From learner to leader – the changing role of the consultant

Dr Peter Lachman outlines why the RCPI has developed a certificate in leadership for new consultants

Medical education often focuses on ensuring future consultants have the skills and knowledge relevant to their specialty. However, the consultant role is complex, involving far more than the management of clinical conditions. The first three years of the consultant role can be stressful as a newly appointed consultant suddenly must become a leader, working within a multidisciplinary team and interacting with the complexity of healthcare management.

The RCPI has recognised the need to develop programmes that can equip consultants with the additional knowledge
and skills that they need to be effective consultants leading a team to deliver safe and effective care.

Recently burnout has become a focus in healthcare, and it has been exacerbated by the Covid pandemic. The Irish Medical Journal, highlighting the challenge of burnout, recommended that preventive measures be undertaken to protect doctors. This is supported by the work undertaken at the National Academy of Sciences, which published a review of burnout and identified the non-clinical components of the job of doctors to be a major contributing factor. We believe that by equipping doctors with the leadership and management skills for their role, we can help to prevent burnout from occurring.

In addition, the increasing demands of the health service to deliver safe, effective and efficient care within budgetary
constraints implies that we need not only look after the wellbeing of the consultants, but also equip them with the
skills to deliver the service.

Leadership

The Medical Council has identified eight domains of professional practice, which describe what a consultant must do to act professionally. At the RCPI, we have identified key leadership components for the consultant and have developed the Certificate in Essential Leadership for New Consultants around these themes – the how to achieve professional practice. This will assist the new consultant in delivering on the domains of professional practice.

Often, leadership for a consultant is learnt behaviour – what has been observed during training. Leadership skills vary and the aim is to develop consultants who know how to be compassionate and humble leaders, at times transactional but mostly transformational, by bringing in the theories of leadership. All these different facets of leadership are required at different times and we will expose the consultants to leaders in the field, who can discuss how they have managed to be successful leaders.

Professionalism

Professionalism is a core component of being a doctor. The Medical Council states that “doctors must always be guided by their primary responsibility to act in the best interests of their patients, without being influenced by any personal consideration. They should act independently in the service of their patients and have a responsibility to advocate with the relevant authorities for appropriate healthcare resources and facilities.

Yet the concept of professionalism has been evolving, with the changing demographics of patients with chronic disease, the need to work within teams, to be part of a collective responsibility, and working within a digital age and changing technologies. Ability has changed over the years and this has been highlighted in the pandemic. Doctors and especially consultants were faced with new demands and the requirement to work differently, make difficult choices and balance competing needs.

A recent editorial in The Lancet concluded that we need to ensure that “we as a profession support our doctors and promote ways of working that incorporate the doctor, the patient, teams, healthcare organisations, workplace environment, and health systems.” In addition, with the growth of patient-centred care, the consultant role has changed to become one of partnership with patients rather than one of simply acting upon them.

The learners on the course will focus on what it means to be a doctor and how the consultant balances the needs of the individual patient with the greater demands of the health service as a whole.

Reflective practice

An essential part of the consultant role is reflective practice and, if done well, can help to protect the wellbeing of
the consultant, the clinical team and the people receiving care. This is a key foundation for developing psychological safety, to understand one’s fallibilities and to be humble and respectful to generate a culture in which everyone is
working for each other to deliver safecare. Reflective practice is at the core of being a modern doctor and learners will
have the opportunity to hone their skills on the course.

Management

Management skills for consultants are needed on numerous levels. The successful consultant needs to know how to manage teams, work with people from different professions, manage a budget, develop business cases, and appraise trainees to ensure they develop into future leaders. All of this requires a different type of skill to that of diagnosing and managing clinical conditions. In addition, a high preforming organisation will have close working relationships between healthcare management and the clinical leadership.

Consultants will need to know how to work with management to use the scarce resources effectively, while advocating for the needs of the patients. This is even more important as we come out of the pandemic and need to manage healthcare differently to achieve the outcomes all desire.

Quality and safety

Quality and patient safety are now essential elements of healthcare. Whereas it was once thought to be part of being a professional, the need to understand the theories and methods of improvement science and patient safety science has become apparent over the past 20 years. Consultants are essential leaders for patient safety and quality and learners will learn about the challenges of keeping people safe, human factors, climate change and equity. These are vital skills that are often overlooked in clinical training.

As we look at the increasing demands of healthcare, we must build a workforce that is focused on delivering high quality care to all. This will require clinical leaders at every level. The consultant is a key component for the success of Irish health care services and by investing in them at the start of their careers, we will reap the benefit for many years to come.

The Certificate in Essential Leadership for New Consultants is designed for recently-appointed consultants or those who wish to apply for consultant roles. The programme will commence in January and run until June 2022. The closing date for applications is 17 December 2021. See the following link: Certificate in Essential Leadership (rcpi.ie)