Identifying informal leaders among medical residents as a basis for educational interventions

Background leadership skills are not usually integrated into the curriculum of medical residents, contributing to variation in skills development. Hence, identifying the manifestations of residents’ informal leadership can guide educational interventions. It is unclear how theories of formal leadership can support the identification of informal leaders. Purpose To propose an approach for identifying the manifestations of informal leadership among medical residents, using this information for proposing interventions. Methods We conducted a social network analysis survey including 68 physicians (22 preceptors and 46 residents) from an internal medicine service of a university hospital using data on advice-seeking relationships, self-assessments of four leadership styles (transformational, relational, adaptive, resilient), and preceptors’ evaluations of the styles’ importance. For each respondent, a Leadership Score was calculated by integrating four network metrics (in-degree, betweenness, in-closeness, and out-closeness) logically associated to the leadership styles. This score was a proxy of “leadership-as-done” (LAD). The average of responses to the self-assessment questions was a proxy of “leadership-as-imagined” (LAI). The scores for both LAD and LAI were weighted by the importance of leadership styles. A scatterplot placed each participant by LAI and LAD scores, partitioned into four groups: established, brittle, and aspirational leaders, and non-leaders. Results Among the residents, 15.2% were established leaders, 23.9% were brittle leaders, 21.7% were aspirational leaders, and 39.1% were non-leaders. Established and brittle leaders stand out as informal leaders. The former regard their skills well developed and play central roles in the network; the latter do not consider their skills well developed, while still being central. Conclusions Educational interventions should focus on enhancing the leadership skills of brittle leaders that match their real demand for advice, giving opportunities for increasing the network centrality of aspirational leaders, providing supervised leadership experiences for non-leaders, and offering advanced training for established leaders.