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Medical School Leadership Essay: Complete Guide

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One of the most challenging parts of the application process for many candidates is composing the leadership essay. They find it difficult to define what leadership is. 

Saying you have "strong leadership skills" is simple, but what does that entail? 

Does that imply you guided a 400-person team toward impossible, lofty objectives? 

Does that mean your chances of demonstrating leadership are zero if you have yet to do that? 

No, definitely not.

It is possible to be a leader in any capacity. However, finding or analyzing one's leadership experiences is not always straightforward. 

Still, it is crucial to ace this essay and convince the admissions committee that you are a determined, goal-oriented leader.

This article will guide you through composing your leadership essay. We have gathered the best tips and sample leadership essays to make it easier.

What is a Leadership Essay for Medical School?

Leadership is an essential skill needed in medical school. Moreover, effective leadership is critical for the healthcare industry to execute reforms and change its corporate culture. 

It is because the current state of the American healthcare system is plagued by several issues, such as rising healthcare expenses, unequal access to care, and racial discrimination in medical practice. 

Hence, you must ensure that when you compose your leadership essay for medical school, the admissions committee will know you are ready to take the challenge. 

Consider Paul Farmer , Vivek Murthy , and Atul Gawande as physicians who have sparked change. These physicians are leaders in their fields and have influenced structural change in particular branches of medicine, whether through study, writing, or policy. 

Like the physicians mentioned above, medical institutions seek out students who are willing to put forth an effort to address issues.

Tips for Writing Medical School Leadership Essays

Your medical school secondary essays will flood your inbox once you hit submit on your primary medical school application . 

If you apply to more schools, you will undoubtedly increase your chances of being accepted somewhere. Still, there is a catch: you will proportionally receive excessive secondaries.

How can you maximize your success when 75+ essays fall into your lap simultaneously? 

Keeping in mind that you should apply to 25–30 schools to be on the safe side and that each program has anywhere from one to nine secondary prompts, the question is: how can you?

We have listed some tips for writing secondary essays for medical school to help you get through the writing process.

Plan Your Time Accordingly

You might wonder how long the application process takes before you compose leadership essays for medical school. 

Your medical school secondary essays will trickle in throughout the summer after you submit your primary, usually starting at the end of June.

You will quickly experience writing fatigue because most medical schools automatically send secondaries back to every primary that has been finished. Therefore, your secondary timetable should be carefully thought out. 

Schools will assume you do not care about your essays if you take too long to send them. 

If you send them in a day but do not take the time to proofread them for grammar and other issues, you will come across as a careless applicant.

Think the Way an Admission Committee Would

Professors and students make up a large portion of admissions panels. They will also read countless leadership essays for medical education. 

Reading applications after application, 75% of which sound the same, will make them incredibly bored.

They will undoubtedly have glazed eyes. With your beginning and introduction, in particular, you need to catch their interest. You definitely do not want your reader to yawn straight away! 

Keep your vocabulary straightforward and your grammatical construction simple throughout your answers.

Avoid Reiterating Yourself

Your AMCAS application is already on file with the selection committee. You will benefit from repetition when composing leadership essays for medical school. 

Admissions officers will become tired and unimpressed if you restate what you said in the personal statement with your secondaries.

You must instead present new knowledge. That does not mean you cannot discuss the same experiences or activities; you most definitely can. However, it implies that you must examine each event differently.

Answer the Prompt Clearly

Too many students when writing leadership essays for medical school, too many students get caught up in what they want to say and fail to answer the question. As a result, similar topics for many essays will have minor variations. 

Ensure you respond to each query even though they are essentially asking the same thing.

Before beginning to write, underline each keyword and sentence. 

When writing your leadership essays, be aware of the questions the school is asking, and structure your essay appropriately. Then, make sure your response directly addresses the query and avoids any major detours.

Do Not Forget to Edit and Proofread

You will grow weary of writing once you have gone through many prompts for each of your institutions. 

The temptation, however, to send the first draft should be resisted. Your chances of obtaining an interview may depend on how well your leadership essays are written.

So, if you require a pause, do so. After that, go back and look over the work for any mistakes. 

Your word processor might have missed a grammatical or spelling mistake that you made. For example, it is possible that you wrote the name of one institution by mistake rather than the other. 

You are human, so errors like this can occur. However, if the admissions committee sees them, you will appear to lack professionalism. So do your best to edit.

Enter your text here...

Leadership Essay Sample Prompts 

Writing a leadership essay can be nerve-wracking. You have to impress the admissions committee while being humble at the same time.

 Hence, it would help if you put a lot of thought into developing a brilliant essay. 

To get you started, here are a few leadership essays prompts that you may encounter during your medical school application:

• How can a good leader improve the healthcare system in your country?
• What are your unique leadership skills? How will you apply it in medical school?
• What are the characteristics of a good leader and follower? Which among these qualities do you have and not have? How can you improve?
• Leadership, Curiosity, and Commitment are the three pillars of our program. Describe how you have exhibited one or more of these qualities on your journey to becoming a doctor. Which categories offer the most tremendous potential for personal development, and why?

Sample Medical School Leadership Essays

Your leadership essay plays a crucial role in your medical school application. Remember that you are competing against hundreds of candidates and must find a way to stand out.

Here are a few model leadership essays you could get ideas for your reference.

Leadership Essay for Medical School Sample 1:

I was chosen to serve as the executive director of BerkeleyShelter. During my second year of college, this undergraduate volunteer group runs a shelter for students facing homelessness. The following year, I established HealthGroup, a nonprofit organization dedicated to expanding access to reasonably priced medications for people with chronic illnesses. My perception of what it means to be a leader has started to shift due to these activities. 

By creating legislation, collaborating with elected officials, and launching campaigns to increase public knowledge of the problems related to medication prices, HealthGroup attempted to effect change. As the company's creator, I took it upon myself to develop a strategy that other employees and members could adhere to. I believed that as a boss, I was responsible for overseeing the organization's operations. 

However, HealthGroup found it challenging to make any noticeable difference in the cost of prescribed drugs. There were too many barriers brought on by pre-existing issues with the American healthcare system. In reality, not much had altered a year after HealthGroups was founded. So, naturally, I didn't expect the healthcare system to be fixed immediately. Still, I didn't anticipate my efforts to have been so ineffective. 

Before my final year of college, I started considering what I could do as the organization's leader to alter HealthGroup. I realized that I hadn't allowed others to express their opinions; instead, I had presumed that I needed to lead the group by myself. Maybe my role as a leader was to foster an environment where others would voice their opinions rather than to determine the organization's course on my own.

Leadership Essay for Medical School Sample 2:Enter your text here...

"Laura needs the ball, please!" "Okay, keep moving forward; don't let her grab the ball!" "You can outrun her by moving your thighs and putting more effort into running." 

My soccer friends frequently overheard these words during practice and during games. I've played soccer for my school for the past two years. I have forged strong relationships with my colleagues over the past two years and have observed that one of a leader's qualities is the capacity to inspire others. John Quincy Adams once said,  "You are a leader if your actions motivate others to dream bigger, learn more, do more, and become more."

I always wanted to be a leader in any circumstance as a young child. When my class was split into groups to work on projects, for instance, I wanted to be the leader—not bossy or overbearing, but rather to make sure my group produced the finest work. When we have group activities, my peers want me to be in charge because they know I'm smart and will push them until the task is completed.

I was a sophomore in college when I decided I wanted to play on an athletic squad. I knew I wouldn't be our top scorer as a rookie player, but I was confident the experience would be helpful. I stood at the sideline on my first day on the field and carefully observed each squad move.

Even though we worked together, I observed that we weren't playing as a team. We were missing a crucial component. After days of research, I concluded that motivation and unity were the keys to building a stronger team. I inspired my peers to push themselves past their comfort zones during practice. After training, I made them run an additional lap or course for ten more minutes. Even though I occasionally annoyed them, they eventually realized how much my persistence had helped them.

I developed into a leader by inspiring my team members. Leadership capacity is more important than subject-matter expertise for someone to be a good leader. Although I didn't have the best performance or the most goals scored on the squad, I did help the team as a whole. We played as individuals at the start of the season but as a team toward the finish. 

Because I'm always willing to assist others, my leadership abilities and experiences in soccer and the classroom have helped me improve. I need to be able to do that if I want to become an excellent orthodontist. I have acquired it and proven it throughout my existence. I'll keep leading by example and pushing others and myself forward as I have so far.

Additional FAQs – Medical School Leadership Essay

How do you show leadership in medical school application, what should be included in a leadership essay, what should you not do in a medical school essay, you're no longer alone on your journey to becoming a physician.

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• Published: 06 April 2022

An analysis of student essays on medical leadership and its educational implications in South Korea

• I Re Lee 1   na1 ,
• Hanna Jung 1   na1 ,
• Yewon Lee 2 ,
• Jae Il Shin 3 &
• Shinki An 1 , 4  

Scientific Reports volume  12 , Article number:  5788 ( 2022 ) Cite this article

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• Health care
• Medical research

To examine medical students’ perceptions of leadership and explore their implications for medical leadership education. We conducted a qualitative analysis of the essays submitted by students in the medical leadership course from 2015 to 2019. We categorised the essays by the characteristics of the selected model leaders (N = 563) and types of leadership (N = 605). A statistically significant proportion of students selected leaders who were of the same gender as themselves (P < 0.001), graduate track students chose leaders in science (P = 0.005), while; military track students chose leaders in the military (P < 0.001). Although the highest proportion of students chose politicians as their model leaders (22.7%), this number decreased over time (P < 0.001), and a wider range of occupational groups were represented between 2015 and 2019. Charismatic leadership was the most frequently selected (31.9%), and over time there was a statistically significant (P = 0.004) increase in the selection of transformational leadership. Students tended to choose individuals whose acts of leadership could be seen and applied. Medical leadership education should account for students’ changing perceptions and present a feasible leadership model, introducing specific examples to illustrate these leadership skills.

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Introduction.

Contemporary medical environments are facing complex issues, such as rising costs of treatment and inadequate access to and inconsistent quality of health care 1 . To address the ever-perplexing issues in medicine, there is an increasing need for effective leadership in health care 2 , 3 . In the past, medical care was primarily conducted by an individual physician. In addition, medical education heavily focused on the diagnosis and treatment of illnesses rather than working as a team to provide solutions that ensure higher quality medical care and safety 4 . However, in modern health care environments, a doctor’s role as a leader has become much more significant not only in physician–patient relationships but also in coordinating team-based tasks in the hospital and managing medical organizations 5 . For instance, as the socioeconomic environment becomes an essential component of a community’s health, physicians are expected to exert leadership in organisations that address public health issues 6 . Accordingly, physicians must be prepared to serve as leaders in health care.

Following the increasing need for leadership in healthcare, leadership skills are being included in physician evaluation criteria. The Association of American Medical Colleges has included leadership as the core requirement for medical students entering residency 7 . The Royal College of Physicians and Surgeons in Canada also includes the role of a leader as one of the main capability frameworks and has reflected this in their medical education 8 . Medical schools in the United States are proceeding with various leadership programs and incorporating leadership curricula into their undergraduate medical education 9 . Further, research shows that medical students now recognize the need for leadership education following the changing environment; 85% of medical students agreed that they should be taught leadership communication skills and teamwork abilities during their medical school years 10 . Korean medical educators also attempt to incorporate medical leadership education into medical education curriculum 11 . Yonsei University College of Medicine (YUCM) offers a leadership curriculum, Doctoring & Medical Humanities: Medical Leadership (DMH-ML), which is a core course covering 16 h (two hours per week for eight weeks) and offered to first-year medical students in the final quarter since 2014. The first 3 weeks feature lectures on basic concepts of leadership. The next three weeks are divided into three elective tracks, from which students choose lessons about leadership taken from: (1) the history of Severance Hospital in South Korea; (2) medical missions and international public health development; (3) business aspects of medicine. The final two weeks of the curriculum provide a summary of the topics covered. The written assignment of the course is a leadership model critique whereby students select a leader of their choice, summarize the leader’s accomplishments, and analyse the strengths and weaknesses found in that leadership. The course aims to facilitate medical students’ understanding of the nature of leadership from various leaders and help them recognize that their role as a leader is one of the fundamental responsibilities as physicians. All students who participated in the class submitted the written assignment, and the prompts for the written assignments were not changed between 2015 and 2019.

As no profiles have been reported on the leader models selected by medical students to date, in this study, we aimed to examine the medical students’ perceptions of leadership and provide directions for leadership education by analysing the characteristics and types of leadership models presented in leadership model critique essays.

We analysed a total of 585 essays submitted between 2015 and 2019. After excluding 35 essays that did not present a model, and double-counting 13 essays that presented two individuals, a total of 563 essays were chosen for this study (125 in 2015, 84 in 2016, 113 in 2017, 120 in 2018, and 121 in 2019). Of the 563 essays, 407 (72.3%) were written by male students and 156 (27.7%) by female students. Regarding admission types, 381 students (67.7%) were identified as undergraduate , 153 students (27.1%) as transfer/graduate, and 29 students (5.2%) as military (Table 1 ). We analysed the demographic characteristics of the model leaders selected in the essays (Table 2 ). A total of 563 individuals were selected as model leaders, 499 men (88.6%), 55 women (9.8%) and 9 other (1.6%), such as names of industries. The comparison of the gender ratio between the selected model leaders and the students showed that male students tended to select male leaders while female students were significantly more likely to select female leaders (P < 0.001) (Table 3 ). A total of 331 leaders (58.8%) belonged to the present generation category, and 232 (41.2%) belonged to the previous generation category. The occupational groups of the model leaders were as follows: politics (n = 128, 22.7%), business (n = 121, 21.5%), science (n = 117, 20.8%), sports (n = 45, 8.0%), social activism (n = 34, 6.0%), arts (n = 33, 5.9%), military (n = 32, 5.7%), religion (n = 18, 3.2%), education/law/exploration (n = 7, 1.2%), and other (n = 28, 5.0%). The comparative analysis of the selected model leaders’ occupational groups and the demographic characteristics of the students showed that a statistically significant proportion of female students (P = 0.0014) chose leaders in science, and a statistically significant proportion of male students chose leaders in sports (P = 0.003) (Table 4 ). Further, a statistically significant proportion of undergraduate students (P = 0.049) chose leaders in politics, transfer/graduate students (P = 0.005) chose leaders in science, and military students chose leaders in the military. When we analysed the changes in the occupational groups of the selected model leaders from 2015 to 2019, the decrease in the number of students who chose leaders in politics was statistically significant (P < 0.001), and the increase in the number of students who chose leaders in sports was statistically significant (P = 0.015) (Table 5 ).

Qualitative analysis

We analysed the leadership types of the selected models in 563 essays according to a qualitative framework developed from thematic and content analysis. Based on the analysis, a total of 605 essays were selected (seven essays with no specific category of leadership type were excluded, and 49 essays that presented two types of leadership were counted twice). Six types of leadership were identified in the following order: (1) Charismatic leadership (193; 31.9%) represented by the keywords “authority”, “ability”, “drive”, “firmness”, “determination”, and “strong execution”, (2) Servant leadership (150; 24.8%) by the keywords “sacrifice”, “serving”, “devotion”, “empathy”, “listening”, “respect”, “embrace”, “humility”, and “love”, (3) Collaborative leadership (117;19.3%) by the keywords “communication”, “team”, “cooperation”, “together”, “member”, “network”, and “horizontal”, (4) Transformative leadership (109;18.0%) by the keywords “change”, “innovation”, “creativity”, “novelty”, “pioneering”, “boldness”, “challenge”, and “creation”, (5) Self-leadership (23; 3.8%) by the key phrases “achievement of one’s goals and achievement of tasks”, and (6) Super-leadership (13;2.1%) by key phrases such as “education”, “teaching”, “human resources”, and “making good leaders” (Table 6 ). A comparison of the proportion of the leadership types in the selected models from 2015 to 2019 revealed that the selection of the transformative leadership type has significantly increased (P = 0.004) (Table 7 ).

The role models as leaders selected by students differed on the basis of the students’ gender and admission type. Although male leaders were dominant, the proportion of female leaders selected by female students was higher than that selected by male students. The selection of the contemporary leaders of the present generation was more common than those leaders of the previous generation. A high proportion of the transfer/graduate students, many with bachelor’s degrees in the sciences, chose leaders who worked in science fields, and a high proportion of the military students chose leaders related to the military. These findings imply that students tend to admire models as leaders among the contemporary figures whose acts of leadership can be observed in real-time as well as models with whom they share more in common, such as gender, academic backgrounds, or occupations, likely because the actions and achievements of such leaders are more understandable and more applicable to their own lives. The educational implication of these findings is the importance of role modelling as well as the influence of the informal, hidden curriculum 12 , 13 , 14 , 15 , 16 , 17 . Just as clinical knowledge and skills can be transmitted formally and informally in clinical situations, leadership in health care can also be transmitted through formal and informal means 18 . Although there are individuals officially designated as leaders in healthcare settings, the presence of individuals influencing other persons in informal ways should be acknowledged. Since individuals can be role models regardless of whether they are officially designated as leaders or whether they have an educational intention, medical educators need to understand the role of informal leadership training 19 . Although many medical schools strive to implement leadership education using various methods 20 , they overlook how informal leadership such as students’ experiences in leading and organizational culture play an important role in developing students' leadership skills 21 . Therefore, medical schools need to develop a faculty development program based on the importance of role modelling, recognizing the fact that role modelling can have both positive and negative effects on medical students 22 . A training program to enhance the leadership abilities of the instructors for better transfer of knowledge to the new generation of students is necessary 23 .

The occupations of leaders chosen by the students changed over the course of the 5 years analysed. At first, many students chose politicians as their model leaders, but the percentage of politicians selected decreased over time, and a wider variety of occupations were represented. This change implies that the students’ perceptions of leadership are shifting and that leaders recognized by society are emerging in various occupational fields. Therefore, medical leadership education and research need to incorporate the interdisciplinary and transdisciplinary approaches to meet continuous social changes 22 . Building a leadership curriculum based on a balanced interdisciplinary approach through the theoretical background in various fields, introducing specific examples of leadership in various areas, and having students reflect on case studies will help students develop various leadership-related competencies 24 .

The types of leadership delineated by the qualitative analysis of the essays showed that the most common type of leadership among the six types was the charismatic type, which is the most traditional leadership type. The traditional figure of a physician with ability, a firm and determined mind, the power to execute, and authority remains the most prominent model as a leader for medical students. As the charismatic leadership type tends to parallel the traditional heroic medical practice led by one-person, medical educators need to emphasize the possible limitations of charismatic leadership in the current health care context, which requires a substantially more team-based approach. As the ratio of students choosing diversified leadership types has gradually increased, it can be considered that the students’ primary concept of medical leadership is changing according to changes in medical society.

The second and third types of leadership stated by students were the servant and collaborative leadership types, which were increasingly recognized as essential in the healthcare field. Earlier, the servant leadership, with its image of dedication to treating patients and contributing to the community 18 , was exemplified as the prominent model for healthcare 25 . The function of collaborative leadership has been increasingly emphasized in the changing medical environment where facilitating successful collaboration within teams and flexibly adapting to changes is becoming more important 26 . Moreover, effective team management and cooperation in health care are known to be closely related to improved outcomes in the treatment of patients 27 . The prevalence of the selection of these types of leadership by the students may reflect their correct understanding of the modern health care approach.

The proportion of transformational leadership increased significantly over time. Transformational leadership is a more suitable leadership type for a constantly changing environment such as that of health care where quick adaptation and decision-making are required 25 , 28 . Recently, The fourth industrial revolution is characterised by developments such as precision medicine, AI-based medical treatment, and telemedicine, and related discussions are underway in medical education. This increase in the proportion of transformational leadership indicates that students recognize the importance of leadership that is sensitive to change and can respond quickly and with sound judgment.

When we compared the selected leaders' occupations and leadership types, it was confirmed that the students presented various leadership types in the same occupational group (Supplementary Table S1 ). This finding implied that there is no stereotyped leadership for a specific occupation but that different types of leadership can be manifested depending on the situations and followers in regard to which the leadership is exercised 28 . In other words, physicians as a leader needs to lead organizations, teams, or themselves using various leadership types rather than pursuing one fixed style. Moreover, mature leaders are more proficient in using different types of leadership, and different leadership levels require different skills 29 . These findings suggest that leadership in health care can be learned through case studies of other occupational groups and the curriculum should include various leadership types rather than emphasizing one style.

Limitations

This study has the following limitations. First, the sample of this study is limited to the medical students in South Korea. Considering that effective leadership behaviors are being accepted to be culture-specific, it is difficult to generalize the qualitative analysis conducted on essays collected from a single medical school 30 . Second, although the percentage of students in each admission type corresponds with the average percentages of undergraduate track (70%) and graduate track (30%) admissions in South Korea, the fact that students in the graduate track would have been in their first year of medical school at the time of essay submission is a limitation. Third, it is possible that the essays submitted by the students were influenced by the lectures held in class. In selecting a model leader, the student may have considered leaders, leadership theories, and types of leadership presented by the instructor. Nevertheless, this study is meaningful because it explores the experiences of the medical students over the past five years, analyses leadership recognized by the students, and examines the changes in their perceptions over time.

Conclusions

Whether leadership is innate or acquired remains a matter of debate, but many experts argue that education and experience can teach the skills and behaviours necessary for developing the ability to lead others 23 , 31 . Therefore, a well-designed leadership curriculum that presents feasible leadership models is needed because students imitate familiar and applicable leaders. Further, in the rapidly changing medical environment, leadership roles are diversifying, and students' perceptions of leadership are changing. Therefore, when medical schools encourage the various approaches to leadership required in modern society, students can foster broad skills in medical leadership.

We reviewed all essays submitted in the first-year core course, titled Doctoring & Medical Humanities: Medical Leadership , from 2015 to 2019, to investigate changes in the perceptions of leadership among medical students. The prompt of the essay required students enrolled in the DMH-ML course to select a model leader, summarize that leader’s achievements, and reflect on the strengths and weaknesses of leadership found. We collected a total of 585 essays and performed quantitative and qualitative analysis (Fig.  1 ).

Schematic diagram of quantitative and qualitative analyses on the essays.

Student demographics and data collection

To perform quantitative analysis, we classified the characteristics of the students as well as those of the leaders they selected. We collected demographic information such as gender and type of admission of the medical students at YUCM who submitted the essays and classified them into three groups: (1) undergraduate track, (2) graduate track, and (3) military track. The undergraduate track is a conventional 6-year program in South Korea and is for students who have immediately graduated from high school. The first two years are equivalent to the pre-med years of an undergraduate degree, and the remaining 4 years are equivalent to the medical years (2 years for preclinical and 2 years for clerkship) of medical schools elsewhere. Thus, by the time of their essay submission, students in the undergraduate track would be in their third year having enrolled at medical school. The graduate track is a four-year program for those with an undergraduate degree. Thus, students transfer straight into the medical years, skipping the pre-med years of medical school. This track is typical of admission to medical school in the United States and Canada. In Australia, England, Ireland, Singapore and South Korea, the undergraduate track and the graduate track are mixed (Fig.  2 ) 32 . Finally, the military track is for the military students with an undergraduate degree commissioned by the army.

Schematic diagram of medical educational system in South Korea.

Quantitative analysis

We also classified the gender, generation, and occupational groups of the selected model leaders. We classified the selected leaders as (1) the previous generation if they had passed away before 2000 and (2) the present generation if they had passed away after 2000 or were still living at the time of the study. The occupational groups of the model leaders were classified as politics, business, science, sports, social activism, arts, military, religion, and education/law/exploration. In addition, when students selected an individual with whom they had a personal relationship such as a parent or a character in a book or movie, we classified them as “other”.

After classifying the characteristics of students and leaders, we analysed the characteristics of selected leaders according to the characteristics of students and observed how the students' perceptions of leadership changed over time from 2015 to 2019.

We used a combination of thematic and contents analyses for our qualitative analysis 33 , 34 . Two authors independently analysed each essay. We omitted essays that did not establish a model leader. For essays with two selected leaders, we analysed them as two separate model leaders. The strengths of each selected model leader portrayed by students were summarized. Disagreements were resolved through group discussion and consensus.

In the first step, we extracted the main contents that delineated the selected leaders' performance, strengths, and weaknesses from the essays for thematic analysis. We then, classified these extracted contents by thematic keywords with similar meanings.

Second, we developed a framework for content analysis through a review of previously published literature.

Finally, the result of the thematic analysis was combined with the result of the content analysis. The framework was formed based on six types of model leadership by matching the 10 leadership types (adaptive, authentic, charismatic, collaborative, servant, self, situational, super, transformational, and transactional) selected through the analysis of previous studies with the leadership types described by the students 27 , 35 , 36 , 37 , 38 , 39 , 40 , 41 : charismatic, servant, collaborative, transformational, super-, and self-leadership.

The six leadership model types are defined as follows. Charismatic leadership centres on the leader’s strong charisma and resolute style that allows members to follow the decisions they make 35 . Servant leadership is based on respect for humans, whereby the leader volunteers to serve each member to help develop their full potential 36 . Collaborative leadership is exerted by leaders who establish a horizontal and trusting relationship with members that enables the group to complete the given tasks through cooperation 27 . Transformational leadership recognises the need for a change within the organisation and opportunities for a leader to envision and enact change 37 . Self-leadership is a force that drives leaders themselves to accomplish their goals, whereas super-leadership nurtures other individuals(followers) and empowers them to lead themselves 38 .

Statistical analysis

We used descriptive statistics to analyse the characteristics of the study subjects. We indicated frequencies and percentages for categorical variables, and a chi-square test and linear-by-linear association were performed to analyse the correlation between two categorical variables. Fisher's exact test was performed if the expected frequency was five or less in the chi-square test. All statistical analyses were performed using IBM SPSS ver. 25.0 (IBM Corp., Armonk, NY, USA), and the statistical significance level was set to p = 0.05.

Ethical considerations

The Yonsei University Health System Institutional Review Board (IRB No: Y-2020-0206) approved the study. We used anonymised materials collected in commonly accepted educational settings according to Article 2 of the Bioethics and Safety Act Enforcement Rule in South Korea. The informed consent requirement was exempt from institutional review board approval. All procedures were conducted in accordance with the relevant guidelines and regulations.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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These authors contributed equally: I Re Lee and Hanna Jung.

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Department of Medical Education, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea

I Re Lee, Hanna Jung & Shinki An

Eulji University School of Medicine, Daejeon, Republic of Korea

Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea

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Yonsei Institute for Global Health, Yonsei University Health System, Seoul, Republic of Korea

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S.A. and J.I.S. designed the study. I.R.L. and H.J. collected the data, and I.R.L., H.J., and S.A. conducted the analysis. I.R.L., H.J., Y.L., S.A. and J.I.S. wrote the first draft of the manuscript. All authors had full access to all of the study data. All authors reviewed, wrote, and approved the final version.

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Volume 20 Supplement 2

Peer Teacher Training in health professional education

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• Published: 03 December 2020

Leadership in healthcare education

• Christie van Diggele 1 , 2 ,
• Annette Burgess 2 , 3 ,
• Chris Roberts 2 , 3 &
• Craig Mellis 4  

BMC Medical Education volume  20 , Article number:  456 ( 2020 ) Cite this article

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Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice. To meet the needs of healthcare in the twenty-first century, competent leaders will be increasingly important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine. Consequently, incorporation of leadership training and development should be part of all health professional curricula. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles. This paper briefly considers the current theories of leadership, and explores leadership skills and roles within the context of healthcare education.

Leadership has many interpretations, and has been likened to “ the abominable snowman whose footprints are everywhere but who is nowhere to be seen” [ 1 ]. It is an influential process, through which groups of people work towards the achievement of a common goal [ 2 ]. Leaders have the ability to shape and influence their followers’ values, attitudes and behaviours through a dyadic relationship. They are able to gain and enlist the support of others in order to achieve shared goals [ 3 , 4 ]. Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice [ 3 ]. In order to achieve more effective outcomes, leadership and management skills are now an expectation and requirement in the healthcare education setting [ 5 ]. However, leaders within healthcare education should not rely on formal positions of authority, but instead, utilise their own appropriate leadership qualities irrespective of their level within the organisation [ 3 ]. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes [ 3 ]. This paper briefly considers the theories of leadership, and explores leadership skills and roles within the context of healthcare education.

Management versus leadership

Management and leadership are considered just as important as each other in accomplishing organisational goals. However, there are differences in the functions of the two roles. Management produces order and consistency, while leadership produces change and movement [ 2 ]. Management has the responsibility of organising all elements within the organisation, so that the leader’s vision and goals are successfully achieved. If poor management is in place, then goals cannot be achieved; and if poor leadership is in place, then there is no clear goal or vision to work towards. Leadership is seen as “setting direction, influencing others and managing change: with management concerned with the marshalling and organisation of resources and maintaining stability” [ 6 ]. These differences are summarised in Table  1 [ 6 , 7 ]. 

Transactional and transformational leadership

Leadership is a social construct, and there are many different leadership models [ 6 ]. Two broad types of leadership are identifiable: “transactional” and “transformational”. And their respective features are a useful way to think about the many types of leadership. Transactional and transformational leadership models are normally amalgamated within organisations to “empower others” (transformational) while holding individuals “accountable” (transactional) for their actions [ 7 , 8 , 9 ]. While it is clear that both transformational and transactional leadership paradigms are needed for an organisation to be effective, the optimal leader predominantly practices the transformational aspects of leadership, rather than transactional [ 10 ].

Transactional leadership

The transactional model is seen as an authoritative relationship that is transaction based, where exchanges occur between a leader and follower, once specific goals are identified or decided upon. Transactional leaders value order and structure, and have formal authority, with positions of responsibility within organisations. They achieve organisational goals through a rewards system and through positive reinforcement. A weakness of this model is the lack of innovation, as individuals are driven by predetermined outcomes, and there is lack of incentive and motivation to perform beyond what is expected [ 6 ].

Transformational leadership

Since the introduction of transformational leadership, the concept of leadership has undergone a major shift from representing an authoritative relationship (transactional), to a process of influencing individuals (transformational). Transformational leadership involves leadership through the transformation of individuals or ‘followers’, to work towards a common organisational goal [ 9 , 10 , 11 ]. This contemporary form of leadership is based on inspiring individuals, and forming teams to achieve goals. Transformational leaders define organisations through the articulation of a clear vision and clear values. The four “I”s of transformational leadership are outlined in Table  2 [ 9 ].

Team leadership

More recently, the focus has shifted towards “team leadership” , with distributed leadership becoming more prevalent within healthcare education, where different professions share influence [ 12 , 13 ]. Increasingly, leadership involves a collaborative role, with an emphasis on shared leadership and thoughtful allocation of responsibilities. Team-based organisations shift central control from the one leader, to the team. Teams are comprised of members who are interdependent, needing to coordinate their activities in order to accomplish their shared goals [ 14 , 15 ]. Personal autonomy, accountability, appropriate recognition, and clarity of roles, are all elements that contribute to optimal team performance. However, to ensure success, the organisational culture needs to support the involvement of individuals in these teams, and encourage leadership qualities [ 15 ]. Teams often fail when they exist in a traditional authority structure, where organisational culture is not supportive of collaborative work, and lower level decision making. Distributed leadership entails sharing of influence by team members, who step forward, or take a step back as needed. Leadership is provided by the person who meets the specific needs of the team at the time, hence providing faster responses to more complex issues in today’s organisations [ 15 , 16 , 17 ]. Effective leaders have an understanding of the conditions needed for teams to function well. For a team to achieve its potential, the operational roles of its members should be matched to their members’ abilities [ 18 ]. Belbin (1991) classified nine roles of team members that contribute to its process and function [ 19 ], outlined in Table  3 . Importantly, within team leadership, no single team role should be regarded as more important than another. Successful teams thrive on their diversity, drawing from the strengths of each member [ 13 ].

Effective leadership

Leaders need to have good time management and organisational skills, the ability to network professionally, display political nous and most importantly, they need to have strong communication skills [ 4 , 20 , 21 ]. Ready acceptance of feedback and self-awareness are important in development of leadership skills [ 20 , 21 ]. Behaviour, habits and biases can be deliberately corrected by utilising received feedback. Although there is not one set of qualities that apply to being an effective leader, certain competencies are valued and contribute to the leadership model in different ways [ 5 ]. Leadership competencies relevant for all health professional educators are outlined in Table  4 [ 3 ].

Language of leadership

Just as education and healthcare organisations have evolved, so too has the team leader. The role of the modern leader reinforces the tenets of stepping forward, collaborating and contributing. This role involves encouraging others by practising followership, and lending meaningful support to other leaders. As already stated, when it comes to leadership, excellent communication skills are a must. In order for successful communication to occur, both the sender and receiver must understand the message. This means that active listening is just as important as active talking [ 22 ]. Language used needs to be [ 22 ]:

Communicate with clarity of your purpose and the role of others

Stimulating

Deliver messages in a powerful, inspiring and dramatic way

Lead by example and walk the talk

Include active listening

Acknowledge what has been communicated, and use questioning skills

Show that you value others and their contributions

Challenges for leaders in healthcare education

There are a number of unique challenges in healthcare education. Healthcare education is delivered across professional disciplines, and notably, across organisational boundaries, involving universities, hospitals, and healthcare services. In turn, these organisations are bound by their own systems, structures, policies, cultures and values. At some point, most leaders in healthcare education need to make a decision about their leadership direction, and whether it lies predominantly in higher education or the clinical setting; and whether it lies in undergraduate education or postgraduate education. It can be difficult to merge roles between organisations, and McKimm (2004) has identified a number of issues and challenges specific to health education leaders, outlined in Table  5 [ 22 , 23 ]. Throughout a career, it may be necessary to maintain an awareness of available opportunities within organisations, and match these to the required experiences and capabilities [ 22 , 23 ] (see Fig. 1 ).

Reflection task

Development of leadership skills

Workforce data indicates that many experienced clinicians and healthcare educators will retire over the next ten years [ 24 , 25 ]. The need for effective succession planning and leadership training is well recognised [ 25 , 26 , 27 ], with a current shortage of emerging leaders moving into leadership roles. Effective leaders need to be nurtured and supported by the organisations in which they are educated, train and work [ 6 ]. As a learned skill, the topic of leadership is gathering momentum as a key curriculum area. Leadership development, assessment and feedback are necessary throughout the education and training of health professionals. Aspiring and current leaders can be identified, trained and assessed through formal leadership development programs, and through supportive organisational cultures. This requires embedding leadership training programs, opportunities for leadership practice, and promotion of professional networks within and beyond the organisation. The importance of mentorship within healthcare education is well recognised, offering a means to further enhance leadership and engagement within the workforce [ 28 ].

While many are assigned as leaders through their job title, it is important to identify, support and develop emerging leaders [ 2 ]. Leadership consists of a learnable set of practices and skills that can be developed by reading literature and attending leadership courses [ 29 ]. Additionally, investment in the social capital of organisations, fostering interprofessional learning and communication in the work setting, and collaboration across organisations assists in leadership development. Developing leadership skills is a life-long process [ 21 ]. Resources and opportunities should be considered to assist in the development of leadership skills. Some examples include:

Reading about leadership e.g. theories on leadership styles

Attending leadership training workshops

Participating in mentorship programs either as mentee or mentor

Joining small group seminars on leadership development

Accepting more responsibilities when required, or when opportunities arise.

Process for effective leadership

A title is not required to enable effective leadership. Leadership may occur in everyday work, and occurs in collaboration with other professionals within the education and healthcare systems. For example, leadership in teaching, administration, research, and/or excellence in clinical practice.

Leadership roles include the important concept of management of both personal and professional practice. Priorities need to be set and time managed to integrate work and personal life. Tools can be used to stay organised, and deliberately manage busy schedules. Effective delegation may be used to share the work of new projects:

Organisation to ensure an understanding of tasks, priorities and deadlines

Establish steps and a sequence to achieve the desired outcomes

List required resources, considering the competencies of individual team members, and match tasks appropriately (also consider skill development needs)

Communicate with team members, monitor progress in activities and provide guidance to team members.

Leadership competencies, and the incorporation of leadership development as part of curricula, are identified as important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine, in meeting the needs of healthcare in the twenty-first century [ 30 ]. With an increase in interprofessional teams and an emphasis on collaboration, more effective outcomes are achieved [ 5 ]. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles, but may occur in everyday work. Good leadership also means knowing when, and how to support others in their endeavours. Provision of opportunities for leadership development is crucial in improving education sectors and health services, and effecting change. The future belongs to healthcare education leaders who demonstrate excellence in teamwork, clinical skills, patient centred care [ 3 ], and responsibly balance accountability with autonomy.

Take-home message

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In college, as I continued to experiment with this narrative form, I discovered medical narratives. I have read everything from Manheimer’s Bellevue to Gawande’s Checklist and from Nuland’s observations about the way we die, to Kalanithi’s struggle with his own decline. I even experimented with this approach recently, writing a piece about my grandfather’s emphysema. Writing allowed me to move beyond the content of our relationship and attempt to investigate the ways time and youth distort our memories of the ones we love. I have augmented these narrative excursions with a clinical bioethics internship. In working with an interdisciplinary team of ethics consultants, I have learned by doing by participating in care team meetings, synthesizing discussions and paths forward in patient charts, and contributing to an ongoing legislative debate addressing the challenges of end of life care. I have also seen the ways ineffective intra-team communication and inter-personal conflicts of beliefs can compromise patient care.

Writing allowed me to move beyond the content of our relationship and attempt to investigate the ways time and youth distort our memories of the ones we love.

By assessing these difficult situations from all relevant perspectives and working to integrate the knowledge I’ve gained from exploring narratives, I have begun to reflect upon the impact the humanities can have on medical care. In a world that has become increasingly data driven, where patients can so easily devolve into lists of numbers and be forced into algorithmic boxes in search of an exact diagnosis, my synergistic narrative and bioethical backgrounds have taught me the importance of considering the many dimensions of the human condition. I am driven to become a physician who deeply considers a patient’s goal of care and goals of life. I want to learn to build and lead patient care teams that are oriented toward fulfilling these goals, creating an environment where family and clinician conflict can be addressed efficiently and respectfully. Above all, I look forward to using these approaches to keep the person beneath my patients in focus at each stage of my medical training, as I begin the task of translating complex basic science into excellent clinical care.

In her essay for medical school, Morgan pitches herself as a future physician with an interdisciplinary approach, given her appreciation of how the humanities can enable her to better understand her patients. Her narrative takes the form of an origin story, showing how a childhood interest in poetry grew into a larger mindset to keep a patient’s humanity at the center of her approach to clinical care.

This narrative distinguishes Morgan as a candidate for medical school effectively, as she provides specific examples of how her passions intersect with medicine. She first discusses how she used poetry to process her emotional response to a local boy’s suicide and ties in concern about teenage mental health. Then, she discusses more philosophical questions she encountered through reading medical narratives, which demonstrates her direct interest in applying writing and the humanities to medicine. By making the connection from this larger theme to her own reflections on her grandfather, Morgan provides a personal insight that will give an admissions officer a window into her character. This demonstrates her empathy for her future patients and commitment to their care.

Her narrative takes the form of an origin story, showing how a childhood interest in poetry grew into a larger mindset to keep a patient's humanity at the center of her approach to clinical care.

Furthermore, it is important to note that Morgan’s essay does not repeat anything in-depth that would otherwise be on her resume. She makes a reference to her work in care team meetings through a clinical bioethics internship, but does not focus on this because there are other places on her application where this internship can be discussed. Instead, she offers a more reflection-based perspective on the internship that goes more in-depth than a resume or CV could. This enables her to explain the reasons for interdisciplinary approach to medicine with tangible examples that range from personal to professional experiences — an approach that presents her as a well-rounded candidate for medical school.

Disclaimer: With exception of the removal of identifying details, essays are reproduced as originally submitted in applications; any errors in submissions are maintained to preserve the integrity of the piece. The Crimson's news and opinion teams—including writers, editors, photographers, and designers—were not involved in the production of this article.

-- Accepted To: A medical school in New Jersey with a 3% acceptance rate. GPA: 3.80 MCAT: 502 and 504

Sponsored by E fiie Consulting Group : “ EFIIE ” boasts 100% match rate for all premedical and predental registered students. Not all students are accepted unto their pre-health student roster. Considered the most elite in the industry and assists from start to end – premed to residency. EFIIE is a one-stop-full-service education firm.

"To know even one life has breathed easier because you have lived. This is to have succeeded." – Ralph Waldo Emerson.

The tribulations I've overcome in my life have manifested in the compassion, curiosity, and courage that is embedded in my personality. Even a horrific mishap in my life has not changed my core beliefs and has only added fuel to my intense desire to become a doctor. My extensive service at an animal hospital, a harrowing personal experience, and volunteering as an EMT have increased my appreciation and admiration for the medical field.

At thirteen, I accompanied my father to the Park Home Animal Hospital with our eleven-year-old dog, Brendan. He was experiencing severe pain due to an osteosarcoma, which ultimately led to the difficult decision to put him to sleep. That experience brought to light many questions regarding the idea of what constitutes a "quality of life" for an animal and what importance "dignity" plays to an animal and how that differs from owner to owner and pet to pet. Noting my curiosity and my relative maturity in the matter, the owner of the animal hospital invited me to shadow the professional staff. Ten years later, I am still part of the team, having made the transition from volunteer to veterinarian technician. Saving a life, relieving pain, sharing in the euphoria of animal and owner reuniting after a procedure, to understanding the emotions of losing a loved one – my life was forever altered from the moment I stepped into that animal hospital.

As my appreciation for medical professionals continued to grow, a horrible accident created an indelible moment in my life. It was a warm summer day as I jumped onto a small boat captained by my grandfather. He was on his way to refill the boat's gas tank at the local marina, and as he pulled into the dock, I proceeded to make a dire mistake. As the line was thrown from the dock, I attempted to cleat the bowline prematurely, and some of the most intense pain I've ever felt in my life ensued.

Saving a life, relieving pain, sharing in the euphoria of animal and owner reuniting after a procedure, to understanding the emotions of losing a loved one – my life was forever altered from the moment I stepped into that animal hospital.

"Call 911!" I screamed, half-dazed as I witnessed blood gushing out of my open wounds, splashing onto the white fiberglass deck of the boat, forming a small puddle beneath my feet. I was instructed to raise my hand to reduce the bleeding, while someone wrapped an icy towel around the wound. The EMTs arrived shortly after and quickly drove me to an open field a short distance away, where a helicopter seemed to instantaneously appear.

The medevac landed on the roof of Stony Brook Hospital before I was expeditiously wheeled into the operating room for a seven-hour surgery to reattach my severed fingers. The distal phalanges of my 3rd and 4th fingers on my left hand had been torn off by the rope tightening on the cleat. I distinctly remember the chill from the cold metal table, the bright lights of the OR, and multiple doctors and nurses scurrying around. The skill and knowledge required to execute multiple skin graft surgeries were impressive and eye-opening. My shortened fingers often raise questions by others; however, they do not impair my self-confidence or physical abilities. The positive outcome of this trial was the realization of my intense desire to become a medical professional.

Despite being the patient, I was extremely impressed with the dedication, competence, and cohesiveness of the medical team. I felt proud to be a critical member of such a skilled group. To this day, I still cannot explain the dichotomy of experiencing being the patient, and concurrently one on the professional team, committed to saving the patient. Certainly, this experience was a defining part of my life and one of the key contributors to why I became an EMT and a volunteer member of the Sample Volunteer Ambulance Corps. The startling ring of the pager, whether it is to respond to an inebriated alcoholic who is emotionally distraught or to help bring breath to a pulseless person who has been pulled from the family swimming pool, I am committed to EMS. All of these events engender the same call to action and must be reacted to with the same seriousness, intensity, and magnanimity. It may be some routine matter or a dire emergency; this is a role filled with uncertainty and ambiguity, but that is how I choose to spend my days. My motives to become a physician are deeply seeded. They permeate my personality and emanate from my desire to respond to the needs of others. Through a traumatic personal event and my experiences as both a professional and volunteer, I have witnessed firsthand the power to heal the wounded and offer hope. Each person defines success in different ways. To know even one life has been improved by my actions affords me immense gratification and meaning. That is success to me and why I want to be a doctor.

This review is provided by EFIIE Consulting Group’s Pre-Health Senior Consultant Jude Chan

This student was a joy to work with — she was also the lowest MCAT profile I ever accepted onto my roster. At 504 on the second attempt (502 on her first) it would seem impossible and unlikely to most that she would be accepted into an allopathic medical school. Even for an osteopathic medical school this score could be too low. Additionally, the student’s GPA was considered competitive at 3.80, but it was from a lower ranked, less known college, so naturally most advisors would tell this student to go on and complete a master’s or postbaccalaureate program to show that she could manage upper level science classes. Further, she needed to retake the MCAT a third time.

However, I saw many other facets to this student’s history and life that spoke volumes about the type of student she was, and this was the positioning strategy I used for her file. Students who read her personal statement should know that acceptance is contingent on so much more than just an essay and MCAT score or GPA. Although many students have greater MCAT scores than 504 and higher GPAs than 3.80, I have helped students with lower scores and still maintained our 100% match rate. You are competing with thousands of candidates. Not every student out there requires our services and we are actually grateful that we can focus on a limited amount out of the tens of thousands that do. We are also here for the students who wish to focus on learning well the organic chemistry courses and physics courses and who want to focus on their research and shadowing opportunities rather than waste time deciphering the next step in this complex process. We tailor a pathway for each student dependent on their health care career goals, and our partnerships with non-profit organizations, hospitals, physicians and research labs allow our students to focus on what matters most — the building up of their basic science knowledge and their exposure to patients and patient care.

Students who read her personal statement should know that acceptance is contingent on so much more than just an essay and MCAT score or GPA.

Even students who believe that their struggle somehow disqualifies them from their dream career in health care can be redeemed if they are willing to work for it, just like this student with 502 and 504 MCAT scores. After our first consult, I saw a way to position her to still be accepted into an MD school in the US — I would not have recommended she register to our roster if I did not believe we could make a difference. Our rosters have a waitlist each semester, and it is in our best interest to be transparent with our students and protect our 100% record — something I consider a win-win. It is unethical to ever guarantee acceptance in admissions as we simply do not control these decisions. However, we respect it, play by the rules, and help our students stay one step ahead by creating an applicant profile that would be hard for the schools to ignore.

This may be the doctor I go to one day. Or the nurse or dentist my children or my grandchildren goes to one day. That is why it is much more than gaining acceptance — it is about properly matching the student to the best options for their education. Gaining an acceptance and being incapable of getting through the next 4 or 8 years (for my MD/PhD-MSTP students) is nonsensical.

-- Accepted To: Imperial College London UCAT Score: 2740 BMAT Score: 3.9, 5.4, 3.5A

My motivation to study Medicine stems from wishing to be a cog in the remarkable machine that is universal healthcare: a system which I saw first-hand when observing surgery in both the UK and Sri Lanka. Despite the differences in sanitation and technology, the universality of compassion became evident. When volunteering at OSCE training days, I spoke to many medical students, who emphasised the importance of a genuine interest in the sciences when studying Medicine. As such, I have kept myself informed of promising developments, such as the use of monoclonal antibodies in cancer therapy. After learning about the role of HeLa cells in the development of the polio vaccine in Biology, I read 'The Immortal Life of Henrietta Lacks' to find out more. Furthermore, I read that surface protein CD4 can be added to HeLa cells, allowing them to be infected with HIV, opening the possibility of these cells being used in HIV research to produce more life-changing drugs, such as pre-exposure prophylaxis (PreP). Following my BioGrad laboratory experience in HIV testing, and time collating data for research into inflammatory markers in lung cancer, I am also interested in pursuing a career in medical research. However, during a consultation between an ENT surgeon and a thyroid cancer patient, I learnt that practising medicine needs more than a scientific aptitude. As the surgeon explained that the cancer had metastasised to her liver, I watched him empathetically tailor his language for the patient - he avoided medical jargon and instead gave her time to come to terms with this. I have been developing my communication skills by volunteering weekly at care homes for 3 years, which has improved my ability to read body language and structure conversations to engage with the residents, most of whom have dementia.

However, during a consultation between an ENT surgeon and a thyroid cancer patient, I learnt that practising medicine needs more than a scientific aptitude.

Jude’s essay provides a very matter-of-fact account of their experience as a pre-medical student. However, they deepen this narrative by merging two distinct cultures through some common ground: a universality of compassion. Using clear, concise language and a logical succession of events — much like a doctor must follow when speaking to patients — Jude shows their motivation to go into the medical field.

From their OSCE training days to their school’s Science society, Jude connects their analytical perspective — learning about HeLa cells — to something that is relatable and human, such as a poor farmer’s notable contribution to science. This approach provides a gateway into their moral compass without having to explicitly state it, highlighting their fervent desire to learn how to interact and communicate with others when in a position of authority.

Using clear, concise language and a logical succession of events — much like a doctor must follow when speaking to patients — Jude shows their motivation to go into the medical field.

Jude’s closing paragraph reminds the reader of the similarities between two countries like the UK and Sri Lanka, and the importance of having a universal healthcare system that centers around the just and “world-class” treatment of patients. Overall, this essay showcases Jude’s personal initiative to continue to learn more and do better for the people they serve.

While the essay could have benefited from better transitions to weave Jude’s experiences into a personal story, its strong grounding in Jude’s motivation makes for a compelling application essay.

-- Accepted to: Weill Cornell Medical College GPA: 3.98 MCAT: 521

Sponsored by E fie Consulting Group : “ EFIIE ” boasts 100% match rate for all premedical and predental registered students. Not all students are accepted unto their pre-health student roster. Considered the most elite in the industry and assists from start to end – premed to residency. EFIIE is a one-stop-full-service education firm.

Following the physician’s unexpected request, we waited outside, anxiously waiting to hear the latest update on my father’s condition. It was early on in my father’s cancer progression – a change that had shaken our entire way of life overnight. During those 18 months, while my mother spent countless nights at the hospital, I took on the responsibility of caring for my brother. My social life became of minimal concern, and the majority of my studying for upcoming 12th- grade exams was done at the hospital. We were allowed back into the room as the physician walked out, and my parents updated us on the situation. Though we were a tight-knit family and my father wanted us to be present throughout his treatment, what this physician did was give my father a choice. Without making assumptions about who my father wanted in the room, he empowered him to make that choice independently in private. It was this respect directed towards my father, the subsequent efforts at caring for him, and the personal relationship of understanding they formed, that made the largest impact on him. Though my decision to pursue medicine came more than a year later, I deeply valued what these physicians were doing for my father, and I aspired to make a similar impact on people in the future.

It was during this period that I became curious about the human body, as we began to learn physiology in more depth at school. In previous years, the problem-based approach I could take while learning math and chemistry were primarily what sparked my interest. However, I became intrigued by how molecular interactions translated into large-scale organ function, and how these organ systems integrated together to generate the extraordinary physiological functions we tend to under-appreciate. I began my undergraduate studies with the goal of pursuing these interests, whilst leaning towards a career in medicine. While I was surprised to find that there were upwards of 40 programs within the life sciences that I could pursue, it broadened my perspective and challenged me to explore my options within science and healthcare. I chose to study pathobiology and explore my interests through hospital volunteering and research at the end of my first year.

Though my decision to pursue medicine came more than a year later, I deeply valued what these physicians were doing for my father, and I aspired to make a similar impact on people in the future.

While conducting research at St. Michael’s Hospital, I began to understand methods of data collection and analysis, and the thought process of scientific inquiry. I became acquainted with the scientific literature, and the experience transformed how I thought about the concepts I was learning in lecture. However, what stood out to me that summer was the time spent shadowing my supervisor in the neurosurgery clinic. It was where I began to fully understand what life would be like as a physician, and where the career began to truly appeal to me. What appealed to me most was the patient-oriented collaboration and discussions between my supervisor and his fellow; the physician-patient relationship that went far beyond diagnoses and treatments; and the problem solving that I experienced first-hand while being questioned on disease cases.

The day spent shadowing in the clinic was also the first time I developed a relationship with a patient. We were instructed to administer the Montreal cognitive assessment (MoCA) test to patients as they awaited the neurosurgeon. My task was to convey the instructions as clearly as possible and score each section. I did this as best I could, adapting my explanation to each patient, and paying close attention to their responses to ensure I was understood. The last patient was a challenging case, given a language barrier combined with his severe hydrocephalus. It was an emotional time for his family, seeing their father/husband struggle to complete simple tasks and subsequently give up. I encouraged him to continue trying. But I also knew my words would not remedy the condition underlying his struggles. All I could do was make attempts at lightening the atmosphere as I got to know him and his family better. Hours later, as I saw his remarkable improvement following a lumbar puncture, and the joy on his and his family’s faces at his renewed ability to walk independently, I got a glimpse of how rewarding it would be to have the ability and privilege to care for such patients. By this point, I knew I wanted to commit to a life in medicine. Two years of weekly hospital volunteering have allowed me to make a small difference in patients’ lives by keeping them company through difficult times, and listening to their concerns while striving to help in the limited way that I could. I want to have the ability to provide care and treatment on a daily basis as a physician. Moreover, my hope is that the breadth of medicine will provide me with the opportunity to make an impact on a larger scale. Whilst attending conferences on neuroscience and surgical technology, I became aware of the potential to make a difference through healthcare, and I look forward to developing the skills necessary to do so through a Master’s in Global Health. Whether through research, health innovation, or public health, I hope not only to care for patients with the same compassion with which physicians cared for my father, but to add to the daily impact I can have by tackling large-scale issues in health.

Taylor’s essay offers both a straightforward, in-depth narrative and a deep analysis of his experiences, which effectively reveals his passion and willingness to learn in the medical field. The anecdote of Taylor’s father gives the reader insight into an original instance of learning through experience and clearly articulates Taylor’s motivations for becoming a compassionate and respectful physician.

Taylor strikes an impeccable balance between discussing his accomplishments and his character. All of his life experiences — and the difficult challenges he overcame — introduce the reader to an important aspect of Taylor’s personality: his compassion, care for his family, and power of observation in reflecting on the decisions his father’s doctor makes. His description of his time volunteering at St. Michael’s Hospital is indicative of Taylor’s curiosity about medical research, but also of his recognition of the importance of the patient-physician relationship. Moreover, he shows how his volunteer work enabled him to see how medicine goes “beyond diagnoses and treatments” — an observation that also speaks to his compassion.

His description of his time volunteering at St. Michael's Hospital is indicative of Taylor's curiosity about medical research, but also of his recognition of the importance of the patient-physician relationship.

Finally, Taylor also tells the reader about his ambition and purpose, which is important when thinking about applying to medical school. He discusses his hope of tackling larger scale problems through any means possible in medicine. This notion of using self interest to better the world is imperative to a successful college essay, and it is nicely done here.

-- Accepted to: Washington University

Sponsored by A dmitRx : We are a group of Chicago-based medical students who realize how challenging medical school admissions can be, so we want to provide our future classmates with resources we wish we had. Our mission at AdmitRx is to provide pre-medical students with affordable, personalized, high-quality guidance towards becoming an admitted medical student.

Running has always been one of my greatest passions whether it be with friends or alone with my thoughts. My dad has always been my biggest role model and was the first to introduce me to the world of running. We entered races around the country, and one day he invited me on a run that changed my life forever. The St. Jude Run is an annual event that raises millions of dollars for St. Jude Children’s Research Hospital. My dad has led or our local team for as long as I can remember, and I had the privilege to join when I was 16. From the first step I knew this was the environment for me – people from all walks of life united with one goal of ending childhood cancer. I had an interest in medicine before the run, and with these experiences I began to consider oncology as a career. When this came up in conversations, I would invariably be faced with the question “Do you really think you could get used to working with dying kids?” My 16-year-old self responded with something noble but naïve like “It’s important work, so I’ll have to handle it”. I was 16 years young with my plan to become an oncologist at St. Jude.

As I transitioned into college my plans for oncology were alive and well. I began working in a biochemistry lab researching new anti-cancer drugs. It was a small start, but I was overjoyed to be a part of the process. I applied to work at a number of places for the summer, but the Pediatric Oncology Education program (POE) at St. Jude was my goal. One afternoon, I had just returned from class and there it was: an email listed as ‘POE Offer’. I was ecstatic and accepted the offer immediately. Finally, I could get a glimpse at what my future holds. My future PI, Dr. Q, specialized in solid tumor translational research and I couldn’t wait to get started.

I was 16 years young with my plan to become an oncologist at St. Jude.

Summer finally came, I moved to Memphis, and I was welcomed by the X lab. I loved translational research because the results are just around the corner from helping patients. We began a pre-clinical trial of a new chemotherapy regimen and the results were looking terrific. I was also able to accompany Dr. Q whenever she saw patients in the solid tumor division. Things started simple with rounds each morning before focusing on the higher risk cases. I was fortunate enough to get to know some of the patients quite well, and I could sometimes help them pass the time with a game or two on a slow afternoon between treatments. These experiences shined a very human light on a field I had previously seen only through a microscope in a lab.

I arrived one morning as usual, but Dr. Q pulled me aside before rounds. She said one of the patients we had been seeing passed away in the night. I held my composure in the moment, but I felt as though an anvil was crushing down on me. It was tragic but I knew loss was part of the job, so I told myself to push forward. A few days later, I had mostly come to terms with what happened, but then the anvil came crashing back down with the passing of another patient. I could scarcely hold back the tears this time. That moment, it didn’t matter how many miraculous successes were happening a few doors down. Nothing overshadowed the loss, and there was no way I could ‘get used to it’ as my younger self had hoped.

I was still carrying the weight of what had happened and it was showing, so I asked Dr. Q for help. How do you keep smiling each day? How do you get used to it? The questions in my head went on. What I heard next changed my perspective forever. She said you keep smiling because no matter what happened, you’re still hope for the next patient. It’s not about getting used to it. You never get used to it and you shouldn’t. Beating cancer takes lifetimes, and you can’t look passed a life’s worth of hardships. I realized that moving passed the loss of patients would never suffice, but I need to move forward with them. Through the successes and shortcomings, we constantly make progress. I like to imagine that in all our future endeavors, it is the hands of those who have gone before us that guide the way. That is why I want to attend medical school and become a physician. We may never end the sting of loss, but physicians are the bridge between the past and the future. No where else is there the chance to learn from tragedy and use that to shape a better future. If I can learn something from one loss, keep moving forward, and use that knowledge to help even a single person – save one life, bring a moment of joy, avoid a moment of pain—then that is how I want to spend my life.

The change wasn’t overnight. The next loss still brought pain, but I took solace in moving forward so that we might learn something to give hope to a future patient. I returned to campus in a new lab doing cancer research, and my passion for medicine continues to flourish. I still think about all the people I encountered at St. Jude, especially those we lost. It might be a stretch, but during the long hours at the lab bench I still picture their hands moving through mine each step of the way. I could never have foreseen where the first steps of the St. Jude Run would bring me. I’m not sure where the road to becoming a physician may lead, but with helping hands guiding the way, I won’t be running it alone.

This essay, a description of the applicant’s intellectual challenges, displays the hardships of tending to cancer patients as a milestone of experience and realization of what it takes to be a physician. The writer explores deeper ideas beyond medicine, such as dealing with patient deaths in a way to progress and improve as a professional. In this way, the applicant gives the reader some insight into the applicant’s mindset, and their ability to think beyond the surface for ways to become better at what they do.

However, the essay fails to zero in on the applicant’s character, instead elaborating on life events that weakly illustrate the applicant’s growth as a physician. The writer’s mantra (“keep moving forward”) is feebly projected, and seems unoriginal due to the lack of a personalized connection between the experience at St. Jude and how that led to the applicant’s growth and mindset changes.

The writer explores deeper ideas beyond medicine, such as dealing with patient deaths in a way to progress and improve as a professional.

The writer, by only focusing on grief brought from patient deaths at St. Jude, misses out on the opportunity to further describe his or her experience at the hospital and portray an original, well-rounded image of his or her strengths, weaknesses, and work ethic.

The applicant ends the essay by attempting to highlight the things they learned at St. Jude, but fails to organize the ideas into a cohesive, comprehensible section. These ideas are also too abstract, and are vague indicators of the applicant’s character that are difficult to grasp.

-- Accepted to: New York University School of Medicine

Sponsored by MedEdits : MedEdits Medical Admissions has been helping applicants get into medical schools like Harvard for more than ten years. Structured like an academic medical department, MedEdits has experts in admissions, writing, editing, medicine, and interview prep working with you collaboratively so you can earn the best admissions results possible.

“Is this the movie you were talking about Alice?” I said as I showed her the movie poster on my iPhone. “Oh my God, I haven’t seen that poster in over 70 years,” she said with her arms trembling in front of her. Immediately, I sat up straight and started to question further. We were talking for about 40 minutes, and the most exciting thing she brought up in that time was the new flavor of pudding she had for lunch. All of sudden, she’s back in 1940 talking about what it was like to see this movie after school for only 5¢ a ticket! After an engaging discussion about life in the 40’s, I knew I had to indulge her. Armed with a plethora of movie streaming sights, I went to work scouring the web. No luck. The movie, “My Son My Son,” was apparently not in high demand amongst torrenting teens. I had to entreat my older brother for his Amazon Prime account to get a working stream. However, breaking up the monotony and isolation felt at the nursing home with a simple movie was worth the pandering.

While I was glad to help a resident have some fun, I was partly motivated by how much Alice reminded me of my own grandfather. In accordance with custom, my grandfather was to stay in our house once my grandmother passed away. More specifically, he stayed in my room and my bed. Just like grandma’s passing, my sudden roommate was a rough transition. In 8th grade at the time, I considered myself to be a generally good guy. Maybe even good enough to be a doctor one day. I volunteered at the hospital, shadowed regularly, and had a genuine interest for science. However, my interest in medicine was mostly restricted to academia. To be honest, I never had a sustained exposure to the palliative side of medicine until the arrival of my new roommate.

The two years I slept on that creaky wooden bed with him was the first time my metal was tested. Sharing that room, I was the one to take care of him. I was the one to rub ointment on his back, to feed him when I came back from school, and to empty out his spittoon when it got full. It was far from glamorous, and frustrating most of the time. With 75 years separating us, and senile dementia setting in, he would often forget who I was or where he was. Having to remind him that I was his grandson threatened to erode at my resolve. Assured by my Syrian Orthodox faith, I even prayed about it; asking God for comfort and firmness on my end. Over time, I grew slow to speak and eager to listen as he started to ramble more and more about bits and pieces of the past. If I was lucky, I would be able to stich together a narrative that may or may have not been true. In any case, my patience started to bud beyond my age group.

Having to remind him that I was his grandson threatened to erode at my resolve.

Although I grew more patient with his disease, my curiosity never really quelled. Conversely, it developed further alongside my rapidly growing interest in the clinical side of medicine. Naturally, I became drawn to a neurology lab in college where I got to study pathologies ranging from atrophy associated with schizophrenia, and necrotic lesions post stroke. However, unlike my intro biology courses, my work at the neurology lab was rooted beyond the academics. Instead, I found myself driven by real people who could potentially benefit from our research. In particular, my shadowing experience with Dr. Dominger in the Veteran’s home made the patient more relevant in our research as I got to encounter geriatric patients with age related diseases, such as Alzhimer’s and Parkinson’s. Furthermore, I had the privilege of of talking to the families of a few of these patients to get an idea of the impact that these diseases had on the family structure. For me, the scut work in the lab meant a lot more with these families in mind than the tritium tracer we were using in the lab.

Despite my achievements in the lab and the classroom, my time with my grandfather still holds a special place in my life story. The more I think about him, the more confident I am in my decision to pursue a career where caring for people is just as important, if not more important, than excelling at academics. Although it was a lot of work, the years spent with him was critical in expanding my horizons both in my personal life and in the context of medicine. While I grew to be more patient around others, I also grew to appreciate medicine beyond the science. This more holistic understanding of medicine had a synergistic effect in my work as I gained a purpose behind the extra hours in the lab, sleepless nights in the library, and longer hours volunteering. I had a reason for what I was doing that may one day help me have long conversations with my own grandchildren about the price of popcorn in the 2000’s.

The most important thing to highlight in Avery’s essay is how he is able to create a duality between his interest in not only the clinical, more academic-based side of medicine, but also the field’s personal side.

He draws personal connections between working with Alice — a patient in a hospital or nursing home — and caring intensely for his grandfather. These two experiences build up the “synergistic” relationship between caring for people and studying the science behind medicine. In this way, he is able to clearly state his passions for medicine and explain his exact motives for entering the field. Furthermore, in his discussion of her grandfather, he effectively employs imagery (“rub ointment on his back,” “feed him when I came back from school,” etc.) to describe the actual work that he does, calling it initially as “far from glamorous, and frustrating most of the time.” By first mentioning his initial impression, then transitioning into how he grew to appreciate the experience, Avery is able to demonstrate a strength of character, sense of enormous responsibility and capability, and open-minded attitude.

He draws personal connections between working with Alice — a patient in a hospital or nursing home — and caring intensely for his grandfather.

Later in the essay, Avery is also able to relate his time caring for his grandfather to his work with Alzheimer’s and Parkinson’s patients, showcasing the social impact of his work, as the reader is likely already familiar with the biological impact of the work. This takes Avery’s essay full circle, bringing it back to how a discussion with an elderly patient about the movies reminds him of why he chose to pursue medicine.

That said, the essay does feel rushed near the end, as the writer was likely trying to remain within the word count. There could be a more developed transition before Avery introduces the last sentence about “conversations with my own grandchildren,” especially as a strong essay ending is always recommended.

-- Accepted To: Saint Louis University Medical School Direct Admission Medical Program

Sponsored by Atlas Admissions : Atlas Admissions provides expert medical school admissions consulting and test preparation services. Their experienced, physician-driven team consistently delivers top results by designing comprehensive, personalized strategies to optimize applications. Atlas Admissions is based in Boston, MA and is trusted by clients worldwide.

The tension in the office was tangible. The entire team sat silently sifting through papers as Dr. L introduced Adam, a 60-year-old morbidly obese man recently admitted for a large open wound along his chest. As Dr. L reviewed the details of the case, his prognosis became even bleaker: hypertension, diabetes, chronic kidney disease, cardiomyopathy, hyperlipidemia; the list went on and on. As the humdrum of the side-conversations came to a halt, and the shuffle of papers softened, the reality of Adam’s situation became apparent. Adam had a few months to live at best, a few days at worst. To make matters worse, Adam’s insurance would not cover his treatment costs. With no job, family, or friends, he was dying poor and alone.

I followed Dr. L out of the conference room, unsure what would happen next. “Well,” she muttered hesitantly, “We need to make sure that Adam is on the same page as us.” It’s one thing to hear bad news, and another to hear it utterly alone. Dr. L frantically reviewed all of Adam’s paperwork desperately looking for someone to console him, someone to be at his side. As she began to make calls, I saw that being a physician calls for more than good grades and an aptitude for science: it requires maturity, sacrifice, and most of all, empathy. That empathy is exactly what I saw in Dr. L as she went out of her way to comfort a patient she met hardly 20 minutes prior.

Since high school, I’ve been fascinated by technology’s potential to improve healthcare. As a volunteer in [the] Student Ambassador program, I was fortunate enough to watch an open-heart surgery. Intrigued by the confluence of technology and medicine, I chose to study biomedical engineering. At [school], I wanted to help expand this interface, so I became involved with research through Dr. P’s lab by studying the applications of electrospun scaffolds for dermal wound healing. While still in the preliminary stages of research, I learned about the Disability Service Club (DSC) and decided to try something new by volunteering at a bowling outing.

As she began to make calls, I saw that being a physician calls for more than good grades and an aptitude for science: it requires maturity, sacrifice, and most of all, empathy.

The DSC promotes awareness of cognitive disabilities in the community and seeks to alleviate difficulties for the disabled. During one outing, I collaborated with Arc, a local organization with a similar mission. Walking in, I was told that my role was to support the participants by providing encouragement. I decided to help a relatively quiet group of individuals assisted by only one volunteer, Mary. Mary informed me that many individuals with whom I was working were diagnosed with ASD. Suddenly, she started cheering, as one of the members of the group bowled a strike. The group went wild. Everyone was dancing, singing, and rejoicing. Then I noticed one gentleman sitting at our table, solemn-faced. I tried to start a conversation with him, but he remained unresponsive. I sat with him for the rest of the game, trying my hardest to think of questions that would elicit more than a monosyllabic response, but to no avail. As the game ended, I stood up to say bye when he mumbled, “Thanks for talking.” Then he quickly turned his head away. I walked away beaming. Although I was unable to draw out a smile or even sustain a conversation, at the end of the day, the fact that this gentleman appreciated my mere effort completely overshadowed the awkwardness of our time together. Later that day, I realized that as much as I enjoyed the thrill of research and its applications, helping other people was what I was most passionate about.

When it finally came time to tell Adam about his deteriorating condition, I was not sure how he would react. Dr. L gently greeted him and slowly let reality take its toll. He stoically turned towards Dr. L and groaned, “I don’t really care. Just leave me alone.” Dr. L gave him a concerned nod and gradually left the room. We walked to the next room where we met with a pastor from Adam’s church.

“Adam’s always been like that,” remarked the pastor, “he’s never been one to express emotion.” We sat with his pastor for over an hour discussing how we could console Adam. It turned out that Adam was part of a motorcycle club, but recently quit because of his health. So, Dr. L arranged for motorcycle pictures and other small bike trinkets to be brought to his room as a reminder of better times.

Dr. L’s simple gesture reminded me of why I want to pursue medicine. There is something sacred, empowering, about providing support when people need it the most; whether it be simple as starting a conversation, or providing support during the most trying of times. My time spent conducting research kindled my interest in the science of medicine, and my service as a volunteer allowed me to realize how much I valued human interaction. Science and technology form the foundation of medicine, but to me, empathy is the essence. It is my combined interest in science and service that inspires me to pursue medicine. It is that combined interest that makes me aspire to be a physician.

Parker’s essay focuses on one central narrative with a governing theme of compassionate and attentive care for patients, which is the key motivator for her application to medical school. Parker’s story focuses on her volunteer experience shadowing of Dr. L who went the extra mile for Adam, which sets Dr. L up as a role model for Parker as she enters the medical field. This effectively demonstrates to the reader what kind of doctor Parker wants to be in the future.

Parker’s narrative has a clear beginning, middle, and end, making it easy for the reader to follow. She intersperses the main narrative about Adam with experiences she has with other patients and reflects upon her values as she contemplates pursuing medicine as a career. Her anecdote about bowling with the patients diagnosed with ASD is another instance where she uses a story to tell the reader why she values helping people through medicine and attentive patient care, especially as she focuses on the impact her work made on one man at the event.

Parker's story focuses on her volunteer experience shadowing of Dr. L who went the extra mile for Adam, which sets Dr. L up as a role model for Parker as she enters the medical field.

All throughout the essay, the writing is engaging and Parker incorporates excellent imagery, which goes well with her varied sentence structure. The essay is also strong because it comes back full circle at its conclusion, tying the overall narrative back to the story of Dr. L and Adam, which speaks to Parker’s motives for going to medical school.

-- Accepted To: Emory School of Medicine

Growing up, I enjoyed visiting my grandparents. My grandfather was an established doctor, helping the sick and elderly in rural Taiwan until two weeks before he died at 91 years old. His clinic was located on the first floor of the residency with an exam room, treatment room, X-ray room, and small pharmacy. Curious about his work, I would follow him to see his patients. Grandpa often asked me if I want to be a doctor just like him. I always smiled, but was more interested in how to beat the latest Pokémon game. I was in 8th grade when my grandfather passed away. I flew back to Taiwan to attend his funeral. It was a gloomy day and the only street in the small village became a mourning place for the villagers. Flowers filled the streets and people came to pay their respects. An old man told me a story: 60 years ago, a village woman was in a difficult labor. My grandfather rushed into the house and delivered a baby boy. That boy was the old man and he was forever grateful. Stories of grandpa saving lives and bringing happiness to families were told during the ceremony. At that moment, I realized why my grandfather worked so tirelessly up until his death as a physician. He did it for the reward of knowing that he kept a family together and saved a life. The ability for a doctor to heal and bring happiness is the reason why I want to study medicine. Medical school is the first step on a lifelong journey of learning, but I feel that my journey leading up to now has taught me some things of what it means to be an effective physician.

With a newfound purpose, I began volunteering and shadowing at my local hospital. One situation stood out when I was a volunteer in the cardiac stress lab. As I attached EKG leads onto a patient, suddenly the patient collapsed and started gasping for air. His face turned pale, then slightly blue. The charge nurse triggered “Code Blue” and started CPR. A team of doctors and nurses came, rushing in with a defibrillator to treat and stabilize the patient. What I noticed was that medicine was not only about one individual acting as a superhero to save a life, but that it takes a team of individuals with an effective leader, working together to deliver the best care. I want to be a leader as well as part of a team that can make a difference in a person’s life. I have refined these lessons about teamwork and leadership to my activities. In high school I was an 8 time varsity letter winner for swimming and tennis and captain of both of those teams. In college I have participated in many activities, but notably serving as assistant principle cellist in my school symphony as well as being a co-founding member of a quartet. From both my athletic experiences and my music experiences I learned what it was like to not only assert my position as a leader and to effectively communicate my views, but equally as important I learned how to compromise and listen to the opinions of others. Many physicians that I have observed show a unique blend of confidence and humility.

What I noticed was that medicine was not only about one individual acting as a superhero to save a life, but that it takes a team of individuals with an effective leader, working together to deliver the best care.

College opened me up to new perspectives on what makes a complete physician. A concept that was preached in the Guaranteed Professional Program Admissions in Medicine (GPPA) was that medicine is both an art and a science. The art of medicine deals with a variety of aspects including patient relationships as well as ethics. Besides my strong affinity for the sciences and mathematics, I always have had interest in history. I took courses in both German literature and history, which influenced me to take a class focusing on Nazi neuroscientists. It was the ideology of seeing the disabled and different races as test subjects rather than people that led to devastating lapses in medical ethics. The most surprising fact for me was that doctors who were respected and leaders in their field disregarded the humanity of patient and rather focused on getting results from their research. Speaking with Dr. Zeidman, the professor for this course, influenced me to start my research which deals with the ethical qualms of using data derived from unethical Nazi experimentation such as the brains derived from the adult and child euthanasia programs. Today, science is so result driven, it is important to keep in mind the ethics behind research and clinical practice. Also the development of personalized genomic medicine brings into question about potential privacy violations and on the extreme end discrimination. The study of ethics no matter the time period is paramount in the medical field. The end goal should always be to put the patient first.

Teaching experiences in college inspired me to become a physician educator if I become a doctor. Post-MCAT, I was offered a job by Next Step Test Prep as a tutor to help students one on one for the MCAT. I had a student who stated he was doing well during practice, but couldn’t get the correct answer during practice tests. Working with the student, I pointed out his lack of understanding concepts and this realization helped him and improves his MCAT score. Having the ability to educate the next generation of doctors is not only necessary, but also a rewarding experience.

My experiences volunteering and shadowing doctors in the hospital as well as my understanding of what it means to be a complete physician will make me a good candidate as a medical school student. It is my goal to provide the best care to patients and to put a smile on a family’s face just as my grandfather once had. Achieving this goal does not take a special miracle, but rather hard work, dedication, and an understanding of what it means to be an effective physician.

Through reflecting on various stages of life, Quinn expresses how they found purpose in pursuing medicine. Starting as a child more interested in Pokemon than their grandfather’s patients, Quinn exhibits personal growth through recognizing the importance of their grandfather’s work saving lives and eventually gaining the maturity to work towards this goal as part of a team.

This essay opens with abundant imagery — of the grandfather’s clinic, flowers filling the streets, and the village woman’s difficult labor — which grounds Quinn’s story in their family roots. Yet, the transition from shadowing in hospitals to pursuing leadership positions in high schools is jarring, and the list of athletic and musical accomplishments reads like a laundry list of accomplishments until Quinn neatly wraps them up as evidence of leadership and teamwork skills. Similarly, the section about tutoring, while intended to demonstrate Quinn’s desire to educate future physicians, lacks the emotional resonance necessary to elevate it from another line lifted from their resume.

This essay opens with abundant imagery — of the grandfather's clinic, flowers filling the streets, and the village woman's difficult labor — which grounds Quinn's story in their family roots.

The strongest point of Quinn’s essay is the focus on their unique arts and humanities background. This equips them with a unique perspective necessary to consider issues in medicine in a new light. Through detailing how history and literature coursework informed their unique research, Quinn sets their application apart from the multitude of STEM-focused narratives. Closing the essay with the desire to help others just as their grandfather had, Quinn ties the narrative back to their personal roots.

-- Accepted To: Edinburgh University UCAT Score: 2810 BMAT Score: 4.6, 4.2, 3.5A

Exposure to the medical career from an early age by my father, who would explain diseases of the human body, sparked my interest for Medicine and drove me to seek out work experience. I witnessed the contrast between use of bone saws and drills to gain access to the brain, with subsequent use of delicate instruments and microscopes in neurosurgery. The surgeon's care to remove the tumour, ensuring minimal damage to surrounding healthy brain and his commitment to achieve the best outcome for the patient was inspiring. The chance to have such a positive impact on a patient has motivated me to seek out a career in Medicine.

Whilst shadowing a surgical team in Texas, carrying out laparoscopic bariatric procedures, I appreciated the surgeon's dedication to continual professional development and research. I was inspired to carry out an Extended Project Qualification on whether bariatric surgery should be funded by the NHS. By researching current literature beyond my school curriculum, I learnt to assess papers for bias and use reliable sources to make a conclusion on a difficult ethical situation. I know that doctors are required to carry out research and make ethical decisions and so, I want to continue developing these skills during my time at medical school.

The chance to have such a positive impact on a patient has motivated me to seek out a career in Medicine.

Attending an Oncology multi-disciplinary team meeting showed me the importance of teamwork in medicine. I saw each team member, with specific areas of expertise, contributing to the discussion and actively listening, and together they formed a holistic plan of action for patients. During my Young Enterprise Award, I facilitated a brainstorm where everyone pitched a product idea. Each member offered a different perspective on the idea and then voted on a product to carry forward in the competition. As a result, we came runners up in the Regional Finals. Furthermore, I started developing my leadership skills, which I improved by doing Duke of Edinburgh Silver and attending a St. John Ambulance Leadership course. In one workshop, similar to the bariatric surgeon I shadowed, I communicated instructions and delegated roles to my team to successfully solve a puzzle. These experiences highlighted the crucial need for teamwork and leadership as a doctor.

Observing a GP, I identified the importance of compassion and empathy. During a consultation with a severely depressed patient, the GP came to the patient's eye level and used a calm, non-judgmental tone of voice, easing her anxieties and allowing her to disclose more information. While volunteering at a care home weekly for two years, I adapted my communication for a resident suffering with dementia who was disconnected from others. I would take her to a quiet environment, speak slowly and in a non-threatening manner, as such, she became talkative, engaged and happier. I recognised that communication and compassion allows doctors to build rapport, gain patients' trust and improve compliance. For two weeks, I shadowed a surgeon performing multiple craniotomies a day. I appreciated the challenges facing doctors including time and stress management needed to deliver high quality care. Organisation, by prioritising patients based on urgency and creating a timetable on the ward round, was key to running the theatre effectively. Similarly, I create to-do-lists and prioritise my academics and extra-curricular activities to maintain a good work-life balance: I am currently preparing for my Grade 8 in Singing, alongside my A-level exams. I also play tennis for the 1st team to relax and enable me to refocus. I wish to continue my hobbies at university, as ways to manage stress.

Through my work experiences and voluntary work, I have gained a realistic understanding of Medicine and its challenges. I have begun to display the necessary skills that I witnessed, such as empathy, leadership and teamwork. The combination of these skills with my fascination for the human body drives me to pursue a place at medical school and a career as a doctor.

This essay traces Alex's personal exploration of medicine through different stages of life, taking a fairly traditional path to the medical school application essay. From witnessing medical procedures to eventually pursuing leadership positions, this tale of personal progress argues that Alex's life has prepared him to become a doctor.

Alex details how experiences conducting research and working with medical teams have confirmed his interest in medicine. Although the breadth of experiences speaks to the applicant’s interest in medicine, the essay verges on being a regurgitation of the Alex's resume, which does not provide the admissions officer with any new insights or information and ultimately takes away from the essay as a whole. As such, the writing’s lack of voice or unique perspective puts the applicant at risk of sounding middle-of-the-road.

From witnessing medical procedures to eventually pursuing leadership positions, this tale of personal progress argues that Alex's life has prepared him to become a doctor.

The essay’s organization, however, is one of its strengths — each paragraph provides an example of personal growth through a new experience in medicine. Further, Alex demonstrates his compassion and diligence through detailed stories, which give a reader a glimpse into his values. Through recognizing important skills necessary to be a doctor, Alex demonstrates that he has the mature perspective necessary to embark upon this journey.

What this essay lacks in a unique voice, it makes up for in professionalism and organization. Alex's earnest desire to attend medical school is what makes this essay shine.

-- Accepted To: University of Toronto MCAT Scores: Chemical and Physical Foundations of Biological Systems - 128, Critical Analysis and Reading Skills - 127, Biological and Biochemical Foundations of Living Systems - 127, Psychological, Social, and Biological Foundations of Behavior - 130, Total - 512

Moment of brilliance.

Revelation.

These are all words one would use to describe their motivation by a higher calling to achieve something great. Such an experience is often cited as the reason for students to become physicians; I was not one of these students. Instead of waiting for an event like this, I chose to get involved in the activities that I found most invigorating. Slowly but surely, my interests, hobbies, and experiences inspired me to pursue medicine.

As a medical student, one must possess a solid academic foundation to facilitate an understanding of physical health and illness. Since high school, I found science courses the most appealing and tended to devote most of my time to their exploration. I also enjoyed learning about the music, food, literature, and language of other cultures through Latin and French class. I chose the Medical Sciences program because it allowed for flexibility in course selection. I have studied several scientific disciplines in depth like physiology and pathology while taking classes in sociology, psychology, and classical studies. Such a diverse academic portfolio has strengthened my ability to consider multiple viewpoints and attack problems from several angles. I hope to relate to patients from all walks of life as a physician and offer them personalized treatment.

I was motivated to travel as much as possible by learning about other cultures in school. Exposing myself to different environments offered me perspective on universal traits that render us human. I want to pursue medicine because I believe that this principle of commonality relates to medical practice in providing objective and compassionate care for all. Combined with my love for travel, this realization took me to Nepal with Volunteer Abroad (VA) to build a school for a local orphanage (4). The project’s demands required a group of us to work closely as a team to accomplish the task. Rooted in different backgrounds, we often had conflicting perspectives; even a simple task such as bricklaying could stir up an argument because each person had their own approach. However, we discussed why we came to Nepal and reached the conclusion that all we wanted was to build a place of education for the children. Our unifying goal allowed us to reach compromises and truly appreciate the value of teamwork. These skills are vital in a clinical setting, where physicians and other health care professionals need to collaborate as a multidisciplinary team to tackle patients’ physical, emotional, social, and psychological problems.

I hope to relate to patients from all walks of life as a physician and offer them personalized treatment.

The insight I gained from my Nepal excursion encouraged me to undertake and develop the role of VA campus representative (4). Unfortunately, many students are not equipped with the resources to volunteer abroad; I raised awareness about local initiatives so everyone had a chance to do their part. I tried to avoid pushing solely for international volunteerism for this reason and also because it can undermine the work of local skilled workers and foster dependency. Nevertheless, I took on this position with VA because I felt that the potential benefits were more significant than the disadvantages. Likewise, doctors must constantly weigh out the pros and cons of a situation to help a patient make the best choice. I tried to dispel fears of traveling abroad by sharing first-hand experiences so that students could make an informed decision. When people approached me regarding unfamiliar placements, I researched their questions and provided them with both answers and a sense of security. I found great fulfillment in addressing the concerns of individuals, and I believe that similar processes could prove invaluable in the practice of medicine.

As part of the Sickkids Summer Research Program, I began to appreciate the value of experimental investigation and evidence-based medicine (23). Responsible for initiating an infant nutrition study at a downtown clinic, I was required to explain the project’s implications and daily protocol to physicians, nurses and phlebotomists. I took anthropometric measurements and blood pressure of children aged 1-10 and asked parents about their and their child’s diet, television habits, physical exercise regimen, and sunlight exposure. On a few occasions, I analyzed and presented a small set of data to my superiors through oral presentations and written documents.

With continuous medical developments, physicians must participate in lifelong learning. More importantly, they can engage in research to further improve the lives of their patients. I encountered a young mother one day at the clinic struggling to complete the study’s questionnaires. After I asked her some questions, she began to open up to me as her anxiety subsided; she then told me that her child suffered from low iron. By talking with the physician and reading a few articles, I recommended a few supplements and iron-rich foods to help her child. This experience in particular helped me realize that I enjoy clinical research and strive to address the concerns of people with whom I interact.

Research is often impeded by a lack of government and private funding. My clinical placement motivated me to become more adept in budgeting, culminating in my role as founding Co-President of the UWO Commerce Club (ICCC) (9). Together, fellow club executives and I worked diligently to get the club ratified, a process that made me aware of the bureaucratic challenges facing new organizations. Although we had a small budget, we found ways of minimizing expenditure on advertising so that we were able to host more speakers who lectured about entrepreneurship and overcoming challenges. Considering the limited space available in hospitals and the rising cost of health care, physicians, too, are often forced to prioritize and manage the needs of their patients.

No one needs a grand revelation to pursue medicine. Although passion is vital, it is irrelevant whether this comes suddenly from a life-altering event or builds up progressively through experience. I enjoyed working in Nepal, managing resources, and being a part of clinical and research teams; medicine will allow me to combine all of these aspects into one wholesome career.

I know with certainty that this is the profession for me.

Jimmy opens this essay hinting that his essay will follow a well-worn path, describing the “big moment” that made him realize why he needed to become a physician. But Jimmy quickly turns the reader’s expectation on its head by stating that he did not have one of those moments. By doing this, Jimmy commands attention and has the reader waiting for an explanation. He soon provides the explanation that doubles as the “thesis” of his essay: Jimmy thinks passion can be built progressively, and Jimmy’s life progression has led him to the medical field.

Jimmy did not make the decision to pursue a career in medicine lightly. Instead he displays through anecdotes that his separate passions — helping others, exploring different walks of life, personal responsibility, and learning constantly, among others — helped Jimmy realize that being a physician was the career for him. By talking readers through his thought process, it is made clear that Jimmy is a critical thinker who can balance multiple different perspectives simultaneously. The ability to evaluate multiple options and make an informed, well-reasoned decision is one that bodes well for Jimmy’s medical career.

While in some cases this essay does a lot of “telling,” the comprehensive and decisive walkthrough indicates what Jimmy’s idea of a doctor is. To him, a doctor is someone who is genuinely interested in his work, someone who can empathize and related to his patients, someone who can make important decisions with a clear head, and someone who is always trying to learn more. Just like his decision to work at the VA, Jimmy has broken down the “problem” (what his career should be) and reached a sound conclusion.

By talking readers through his thought process, it is made clear that Jimmy is a critical thinker who can balance multiple different perspectives simultaneously.

Additionally, this essay communicates Jimmy’s care for others. While it is not always advisable to list one’s volunteer efforts, each activity Jimmy lists has a direct application to his essay. Further, the sheer amount of philanthropic work that Jimmy does speaks for itself: Jimmy would not have worked at VA, spent a summer with Sickkids, or founded the UWO finance club if he were not passionate about helping others through medicine. Like the VA story, the details of Jimmy’s participation in Sickkids and the UWO continue to show how he has thought about and embodied the principles that a physician needs to be successful.

Jimmy’s essay both breaks common tropes and lives up to them. By framing his “list” of activities with his passion-happens-slowly mindset, Jimmy injects purpose and interest into what could have been a boring and braggadocious essay if it were written differently. Overall, this essay lets the reader know that Jimmy is seriously dedicated to becoming a physician, and both his thoughts and his actions inspire confidence that he will give medical school his all.

The Crimson's news and opinion teams—including writers, editors, photographers, and designers—were not involved in the production of this content.

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Leadership and Management Techniques For All Doctors

What is Leadership and Management? 

Leadership is a word that is often used and seldom truly understood. From medical school interviews through to senior career progression, the attributes of leadership are sought after. 

Good leadership is not automatically found with career progression and senior job roles. Leadership is the ability to translate a vision into reality. Materialising this vision into reality requires team working to achieve a common goal. Leadership is about focussing on the big picture, detecting where change is needed and implementing this change by inspiring and coaching members of the team to effectively achieve the change.

Leaders create leaders - leadership is not about inspiring yourself to be the best you can be, rather it is about role modelling behaviours that inspire others to become the best version of themselves. 

Management is about utilising the resources available to an organisation be it financial, human, machinery and integrating them together efficiently to achieve a goal. 

Leadership and management overlap but are uniquely distinct. Leadership focuses on change and exploring new possibilities with view to improving an organisation. Management focuses on the effectiveness of daily operations. 

Duties of a Doctor: 

There are a myriad of duties that doctors carry out on a daily basis. The GMC duties of a doctor highlights four, high standard domains (1) that doctors must follow: 

Knowledge, Skills and Performance: where patient safety must be prioritised, and clinicians are required to keep up to date with academic knowledge and recognise their professional limits.  

Safety and Quality: patient’s safety, health and quality of service must not be compromised.

Communication, Partnership and Teamwork: patients should be involved in their healthcare decisions. Information must be presented fully for informed consent and their autonomy respected.

Maintaining Trust: doctors must act with probity and maintain patient’s and the public’s trust in the medical profession. 

These domains set regulations for clinical, academic and professional duties that doctors have within teams in medical practice. They also provide a pre-set, uniform, high standard of care for patients. 

Leadership and Management in Healthcare:

The role of medical leadership in improving healthcare is recognised. It is also recognised that within multi-disciplinary teams, doctors have the penultimate responsibility in ensuring that patient care is not compromised. 

Leadership in the setting of healthcare is of immense importance as the role of a doctor is to detect, implement and lead change when there is improvement to be made in healthcare services or systems.

The Medical Leadership Competency Framework (MLCF) developed by the Academy of Medical Royal Colleges and NHS Institute for Innovation and Improvement contains leadership competencies that are designed to engage doctors in planning, delivering and transforming health services. This framework moves away from the conventional view of positional leadership and encourages shared leadership. Shared leadership is based on leadership arising from individuals at different levels where everyone is collectively responsible for the success of the organisation. 

Acts of leadership within teams of medical practice will differ based on job roles and experience. Depending on the job role, there are leadership duties that apply to all doctors and extra-responsibilities to doctors who are involved in formal management roles.  

Leadership Duties of a Doctor:

Doctors of all specialities and grades are expected to carry out leadership duties in their workplace. Leadership responsibilities include participating in projects with work colleagues to better patient care quality, utilising resources efficiently and productively as well as teaching junior colleagues and students. 

They also have a duty of care in the workplace to their colleagues and patients. Doctors must actively act if a patient's safely is jeopardised and acknowledge the diverse background of patients and colleagues. They must ensure a discrimination free workplace. 

The Healthcare Leadership Model: 

This model (4) contains nine leadership dimensions which can be used collectively or separately to promote leadership within healthcare workers. 

Inspiring shared purpose: having a shared goal among members of the multi-displinary team is crucial to the achievement of that goal/service. Leadership here involves role modelling actions and commitments to this goal and inspiring others to follow suit. 

Leading with care: leaders have to be tentative to their team members to support them in performing as best they can. This is done by creating a safe, supportive environment and encouraging team members to seek help when needed.

Evaluating information: leaders must make informed decisions and therefore should continuously collect and evaluate data about their team/service. The data should be used to make evidence-based verdicts. 

Connecting our service: understanding how other teams contribute to healthcare is vital. Leaders must appreciate that not every team operates the same and have to respect their differences. They must cooperate with other teams to achieve the common goal of high standard patient care.  

Sharing the vision: inspiring the team for change can be a difficult job as change is not liked by most. Honest and passionate communication between leaders and their team can motivate the team to work towards that change and achieve a common goal. 

Engaging the team: leaders value their team members and their individual qualities. They respect everyone’s contributions which motivates team members to engage in the change/shared goal. Instilling pride within individuals of the team results in increased contribution.

Holding to account: leaders must be transparent about their expectations of their team and giving subsequent freedom for the team to meet them. Having clear goals and quality standards results in the team delivering what is expected and more. 

Developing capability: leaders must constantly strive for improvement and so continuous personal development is crucial. Leaders must be role models and support their teams to continuously learn and develop new skills. This is important so that the team is prepared for future challenges and innovative change. 

Influencing for results: maintaining relationships and building new ones is crucial to ensure continuous improvement of services. Leaders use personal skills, networking abilities and professional knowledge to promote cooperation between different organisations. 

In conclusion, both leadership and management are required to drive the success of an organisation and doctors of all grades are expected to be proficient in them. Managerial skills focus on smooth and efficient running of day-to-day operations including best allocation of resourcing and task allocation. Leadership skills focus on creating a direction of change and inspiring members of the team to unite and work together towards achieving it. The importance of leadership in healthcare is well recognised and results in high standards of care for patients.

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• http://orcid.org/0000-0001-5809-7173 Oscar Lyons 1 ,
• Robynne George 2 ,
• Joao R Galante 3 , 4 ,
• Alexander Mafi 5 ,
• Thomas Fordwoh 5 ,
• http://orcid.org/0000-0001-9079-7508 Jan Frich 6 ,
• http://orcid.org/0000-0001-6672-3859 Jaason Matthew Geerts 7 , 8
• 1 Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK
• 2 Royal United Hospital Bath NHS Trust , Bath , UK
• 3 Department of Medical Education , Oxford University Hospitals NHS Foundation Trust , Oxford , UK
• 4 Cardiology Department , Buckinghamshire Healthcare NHS Trust , Amersham , UK
• 5 University of Oxford Medical School , University of Oxford , Oxford , UK
• 6 Department of Health Management and Health Economics , University of Oslo , Oslo , Norway
• 7 Research and Leadership Development , Canadian College of Health Leaders , Ottawa , Ontario , Canada
• 8 The Business School (formerly Cass) , University of London , London , UK
• Correspondence to Dr Oscar Lyons, Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK; oscar.lyons{at}nds.ox.ac.uk

Health systems invest significant resources in leadership development for physicians and other health professionals. Competent leadership is considered vital for maintaining and improving quality and patient safety. We carried out this systematic review to synthesise new empirical evidence regarding medical leadership development programme factors which are associated with outcomes at the clinical and organisational levels. Using Ovid MEDLINE, we conducted a database search using both free text and Medical Subject Headings. We then conducted an extensive hand-search of references and of citations in known healthcare leadership development reviews. We applied the Medical Education Research Study Quality Indicator (MERSQI) and the Joanna Briggs Institute (JBI) Critical Appraisal Tool to determine study reliability, and synthesised results using a meta-aggregation approach. 117 studies were included in this systematic review. 28 studies met criteria for higher reliability studies. The median critical appraisal score according to the MERSQI was 8.5/18 and the median critical appraisal score according to the JBI was 3/10. There were recurring causes of low study quality scores related to study design, data analysis and reporting. There was considerable heterogeneity in intervention design and evaluation design. Programmes with internal or mixed faculty were significantly more likely to report organisational outcomes than programmes with external faculty only (p=0.049). Project work and mentoring increased the likelihood of organisational outcomes. No leadership development content area was particularly associated with organisational outcomes. In leadership development programmes in healthcare, external faculty should be used to supplement in-house faculty and not be a replacement for in-house expertise. To facilitate organisational outcomes, interventions should include project work and mentoring. Educational methods appear to be more important for organisational outcomes than specific curriculum content. Improving evaluation design will allow educators and evaluators to more effectively understand factors which are reliably associated with organisational outcomes of leadership development.

• medical leadership
• development

Data availability statement

Data are available upon reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/leader-2020-000360

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Introduction

Health systems invest significant resources in leadership development for physicians and other health professionals. 1 Competent leadership is considered vital for team effectiveness, for clinical and financial performance and for maintaining and improving quality and patient safety. 1–5 Clinical leadership development involves activities to promote leadership competencies among clinicians, while medical leadership development refers to activities centred on doctors.

Research suggests that medical leadership development can improve outcomes at individual, organisational and clinical levels. 6–11 Evidence backing medical leadership development activities has, however, been variable in quality. 1 7–10 12–15 There has been a particular lack of research and evaluation that goes beyond individual learner feedback and subjective outcomes. 6–9 One systematic review of 45 studies evaluating leadership development interventions for doctors found that effective interventions were characterised by the use of multiple learning methods, including seminars and group work, alongside action learning projects in multidisciplinary teams. 8 These findings were echoed in a recent study by Geerts et al , 9 who emphasised that plans need to be in place for transferring learning from the intervention into the working environment.

We undertook this systematic review to synthesise recent empirical evidence regarding medical leadership development programme factors associated with outcomes at the clinical and organisational levels. We specifically investigated links between aspects of programme design, delivery and evaluation and improved outcomes. Given the variable quality of studies highlighted in previous reviews, 7–9 we applied two validated critical appraisal instruments 16 17 to isolate higher reliability findings. This review is the first to apply both instruments in order to identify and synthesise the highest quality empirical evidence in medical leadership development.

The design of this review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 18 and the Best Evidence in Medical Education (BEME) guide for systematic reviews. 19 Our methods were based on the review conducted by Frich et al , 8 with methodological changes drawn from other reviews. 7 9 10 14 15 20 Following the BEME recommendations for systematic reviews, 19 we hand-searched references and citations of known reviews extensively to supplement our database search. In line with recommendations from Geerts et al 9 and Rosenman et al , 7 we assessed study quality using the Medical Education Research Study Quality Indicator (MERSQI), which is designed to measure the methodological quality of quantitative medical education research studies. 16 We added the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, 17 which is designed for meta-aggregation of qualitative research and is well-established in healthcare research. 21

Search strategy

We began this review by re-examining the data set identified in the review of leadership development for physicians by Frich et al . 8 With assistance from a specialist librarian at the University of Oxford, we then based our search strategy on Frich et al ’s review. 8 Using the Ovid MEDLINE database, we conducted a search using both free text and Medical Subject Headings. The full search terms are listed in the online supplemental material . This search identified 501 unique publications. We then conducted an extensive hand-search of references and of citations in known healthcare leadership development reviews using Web of Science and Google Scholar. This identified an additional 107 studies for possible inclusion, for a total of 608 records for screening ( figure 1 ).

Supplemental material

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PRISMA diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Inclusion criteria

We included any peer-reviewed study published in English between January 2000 and January 2020 which:

Describes a leadership development intervention (programme, workshop, course and so on).

Includes physicians as learners (defined here as any practising doctor post-qualification).

Evaluates the leadership development intervention.

Qualitative, quantitative and mixed evaluations were included. We excluded studies where leadership development was a minor focus or where the proportion of physicians was lower than 10% of intervention participants.

Screening process

Two members of the review team (OL and TF) independently screened all study titles and abstracts for eligibility. Articles that were approved by either reviewer progressed to full-text review. Two members of the review team independently reviewed for inclusion the full text of all 207 articles that passed the title and abstract screen (TF and RG reviewed half each, OL reviewed all). Where there was disagreement about inclusion, all three reviewers (OL, TF, RG) reached consensus by discussion, with the third reviewer (TF or RG) arbitrating where required.

Data abstraction

After screening and reviewing for eligibility, 117 unique studies were included for abstraction and analysis. Data were abstracted and coded for educational setting, methods, content, evaluation methods and outcomes. Outcome data were categorised according to an adapted version of Kirkpatrick’s Framework for evaluation of training programmes (see table 1 ). 19 22 One reviewer abstracted and coded all 117 included studies (OL). The second reviewers (RG/JRG/AM/TF) each abstracted and coded at least five studies in full to ensure consistency between reviewers. Data abstraction and coding for all 117 studies was then cross-checked by the second reviewers. Any differences were resolved by consensus, with a third reviewer arbitrating where required. Where possible, statistical tests performed in studies were replicated and checked for accuracy.

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Kirkpatrick’s Framework for evaluation of training programmes, with adaptations from Frich et al 8

Study quality appraisal

Previous reviews have shown marked variation in the quality of studies of medical leadership development. 7 9 10 14 15 20 To isolate the most reliable evidence linking medical leadership programmes to improved outcomes, two researchers independently critically appraised each included study using the MERSQI and JBI Instruments. 16 21 Differences in MERSQI and JBI quality score were resolved by consensus, and a third researcher arbitrated where needed.

The MERSQI was applied to all 117 studies. The MERSQI is a validated appraisal tool consisting of 10 items in six domains which relate to design, sampling, type of data collected, validity of evaluation methods, analysis and outcomes. 16 Each domain is scored to a maximum of 3, for a total score of 5–18. In line with Geerts et al , 9 studies with scores of 12 or higher were categorised as higher reliability studies (see the Data analysis section).

The JBI Checklist for Qualitative Studies was also applied where a study used mixed methods (k=53) or qualitative methods (k=10). Fundamental differences in study design, sampling, evaluation instruments and analysis preclude summative comparison of mixed-methods or qualitative studies to quantitative studies using the MERSQI. 16 21 23 24 The JBI Checklist is considered the most appropriate qualitative critical appraisal tool for use in pragmatic meta-aggregation of qualitative research. 24 It includes 10 items which regard the study’s research questions, methods, analysis and reporting, for a total score of 0–10. Following recommendations from the JBI Reviewers’ Manual, 17 a cut-off score for higher reliability studies was predetermined at 6/10. This score was chosen as studies obtaining six or more points included most key elements of high-quality design.

Data analysis

MERSQI and JBI Scores were used to establish which studies presented more reliable evidence of outcomes. Summary statistics were calculated for all 117 studies. In line with Geerts et al , 9 studies with a final MERSQI Score of 12/18 or higher were also analysed separately to isolate the most reliable evidence, as were qualitative and mixed-methods studies which achieved the pre-determined JBI Score of 6/10 or higher. As there was substantial methodological heterogeneity, study characteristics and outcomes were synthesised using a meta-aggregation approach. 25 All study quality appraisal scores are presented in the Online supplemental table 1 , and full data extraction tables are available on request.

Study reliability (MERSQI and JBI)

Twenty-eight of 117 studies (25%) were categorised as higher reliability. Two studies were categorised as higher reliability by both the MERSQI and the JBI tool, 26 27 14 studies (12%) by the MERSQI only and 12 studies (10%) by the JBI tool only. The median critical appraisal score according to the MERSQI was 8.5 (range 5–16 from possible range of 5–18) and the median critical appraisal score according to the JBI was 3 (range 0–9 from possible range of 0–10). Online supplemental table 1 includes the MERSQI and JBI Scores for all included studies.

Study design showed considerable room for improvement, as shown in online supplemental tables 2 and 3 . Nearly half the of studies (46%) relied on post-programme evaluations only, and 92% did not include a control group. Of the nine studies that did include control groups, most had substantial methodological flaws in their selection of control groups. One common method for control group recruitment was to use unsuccessful course applicants. 28–30 In terms of evaluation design, the median evaluation instrument score was 0 (range 0–3). The majority of studies (59%) did not fulfil any of the MERSQI requirements for evaluation instruments, including reporting questionnaire design, wording and content. Objective outcome measures were used in only a minority of studies, with 60% relying solely on self-reported measures.

Data analysis and reporting likewise showed considerable limitations. Only one in five studies (20%) met criteria for comprehensive analysis and reporting of data. Few studies analysed their data beyond descriptive statistics to consider the generalisability and implications (13%). In many cases, studies omitted basic statistical significance tests.

Many studies did not contain key reporting elements for qualitative research as outlined in the JBI tool (see online supplemental table 3 ). There was clear congruity between research methodologies chosen and the research objectives and methods employed in 60% of studies. A minority of studies adequately reported their analysis (28%) and interpretation of data (25%), the potential for the researcher to have influenced data collection and interpretation (23%) and the researcher’s cultural or theoretical orientation (15%). Participant voices were clearly represented through quotes in only 16/53 (30%) of mixed-methods studies and 5/10 (50%) of qualitative studies. There was a statement of ethical approval or ethics exemption in only 26 of 63 studies (40%) which used qualitative methods. No study included a statement of philosophical perspective (normally expected for qualitative research). 17

Programme design

There was considerable heterogeneity in leadership development intervention design. It was often unclear whether established good practice for development of medical education interventions was followed, as shown in figure 2 . 9 31 Only 52 studies (44%) reporting having conducted a needs assessment before their intervention, and only 20 studies (17%) explicitly reported using an established capability or competency framework to inform leadership programme goals and objectives. There was, however, a plan for training transfer reported or built into 68 of 117 interventions (59%).

Educational design components: studies which reported Kirkpatrick level 4 outcomes (k=34) compared with studies that did not report Kirkpatrick level 4 outcomes (k=83).

The majority of interventions were carried out in a single hospital department (27%), single hospital (22%) or a single university (12%). Just under a quarter (23%) of interventions were conducted in multiple healthcare centres. A further 15% of studies were conducted within a specialty training programme outside healthcare centres.

Most of the studies took place in the USA (67%) or the UK (16%). The remainder of studies were in other European countries (7%), Canada (4%) or Australia (3%), with a single study each from Africa, 32 India, 33 Israel 34 and Qatar. 35

Programmes ranged in length from 2 hours to 4 years. The median intervention length was 6 months, and the most common length was 1 year (19%). Only 18 interventions (15%) lasted longer than 1 year. Five interventions (4%) were shorter than 1 day.

Programme faculty

Programmes were predominately delivered by either in-house faculty (36%) or a mix of in-house and external faculty (32%). Programmes delivered by mixed faculty were most likely to show organisational outcomes, as shown in figure 3 . The professional backgrounds, qualifications and experience of faculty were generally not reported.

Relationship between faculty source and programme outcomes. Higher reliability studies were those with Medical Education Research Study Quality Indicator Score of at least 12/18 or Joanna Briggs Institute Score of at least 6/10. NR, not reported.

Participants

In terms of participant selection criteria, the majority of interventions included participants who volunteered (27%), were nominated (19%) or who applied to the programme (16%). In some cases the application process was highly competitive. Interventions were mandatory in one-fifth of studies (20%). A considerable proportion of all studies (23%) did not report the selection process for their learners, including one quarter (25%) of the studies categorised as higher reliability by MERSQI criteria.

Educational methods

A wide range of educational methods were employed in various combinations across the reviewed studies, as shown in figure 4 . Most interventions included lectures (68%) and small group work (61%). Project work was included in the majority of studies with organisational outcomes (68%), but only in a minority of studies which did not report organisational outcomes (33%). Individual or team mentoring was also more prevalent where organisational outcomes were reported (47% vs 23%).

Educational methods: studies which reported Kirkpatrick level 4 outcomes (k=34) compared with studies that did not report Kirkpatrick level 4 outcomes (k=83).

Educational content

Educational content varied considerably among interventions. The most consistent content area was leadership theory (reported in 65% of interventions). The other common content areas were performance management (44%), self-management (41%), change management (39%), communication (36%), teamwork (33%), quality improvement (30%), healthcare policy (27%), healthcare finance (26%) and leadership behaviours (20%). There were no notable educational content differences in higher reliability studies or in studies which reported organisational outcomes (Kirkpatrick level 4).

Evaluation methods

A wide range of evaluation methods were employed across the included studies. Nearly half used quantitative methods only for their evaluation (46%). Of the remainder, most studies used mixed methods (45%), with 10 studies (9%) using purely qualitative methods. These proportions were similar in the higher reliability studies (41% quantitative, 48% mixed methods, 10% qualitative).

Four out of every five studies (82%) used questionnaires in their evaluation. Almost all of these employed Likert Scale items (92%) and one-third included open questions (34%). Only 8% used content or construct validated questionnaires. The proportion of higher reliability studies using validated questionnaires was slightly higher at 20% (MERSQI) and 18% (JBI). An additional six studies (6%) had conducted an expert review of their questionnaire for content validity only.

More than two-thirds of the included studies relied solely on self-ratings (69%). A minority of studies included ratings from subordinates (3%), peers (7%), superiors (12%) or experts (20%). The proportion of higher reliability studies which relied on self-ratings was lower (39%), with increased use of ratings from peers (14%), superiors (25%) or experts (39%).

The majority of studies (72%) included the collection of outcome data regarding behavioural changes (Kirkpatrick level 3, 57%) or organisational outcomes (Kirkpatrick level 4, 24%). Only three studies relied solely on Kirkpatrick level 1 outcomes (reaction). 36–38

Nearly half of the studies used single group post-programme only designs (46%), with most of the other half using single group pre-programme and post-programme designs (46%). Most studies included a post-programme evaluation completed immediately at the end of the programme (90%). Only 18 studies (15%) included a longer-term evaluation. In higher reliability studies, longer-term evaluations were associated with increased reporting of organisational outcomes (56%) when compared with immediately-post designs (31%). All 16 higher reliability studies as assessed by the MERSQI used pre and post designs. Six of these included a non-randomised control group (38%), and one study included a randomised control group (6%). This was the only randomised control group used in any of the 117 studies.

Behavioural and organisational outcomes in higher reliability studies

A full summary of outcomes from all 117 studies is provided in online supplemental table 1 .

There was a range of behavioural (Kirkpatrick level 3) and organisational (Kirkpatrick level 4) outcomes demonstrated in higher reliability studies.

Behavioural changes were objectively demonstrated in higher reliability studies through observed changes in behaviour, 26 27 39–43 promotions, 44 45 increased responsibilities or titles 28 46–49 and project completion. 50–52 Subjective changes in behaviour included improved communication, 39 influence, 50 delegation, 27 collaboration, 53 involvement in service improvement 47 and application of skills learnt or improved leadership in general. 39 40 54–57 These changes were indicated through interviews, free text questionnaire responses and behavioural self-assessments.

Organisational outcomes in higher reliability studies (Kirkpatrick level 4) were defined prospectively and in most cases were objectively demonstrated through leadership project impact evaluations. Projects achieved a range of outcomes, including reduced waiting times, 50 improved patient care 46 50 and cost savings. 27 46 47 50 By assessing the financial impact of projects completed during the intervention and relating this to programme costs, one higher reliability study reported a 364% financial return-on-investment (ROI). 27 Other objective outcomes included reduced organisational turnover of participants, 28 improved departmental working climate, 39 reduced sick leave 44 and increased promotion of women. 45 Organisational outcomes were subjectively indicated through reports of increased staff retention 56 and improvement in organisational effectiveness. 27 One study reported that ‘intangible benefits’ resulted in a 106% financial ROI. 51

Organisational outcomes in higher reliability studies were reported more frequently from programmes delivered by a mix of internal and external faculty than from programmes delivered by only external faculty (83% vs 11%), as shown in figure 2 . Organisational outcomes were also more frequently reported from interventions conducted in a whole hospital (57%) or multiple hospitals (40%), compared with interventions conducted in a single specialty (conference or outside-hospital training programme) (33%), single university (25%) or in a single department (0%). There were no notable differences in outcomes related to specific educational content.

Higher reliability studies that reported organisational outcomes were more likely have included project work (70% vs 44%), mentoring (50% vs 22%), coaching (22% vs 11%) and reflective instruments such as personality type assessments (22% vs 6%) than higher reliability studies that did not report organisational outcomes. Organisational outcomes were reported less frequently in higher reliability studies that included simulation or role play (10% vs 33%).

The aim of this review was to synthesise recent empirical evidence and explore factors associated with higher level outcomes in physician leadership development.

We found a substantial increase in the number of studies which evaluate medical leadership development interventions compared with previous reviews. 6–10 14 15 In many studies, it is still not clear whether best practices for design, delivery and evaluation are being followed. 31 It is also not clear whether there are sufficient behavioural and organisational outcomes to justify the considerable and increasing investments in medical leadership development.

Compared with previous reviews, we found an increase in the proportion of studies which report the use of active learning methods such as project work, simulation, discussions and reflections, which are widely accepted to be a vital component of leadership development 58 and which were associated in our review with increased Kirkpatrick level 4 outcomes.

No single leadership development content area was particularly associated with improved outcomes. With respect to educational methods, however, there was an association between the inclusion of individual or group project work and of mentoring with organisational outcomes. This may support the established position that educational methods are more important than specific curriculum content for leadership development. 1 58 Simulation and role play were less common in higher reliability studies which reported organisational outcomes that those that did not report organisational outcomes. This unexpected finding could result from these studies being situated in a training environment rather than a working environment. Alternatively, it could result from the evaluation process and study designs rather than from a lack of organisational impact. Studies which included simulation and role play tended to focus their evaluations on objective changes in behaviour at the expense of evaluating organisational outcomes (see online supplemental table 1 ). Interestingly, lacking a leadership development framework did not seem to impede programmes from reporting organisational outcomes. This may indicate that programmes which are designed as bespoke solutions to local needs are more likely to achieve organisational impact than pre-packaged approaches to leadership development.

There was an additional association of more senior participant level with organisational outcomes. This may be related to the wider scope of influence or practice of senior physicians compared with resident physicians. It could also indicate that there is a longer post-programme development period before residents are able to have an impact on organisational outcomes. This would align with the finding that programmes which evaluated longer-term outcomes were more likely to report organisational outcomes.

Importantly, our findings indicated that leadership development interventions which used a combination of internal and external faculty were most likely to report organisational outcomes, and those interventions which used external faculty only were least likely. This could have significant implications for procurement and design of leadership development interventions across healthcare, particularly as courses run internally are associated with significantly reduced costs. 59 60

As in previous physician leadership development reviews that used critical appraisal instruments, 7 9 we found that studies frequently did not meet criteria for high reliability. Many studies failed to report important methodological features, which restricts readers’ ability to appraise studies and learn from their findings. This was particularly notable in terms of questionnaire design, with fewer than one in 10 studies using validated questionnaires or reporting their questionnaire content in detail. Most studies also did not report or analyse outcome evaluation data comprehensively. Many study designs were biased towards obtaining positive results, particularly in terms of the absence of control groups, having stringent or undisclosed selection criteria, including leading questions on questionnaires and relying solely on self-ratings. This is likely to have resulted in improved reported outcomes. The lack of evaluation quality seems to indicate perfunctory attention paid to evaluation design and precludes confident conclusions from these studies. Future studies could benefit from consulting study quality appraisal checklists such as the MERSQI and JBI in advance, in order to effectively design their evaluations.

This review does indicate that certain recommendations for improved programme evaluation are beginning to be applied into research. Whereas only 29% of the studies reviewed by Frich et al 8 included qualitative components, 63 (54%) of the 117 studies included in our review used mixed or qualitative methods. In a nascent and complex field such as medical leadership development research, 1 8 9 61 qualitative methods can have value in terms of establishing effective programme design features to achieve desired outcomes, 21 25 31 as well as helpful nuances of how, for whom, to what extent or in what circumstances interventions are effective or not. 9 10 62

Additionally, many studies in this systematic review evaluated outcomes at Kirkpatrick level 3 behavioural change (57%) or level 4 organisational outcomes (24%). This is a significant improvement from previous reviews. 7 8 14 Changes in behaviour (level 3) and organisational outcomes (level 4) are more closely associated with transfer of learning to the working environment than participant reaction (level 1) and learning (level 2). 63–65

Limitations and strengths

This review was limited by the reliability of the studies included. We attempted to control for study reliability using critical appraisal tools with cut-off scores for higher reliability studies. To the best of our knowledge, this is the first systematic review of healthcare leadership development interventions to use the JBI critical appraisal tool to critically appraise qualitative studies. The JBI tool enabled us to identify 12 additional higher reliability qualitative and mixed-methods studies which were not identified using the MERSQI. Marked heterogeneity of studies and evaluations precluded a formal meta-analysis, therefore, we adopted a meta-aggregation approach. This enabled us to highlight design components that are correlated with behavioural and organisational outcomes in higher reliability studies.

A substantial majority of studies reported only positive outcomes, which could represent a publication bias, and we limited our review to English language peer-reviewed studies. In line with Frich et al , 8 our database search was limited to MEDLINE, however, we augmented our database search with an extensive hand-search of reference lists and citations using Web of Science and Google Scholar. The hand-search revealed that many relevant empirical studies were absent from recent reviews despite some of those reviews searching a greater range of research databases. This could indicate flaws in healthcare leadership development literature tagging and filing procedures within medical and educational databases.

Our review has practical implications for those commissioning, designing and evaluating medical leadership development programmes in healthcare. No specific area of curriculum content and no particular leadership development framework were clearly associated with behavioural or organisational outcomes. While relevance and appropriateness of educational content is important, 31 this systematic review has more clear implications for leadership development methods than for specific content. Where possible, interventions should include projects and individual or group mentoring. Transfer of learning from the programme into learners’ daily work and their organisations should be planned into the programme and where possible active learning educational designs should be employed, including opportunities for learners to set their own goals for development. External faculty should be judiciously used to supplement in-house faculty, not as a replacement for in-house expertise.

In terms of evaluation design, efforts should be made to ensure that evaluations are cost-effective and produce data that is useful for both practitioners and researchers. 66 67 Effective mixed-methods evaluation strategies should be integrated into evaluation designs. Study quality checklists such as the MERSQI and JBI could be consulted in the programme design phase to help build high quality quantitative and qualitative evaluation methods into programmes. At the minimum, evaluation design should include consideration of assessment at multiple time points, inclusion of control groups and collection of objective data, as well as collection of qualitative data from interviews, focus groups, questionnaires or observations. Programme goals and intended organisational outcomes should be explicitly considered during evaluation design 67 so that measures of organisational outcomes (including project outcomes) can be incorporated into the evaluation design. Improving study design and building robust evaluation methods into programmes will allow evaluators and educators to more effectively understand factors which are reliably associated with high level programme outcomes. This could both inform the improvement of individual programmes and contribute to the medical leadership literature as a whole. It is only through more considered and thorough evaluation of physician leadership development programmes that we will be able to justify the investment they represent.

Ethics statements

Patient consent for publication.

Not required.

Acknowledgments

We would like to thank Tatjana Petrinic, University of Oxford Health CareHealthcare Librarian, for her invaluable assistance and advice in the search process.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

Twitter @oscarlyonsnz, @J_Frich, @jaasongeerts

Contributors OL, RG and JRG planned the review. OL, RG and TF screened studies for inclusion. OL, RG, JRG, AM and TF abstracted and coded studies. OL, RG, JRG, AM, TF, JF and JMG contributed to analysis, writing and editing the manuscript.

Funding Oscar Lyons was supported during this work by a Rhodes Scholarship, a Goodger and Schorstein Research Scholarship (University of Oxford) and the Shirtcliffe Fellowship (Universities New Zealand)

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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• v.20(Suppl 2); 2020

Leadership in healthcare education

Christie van diggele.

1 The University of Sydney, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building A27, Sydney, NSW 2006 Australia

2 The University of Sydney, Faculty of Medicine and Health, Sydney Health Professional Education Research Network, The University of Sydney, Sydney, Australia

Annette Burgess

3 The University of Sydney, Faculty of Medicine and Health, Sydney Medical School – Education Office, The University of Sydney, Sydney, Australia

Chris Roberts

Craig mellis.

4 The University of Sydney, Faculty of Medicine and Health, Sydney Medical School – Central Clinical School, The University of Sydney, Sydney, Australia

Associated Data

Not applicable.

Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice. To meet the needs of healthcare in the twenty-first century, competent leaders will be increasingly important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine. Consequently, incorporation of leadership training and development should be part of all health professional curricula. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles. This paper briefly considers the current theories of leadership, and explores leadership skills and roles within the context of healthcare education.

Leadership has many interpretations, and has been likened to “ the abominable snowman whose footprints are everywhere but who is nowhere to be seen” [ 1 ]. It is an influential process, through which groups of people work towards the achievement of a common goal [ 2 ]. Leaders have the ability to shape and influence their followers’ values, attitudes and behaviours through a dyadic relationship. They are able to gain and enlist the support of others in order to achieve shared goals [ 3 , 4 ]. Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice [ 3 ]. In order to achieve more effective outcomes, leadership and management skills are now an expectation and requirement in the healthcare education setting [ 5 ]. However, leaders within healthcare education should not rely on formal positions of authority, but instead, utilise their own appropriate leadership qualities irrespective of their level within the organisation [ 3 ]. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes [ 3 ]. This paper briefly considers the theories of leadership, and explores leadership skills and roles within the context of healthcare education.

Management versus leadership

Management and leadership are considered just as important as each other in accomplishing organisational goals. However, there are differences in the functions of the two roles. Management produces order and consistency, while leadership produces change and movement [ 2 ]. Management has the responsibility of organising all elements within the organisation, so that the leader’s vision and goals are successfully achieved. If poor management is in place, then goals cannot be achieved; and if poor leadership is in place, then there is no clear goal or vision to work towards. Leadership is seen as “setting direction, influencing others and managing change: with management concerned with the marshalling and organisation of resources and maintaining stability” [ 6 ]. These differences are summarised in Table  1 [ 6 , 7 ]. 

Leadership versus Management (adapted from Swanwick & McKimm, 2011) [ 6 ]

Transactional and transformational leadership

Leadership is a social construct, and there are many different leadership models [ 6 ]. Two broad types of leadership are identifiable: “transactional” and “transformational”. And their respective features are a useful way to think about the many types of leadership. Transactional and transformational leadership models are normally amalgamated within organisations to “empower others” (transformational) while holding individuals “accountable” (transactional) for their actions [ 7 – 9 ]. While it is clear that both transformational and transactional leadership paradigms are needed for an organisation to be effective, the optimal leader predominantly practices the transformational aspects of leadership, rather than transactional [ 10 ].

Transactional leadership

The transactional model is seen as an authoritative relationship that is transaction based, where exchanges occur between a leader and follower, once specific goals are identified or decided upon. Transactional leaders value order and structure, and have formal authority, with positions of responsibility within organisations. They achieve organisational goals through a rewards system and through positive reinforcement. A weakness of this model is the lack of innovation, as individuals are driven by predetermined outcomes, and there is lack of incentive and motivation to perform beyond what is expected [ 6 ].

Transformational leadership

Since the introduction of transformational leadership, the concept of leadership has undergone a major shift from representing an authoritative relationship (transactional), to a process of influencing individuals (transformational). Transformational leadership involves leadership through the transformation of individuals or ‘followers’, to work towards a common organisational goal [ 9 – 11 ]. This contemporary form of leadership is based on inspiring individuals, and forming teams to achieve goals. Transformational leaders define organisations through the articulation of a clear vision and clear values. The four “I”s of transformational leadership are outlined in Table  2 [ 9 ].

The four “I”s of transformational leadership (adapted from Bass & Aviolo, 1994) [ 9 ]

Team leadership

More recently, the focus has shifted towards “team leadership” , with distributed leadership becoming more prevalent within healthcare education, where different professions share influence [ 12 , 13 ]. Increasingly, leadership involves a collaborative role, with an emphasis on shared leadership and thoughtful allocation of responsibilities. Team-based organisations shift central control from the one leader, to the team. Teams are comprised of members who are interdependent, needing to coordinate their activities in order to accomplish their shared goals [ 14 , 15 ]. Personal autonomy, accountability, appropriate recognition, and clarity of roles, are all elements that contribute to optimal team performance. However, to ensure success, the organisational culture needs to support the involvement of individuals in these teams, and encourage leadership qualities [ 15 ]. Teams often fail when they exist in a traditional authority structure, where organisational culture is not supportive of collaborative work, and lower level decision making. Distributed leadership entails sharing of influence by team members, who step forward, or take a step back as needed. Leadership is provided by the person who meets the specific needs of the team at the time, hence providing faster responses to more complex issues in today’s organisations [ 15 – 17 ]. Effective leaders have an understanding of the conditions needed for teams to function well. For a team to achieve its potential, the operational roles of its members should be matched to their members’ abilities [ 18 ]. Belbin (1991) classified nine roles of team members that contribute to its process and function [ 19 ], outlined in Table  3 . Importantly, within team leadership, no single team role should be regarded as more important than another. Successful teams thrive on their diversity, drawing from the strengths of each member [ 13 ].

Roles of team members that contribute to its process and function (adapted from Belbin, 1991) [ 19 ]

Effective leadership

Leaders need to have good time management and organisational skills, the ability to network professionally, display political nous and most importantly, they need to have strong communication skills [ 4 , 20 , 21 ]. Ready acceptance of feedback and self-awareness are important in development of leadership skills [ 20 , 21 ]. Behaviour, habits and biases can be deliberately corrected by utilising received feedback. Although there is not one set of qualities that apply to being an effective leader, certain competencies are valued and contribute to the leadership model in different ways [ 5 ]. Leadership competencies relevant for all health professional educators are outlined in Table  4 [ 3 ].

Leadership competencies for health professional educators (adapted from Oates, 2012) [ 3 ]

Language of leadership

Just as education and healthcare organisations have evolved, so too has the team leader. The role of the modern leader reinforces the tenets of stepping forward, collaborating and contributing. This role involves encouraging others by practising followership, and lending meaningful support to other leaders. As already stated, when it comes to leadership, excellent communication skills are a must. In order for successful communication to occur, both the sender and receiver must understand the message. This means that active listening is just as important as active talking [ 22 ]. Language used needs to be [ 22 ]:

• Communicate with clarity of your purpose and the role of others

Stimulating

• Deliver messages in a powerful, inspiring and dramatic way
• Lead by example and walk the talk

Include active listening

• Acknowledge what has been communicated, and use questioning skills
• Show that you value others and their contributions

Challenges for leaders in healthcare education

There are a number of unique challenges in healthcare education. Healthcare education is delivered across professional disciplines, and notably, across organisational boundaries, involving universities, hospitals, and healthcare services. In turn, these organisations are bound by their own systems, structures, policies, cultures and values. At some point, most leaders in healthcare education need to make a decision about their leadership direction, and whether it lies predominantly in higher education or the clinical setting; and whether it lies in undergraduate education or postgraduate education. It can be difficult to merge roles between organisations, and McKimm (2004) has identified a number of issues and challenges specific to health education leaders, outlined in Table  5 [ 22 , 23 ]. Throughout a career, it may be necessary to maintain an awareness of available opportunities within organisations, and match these to the required experiences and capabilities [ 22 , 23 ] (see Fig. ​ Fig.1 1 ).

Issues and challenges of health education leaders (adapted from McKimm, 2004) [ 22 , 23 ]

Reflection task

Development of leadership skills

Workforce data indicates that many experienced clinicians and healthcare educators will retire over the next ten years [ 24 , 25 ]. The need for effective succession planning and leadership training is well recognised [ 25 – 27 ], with a current shortage of emerging leaders moving into leadership roles. Effective leaders need to be nurtured and supported by the organisations in which they are educated, train and work [ 6 ]. As a learned skill, the topic of leadership is gathering momentum as a key curriculum area. Leadership development, assessment and feedback are necessary throughout the education and training of health professionals. Aspiring and current leaders can be identified, trained and assessed through formal leadership development programs, and through supportive organisational cultures. This requires embedding leadership training programs, opportunities for leadership practice, and promotion of professional networks within and beyond the organisation. The importance of mentorship within healthcare education is well recognised, offering a means to further enhance leadership and engagement within the workforce [ 28 ].

While many are assigned as leaders through their job title, it is important to identify, support and develop emerging leaders [ 2 ]. Leadership consists of a learnable set of practices and skills that can be developed by reading literature and attending leadership courses [ 29 ]. Additionally, investment in the social capital of organisations, fostering interprofessional learning and communication in the work setting, and collaboration across organisations assists in leadership development. Developing leadership skills is a life-long process [ 21 ]. Resources and opportunities should be considered to assist in the development of leadership skills. Some examples include:

• Reading about leadership e.g. theories on leadership styles
• Attending leadership training workshops
• Participating in mentorship programs either as mentee or mentor
• Joining small group seminars on leadership development
• Accepting more responsibilities when required, or when opportunities arise.

Process for effective leadership

A title is not required to enable effective leadership. Leadership may occur in everyday work, and occurs in collaboration with other professionals within the education and healthcare systems. For example, leadership in teaching, administration, research, and/or excellence in clinical practice.

Leadership roles include the important concept of management of both personal and professional practice. Priorities need to be set and time managed to integrate work and personal life. Tools can be used to stay organised, and deliberately manage busy schedules. Effective delegation may be used to share the work of new projects:

• Organisation to ensure an understanding of tasks, priorities and deadlines
• Establish steps and a sequence to achieve the desired outcomes
• List required resources, considering the competencies of individual team members, and match tasks appropriately (also consider skill development needs)
• Communicate with team members, monitor progress in activities and provide guidance to team members.

Leadership competencies, and the incorporation of leadership development as part of curricula, are identified as important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine, in meeting the needs of healthcare in the twenty-first century [ 30 ]. With an increase in interprofessional teams and an emphasis on collaboration, more effective outcomes are achieved [ 5 ]. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles, but may occur in everyday work. Good leadership also means knowing when, and how to support others in their endeavours. Provision of opportunities for leadership development is crucial in improving education sectors and health services, and effecting change. The future belongs to healthcare education leaders who demonstrate excellence in teamwork, clinical skills, patient centred care [ 3 ], and responsibly balance accountability with autonomy.

Take-home message

Acknowledgements

About this supplement.

This article has been published as part of BMC Medical Education Volume 20 Supplement 2, 2020: Peer Teacher Training in health professional education. The full contents of the supplement are available online at URL. https://bmcmedicaleducation.biomedcentral.com/articles/supplements/volume-20-supplement-2 .

Abbreviation

Authors’ contributions

CVD, AB and CM contributed to the drafting, and critical review of the manuscript. CR contributed to the critical review of the manuscript. All authors read and reviewed the final version of the manuscript.

No funding was received.

Availability of data and materials

Ethics approval and consent to participate, consent for publication, competing interests.

The authors have no competing interests to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Six Medical School Secondary Essays You Can Start Writing Right Now! (And which ones you should wait on!)

Introduction

Each year, we work with a select number of medical school applicants to help them draft strong, distinct personal statements and descriptions for the Work and Activity sections within their AMCAS applications , which are due at the end of May. 

They inevitably ask us, in the days after submitting, “This is when we get a break, right? Secondaries aren’t until July.”

Our answer? “Yes” aaaand “no.”

Though secondary applications will not rear their heads until July, that doesn’t mean you shouldn’t make great use of your time in June to render secondaries less demanding (and soul-sucking) when the time comes.

There are certain essay types we recommend writing in advance, since the odds are incredibly in your favor that you will need to submit them come July, and there are some essays we recommend waiting to write. (More on those later.) 

Write in Advance: 

There are six medical school secondary essays you can begin writing ahead of time, banking on the likelihood that you can use at least some of that writing once prompts are released. They are as follows:

• The Diversity Essay

The Adversity Essay

The hobby essay.

• The Gap Year Essay 

The Leadership Essay

The medical career essay.

Let’s dive into each.

First up: The Diversity Essay

Ah, the diversity essay, a perfect opportunity for you to share with admissions what it is about your background and past experiences that will bring a fresh perspective to their student body, and ultimately enable you to provide quality care to a diverse patient population down the line.

Let’s start by looking at some examples of what these essay prompts have looked like in years past:

The Perelman School of Medicine (PSOM) is deeply committed to recruiting a diverse class to enrich an inclusive team-based learning experience. How would you and your experiences contribute to the diversity of the student body and/or how would you contribute to an inclusive atmosphere at PSOM? Please explain and limit your response to 1,000 characters.   The Feinberg School of Medicine values diversity as a measure of excellence.  We define diversity as the totality of the characteristics and experiences of our students.  We believe that a diverse student body improves the educational environment and the ability of our graduates to serve an increasingly diverse patient population. Everyone has their own narrative.  Please provide more detail about how your experiences would enrich the Northwestern community. (200 word max)   Kaiser Permanente is committed to advancing equity, inclusion, and diversity for all. How will you contribute to the diversity of the Kaiser Permanente Bernard J. Tyson School of Medicine ? (250 words)

The diversity essay is incredibly common on all kinds of admission applications—medical school secondary applications being no exception—which means, odds are, you’re going to need to write one. So, save yourself some time and headaches in July by writing it in advance. The prompts listed above are great launching points for your brainstorming process.

A strong diversity essay will… reveal more about your background and offer admissions a glimpse into some of the unique life experiences you bring to the table. You’ll want admissions to finish your essay knowing that you have the ability to work with people from all walks of life and that you value the opportunity to do so.

The adversity essay asks applicants to describe a challenge they overcame or address a moment in which they felt they had failed. 

Here are some examples:

Briefly describe a situation where you had to overcome adversity; include lessons learned and how you think it will affect your career as a future physician. (2500 characters) ( The Johns Hopkins University School of Medicine )   We are all navigating through challenging times, and physicians and physician-scientists must contend with many instances of uncertainty. Describe a time when you faced a situation that was ambiguous, confusing, or uncertain, and how you navigated making a decision without complete information. (3000 characters) ( University of Pennsylvania Perelman School of Medicine )   Tell us about a time when you have had to overcome adversity. (1,500 characters) ( University of Nebraska Medical Center College of Medicine )   Discuss a time in your life in which you have failed at something other than an academic experience. How did you confront the failure and what did you learn from it? Please describe how you typically approach challenges that you face in your life. (350 words) ( University of Arizona College of Medicine – Tucson )

A strong response to an Adversity essay prompt will… illuminate how you respond when presented with a hurdle or challenge. We recommend you explain the challenge, failure, and/or situation at hand, then dedicate most of the words available to walk admissions through your thought process, reaction, and takeaways. Be careful not to write about anything that may seem trite, like getting a C on an exam. Your response will showcase qualities like initiative, resilience, and an ability to learn from past missteps. A word of advice: Make sure your topic doesn’t overlap too much with the idea you plan to write about for your leadership essay down the line. You want admissions to learn unique and valuable information about how you react when faced with difficult situations.

Admissions knows (or hopes!) that you have other interests besides medicine. This is an opportunity for you to show that you are a well-rounded human with diverse interests.

Let’s take a look at some prompts:

Outside of medicine, and beyond what we can read in your application, please tell us what you’re curious about, or what you’re passionate about, or what brings you joy – and why. Some examples include listening to historical novels, exploring national parks, woodworking, baking cupcakes, podcasting, knitting, playing pickleball, filmmaking, making music, etc. Do not exceed 2500 characters including spaces (about 400 words) ( University of Michigan Medical School)   Please describe your hobbies (or non-academic pursuits) and how they will influence your success as an Osteopathic medical student and/or Osteopathic physician in the future. (2000 characters) ( Touro University California College of Osteopathic Medicine )   Indicate what you do for fun and diversion (hobbies, special interests, etc.). ( Florida State University College of Medicine )

A strong response to a hobby essay prompt will… give admissions insight into what makes you tick when you’re out of your scrubs and in layman’s clothes. Since a career in medicine is often accompanied by stress, it’s imperative that you have other activities and hobbies in your life that allow you to decompress in a healthy, sustainable way. Maybe you want to write about your love for mountain biking in the early morning before the world wakes up, or perhaps how you kick back and play bass in an Irish punk band (does music not have healing powers, too?). Don’t list awards you’ve received; instead, tell a story about something meaningful to you. This is a chance for you to stand out and for admissions to deepen their understanding of what brings you joy.

The Gap Year Essay

In your secondary travels, you will likely come across some variation of the gap year essay. Admissions wants to know: what did you do (or what do you plan to do) between graduating college and attending medical school?  

Here are some examples of these prompts:

If you are currently not a full time student, please briefly describe the activities you are participating in this academic year. (100 words or less) ( Icahn School of Medicine at Mount Sinai )   If you have taken any time off from your studies, either during or after college, please describe what you have done during this time and your reasons for doing so. (2500 characters) ( NYU Grossman School of Medicine )   If you have a year or more between college graduation and medical school matriculation, describe both your completed activities and future plans during the gap period. (200 word max) ( Northwestern University Feinberg School of Medicine )   Are you planning on taking time off after college? Please describe your activities during this time in 500 characters or less. ( University of Pennsylvania Perelman School of Medicine )   If you have already received your bachelor’s degree, please describe what you have been doing since graduation, and your plans for the upcoming year. (2000 characters) ( The Johns Hopkins University School of Medicine )

A strong response will… add more context to your application. Maybe you plan to volunteer or travel the world in the year between undergrad and medical school. Perhaps you have responsibilities at home to attend to or it’s been a few years since you graduated with your Bachelor’s degree, and you’ve been acquiring real-world work experience (e.g. internships, shadowing experiences) that you will bring with you to med school. Tell your story in a way that reveals more information about you and further connects your past or near-future plans to a career in medicine.

The leadership essay presents you with the opportunity to do a little humble bragging.

Let’s look at some prompt examples:

Tell us about your leadership experience(s) and/or key leadership skills. (Organized a fundraiser, had club/organization officer role, etc.) How do you motivate or influence people? If none, please write not applicable. (1600 characters) ( Florida Atlantic University Charles E. Schmidt College of Medicine )   Please share some personal examples of problem solving in a team environment and/or leadership experience that would lead to your success in a Problem Based Learning environment. (4000 characters) ( Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine )   Describe your leadership style. Provide a specific example of how you have applied your leadership style. (100 words minimum) ( Loyola University Chicago Stritch School of Medicine )   Describe examples of leadership experience in which you have significantly influenced others, helped resolve disputes, or contributed to group efforts over time. (1000 characters) ( University of Kansas School of Medicine )

A strong response will… showcase your leadership qualities without sounding boastful or grandiose. The truth is, leadership can take on many different forms, and there are different ways to be a leader. A thoughtful response will show that you not only have what it takes to step up to the plate, but also work well with and empower others, value input, and move with integrity. 

Many medical schools will ask about your goals as a physician, how you plan to impact medicine, and/or how you view a physician’s role within the greater community.

Where do you see yourself in your medical career fifteen to twenty years from now? (750 characters) ( University of Alabama at Birmingham Marnix E. Heersink School of Medicine )   What quality or attribute do you think is most important in being a physician? Please explain. (150 words) ( Quinnipiac University Frank H. Netter MD School of Medicine )   What do you consider to be the role of the physician in the community? (200 words) ( Emory University School of Medicine )   Imagine and reflect upon your life and medical career at the time of retirement. What do you envision being your proudest/most significant accomplishment? (500 words) ( Michigan State University College of Human Medicine )

A strong response will… show admissions that you’ve thought critically about the future you envision for yourself and have reflected on why you want to pursue a career in medicine. It will also reveal what you would like your legacy to be and how these experiences align with your long-term life goals. If it’s your first time deeply considering these questions, we recommend you leave yourself plenty of time to brainstorm and freewrite. You might just discover new things about yourself in the process!

Wait to Write:

Next up are the essay types that we recommend waiting to write.

The Why Essay

Why do you want to attend this particular medical school? Odds are you remember the Why Essay from your undergrad days. If not, let us remind you. The Why Essay is an opportunity to show admissions that you’ve done your research and can say (or write) with confidence that the school in question is the ideal school for you to pursue your degree, and in turn, you are the ideal candidate for their institution.

Given the distinctive educational philosophy and integrated curriculum at FSM, describe how your personal characteristics and learning style would align with the institution. (200 word max) ( Northwestern University Feinberg School of Medicine )   Please explain your reasons for applying to the Perelman School of Medicine and limit your response to 1,000 characters.    The Admissions Committee uses a holistic approach to evaluate a wide range of student qualities and life experiences that are complementary to demonstrated academic excellence, strong interpersonal skills and leadership potential. What unique qualities or experiences do you possess that would contribute specifically to the NYU Grossman School of Medicine community?   How will the University of Connecticut School of Medicine best serve your needs of becoming a physician or physician scientist? (1800 characters)   What is your specific interest in the MD Program at GW ? What opportunities would you take advantage of as a student here? Why? (1750 characters)

A strong response will… differentiate you from other applicants. Each of your Why Essays should be geared toward each particular school. Sure, you can use the same general template, but a strong Why Essay will not be fully recyclable for any other institution because it will reference specific details unique to each one.

We recommend saving this essay for later since it’s possible your dream school(s) will not invite you to complete a secondary application. However, that doesn’t mean you still can’t do some preliminary work in the meantime. In order to make the writing process easier down the line, you can begin researching the schools you’re most excited about and taking detailed notes to reference while writing your essays later. What is it about the schools that you love? How do their offerings or missions align with your goals? Having notes will make writing this essay a breeze when the time (hopefully!) comes.

The Additional Info Essay

The Additional Information Essay is an opportunity for you to address anything the school in question hasn’t asked, but you think it would behoove them to know.

Let’s look at a few examples:

If there is an important aspect of your personal background or identity or a commitment to a particular community, not addressed elsewhere in the application, that you would like to share with the Committee, we invite you to do so here. Aspects might include, but are not limited to significant challenges in or circumstances associated with access to education, living with a disability, socioeconomic factors, immigration status, or identification with a culture, religion, race, ethnicity, sexual orientation or gender identity. Briefly explain how such factors have influenced your motivation for a career in medicine. Completing this section is optional. (150 words or less) ( Icahn School of Medicine at Mount Sinai )   This section is optional. It should be used to bring to the attention of the Admissions Committee any important information (personal, academic, or professional) not discussed in other sections of your Yale Secondary Application. If you are a recent graduate, please also list your post-graduation plans/activities in the “Additional Information” section and submit any relevant updates for finalized plans/activities as the application year progresses. Please limit your response to 500 words. ( Yale School of Medicine )   Is there any further information that you would like the Committee on Admissions to be aware of when reviewing your file that you were not able to notate in another section of this or the AMCAS Application? (No word limit) ( Georgetown University School of Medicine )

A strong response will… fill in any gaps in your application and offer one additional brush stroke or lens to the portrait of your candidacy.

We recommend waiting to write this essay because it’s difficult to gauge ahead of time what questions you will be asked, and you may very well have material drafted for other applications that fit perfectly here.  

Our Advice for Creating a Plan of Action

We recommend setting a goal for yourself, whatever feels feasible for you.

In an ideal world, by the end of June, you would have six 300 to 400-word essays prepared and fully edited—that way, when the prompts roll out in July, you have quality material to pull from to piece together your responses. 

Rough drafts won’t cut it here. You should have tight paragraphs that can be moved around based on the individual prompts. 

Let’s say, for example, you encounter a prompt that asks about a time you faced adversity and how you will apply what you learned from that experience to accomplishing your future goals. If you’ve followed our advice, you will have two thoughtful essays prepared that you can finesse to become one cohesive draft for this combo prompt. 

Another tactic worth noting: manage your own expectations. If you’re applying to medical school, you’re most likely someone who cares about others and pays attention to details, so you may also be an overachiever prone to perfectionism. 

Remember: done is better than perfect. Instead of spending hours trying to get that one metaphor perfect, write down the main idea and move on to the next essay. Come July, you won’t have time to worry about such minutiae, and a finished, submitted essay is always going to be better than an absolutely perfect essay that isn’t polished until weeks after the deadline. (Also, does an absolutely perfect essay even exist?) Keep up your momentum, don’t get stuck on minute details, and try to work at a sustainable pace.

As medical school essay advising experts who have been through the process countless times, trust us: the more you can do in advance, the better. It will save you from nights of banging your head against the table as emails roll in one after the other asking you to write more essays…and giving you just two weeks to do it!  

This process is manageable, but it requires forward thinking, time management, and flexibility—all traits and skills of a successful doctor, so we know you’ve got it in you!

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Tags: MD , med school , med school applications , med school essays , medical school , medical school essays , medical school prompts , postgrad , secondaries , secondary applications , secondary season

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