraduate leadership and management. This document will outline what FMLM believes students should be taught on these topics, in order to prepare them for life as a junior doctor. It has gone through a wide consultation with a full range of stakeholders, and although feedback has been largely positive, there have been suggestions that medical students ‘don’t need to learn this stuff’ and that it’s ‘best left for postgraduate years’. Why?
Show me a medical student that needs to be able to perform an arterial blood gas. Show me a medical student that needs to be able to prescribe antibiotics. Students are taught these skills because they will be required in the future, as an F1 (ie they are developed vertically). The 21st century NHS seems characterised by a drive for continuous improvement in care, within evermore finite resources; therefore, show me a junior doctor who will not require at least some skills for leadership in team-working, task prioritisation and quality improvement.
My time as a National Medical Director’s Clinical Fellow has been epitomised by changing attitudes. A year and a half ago, when I sought a training number in academic surgery (because that was what the conveyor belt of training was thrusting me towards, and what my CV was primed for), I would not have imagined that in August I would be commencing a post as a public health registrar. It is the vertical development opportunities I have had this year - be it through heat experiences2 (managing multiple stakeholders for impactful publications), colliding perspectives (exploring ‘tribalism’ and the stereotypes of clinicians and managers) or elevated sensemaking (mentorship from senior leaders) - that have left me feeling enthused, excited and prepared for that challenge. Preventive medicine must take a lead if the strains on NHS resources are to be eased. Vertical leadership development will be vital to the success of this and must surely feature with greater prominence in all undergraduate and postgraduate training programmes, if only to empower trainees, and support their ambition to be the makers of change.
- Petrie N, Future trends in Leadership Development. Center for Creative Leadership.
- Petrie N, The How-To of Vertical Leadership Development. Center for Creative Leadership.