Educational leadership in physicians' specialist training : programme directors' experiences

Sammanfattning: Competent physicians working in teams with other health professionals are a prerequisite for excellent patient care. The context for this thesis is physicians’ specialist training, which consists of workplace learning in an environment primarily designed for other purposes than education, with sometimes contradictory objectives. Educational leaders have been singled out as important for the educational quality. Their tasks are complex and their influence on education may be challenging. Notwithstanding, factors that are influencing effectiveness in completing the tasks remain unexplored. The overall aim of this thesis is to explore educational leadership in physicians’ specialist training. The central research question is, ‘Which factors influence the role of the programme directors in Sweden?’ The four empirical studies are positioned within a cultural conceptual perspective on leadership, recognizing context as an influential factor in facilitating and limiting leadership. The studies are guided by a constructivist approach, three using qualitative methods and one a quantitative method. Study I explored programme directors’ perceptions of their work tasks, interpreted within Bolman and Deal’s theoretical framework. The structural (structuring the education) and human resource function (supporting individuals and handling relations) were emphasized. Less described were the political (negotiating and mediating) and the symbolic function (influencing the educational culture). Study II explored factors perceived to influence programme directors’ effectiveness. Individual factors, such as the programme director’s own competence, were mainly facilitating, while structural factors, such as conditions for the role, were mainly hindering. Whether relational (such as communication and support) and attitudinal factors (such as values and attitudes) were perceived to be hindering or facilitating differed between the participants. Study III investigated factors related to the role of the programme directors that are associated with high educational quality. The findings showed that factors at both individual, relational, attitudinal and structural level were associated with high quality. Factors related to communication, support and attitude seemed to be of particular importance. Most high-quality education was found for the programme directors at a single unit that experienced sufficient impact on education. Study IV explored the process of successful change implementation. Similarities shown included experiencing the change to be meaningful, working in coalition with others and employing a long-term perspective on change, where involvement and anchoring were essential. Experiencing mandate was central, which was dependent on the next level of leadership. The findings show that the programme director role is influenced by contextual factors such as organisatorial characteristics and values, factors related to the leadership role such as conditions fore the role and competence, and factors related to the specialist training organisation and climate, such as communicationn and attitudes. Power and mandate are central concepts, and since the role mainly relies on personal power sources, relational factors may be of particular importance. In line with a diminished focus on leadership traits, the main message in this thesis argues that in order to strengthen the role of programme directors, a differentiated strategy with an aim to increase programme directors’ influence on specialist training should be used.