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Overused term, under-utilized skill

Let’s not leave leadership out in the cold…it’s a skill we all need.

While training in paediatrics there are a number of things that are obvious you need to learn. These may be practical (e.g. a lumbar puncture), knowledge-based (recognising when a prolonged illness may in fact be Kawasaki’s disease) or communication centred (how to discuss sensitive issues with a distressed teenager).

However, traditionally a number of skills that are relevant to doctors of all specialties have not been prominent in curricula and are often left to a two-day course in the last year of training. Medical management, clinical leadership, understanding health policy all come into this, often poorly learned and delivered, facet of medical training. There are a number of reasons for this:


Concepts of leadership conjure up images of Winston Churchill and a sense you can only be a medical leader if you model yourself on Lord Darzi. This is completely incorrect – leadership is a shared responsibility, which everyone can contribute to. Running a ward round, leading an arrest, planning a rota devoid of middle grades are all facets of leadership and management that paediatric trainees face every day and yet insufficient time is spent exploring these areas, particularly by consultant trainers.

It’s just a fad

Leadership and management appear to be buzzwords attached to any document in order to increase its impact. In the same way that everything needed to be “evidence-based” a decade ago, there is a sense that these terms are just add-ons for CVs or portfolios and convey very little practical benefit. Well, evidence-based medicine is here to stay and pervades all aspects of our practice. In the same way, it is likely, although the process is moving more slowly, that these attributes will become fundamental parts of training. The current president of the RCPCH in the United Kingdom, Dr. Hilary Cass, is a passionate advocate of trainees becoming more integrated and involved in the delivery of paediatric care (and not just seeing patients!). And the recent Keogh report into fourteen failing, struggling trusts identifies that junior doctors are a key part of effecting change.

Someone else will do it

The reforms of health services in response to rising demand proposed by the government and the medical colleges throughout the world are likely to result in changes to how departments and units are run. An increased focus on value (which requires both an understanding of the quality AND cost of care) will mean paediatricians will need to understand how developing systems will function. They will need to do this from their first day as a consultant as it will not be possible for a clinical director to do everything themselves. As the current generation of trainees begins to work through training pathways, it is likely that these core skills may become key factors at consultant interviews.

There are many ways to access learning resources to develop and learn more about this exciting but also challenging area. Social media provides an easy way to access these but also listen to the ongoing debate, which can sometimes be very challenging.


  • Damian Roland is a Paediatric Emergency Medicine and Honorary Associate Professor. His research interests include scoring systems in emergency and acute care and educational evaluation. Damian also chairs PERUKI (Paediatric Emergency Research United Kingdom and Ireland), which gives him and the team an opportunity to raise awareness of the important of research and evidence based practice at scale. The list of the many things Damian hasn’t done or achieved is far longer but through these he learns and develops new ideas.


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