Implicit leadership theories and followership informs understanding of doctors’ professional identity formation: A new model

Abstract

Aims:The process of becoming a professional is a lifelong, constantly mediated journey. Professionals work hard to maintain their professional and social identities which are enmeshed in strongly held beliefs relating to 'selfhood'. The idea of implicit leadership theories (ILT) can be applied to professional identity formation (PIF) and development, including self-efficacy. Recent literature on followership suggests that leaders and followers co-create a dynamic relationship and we suggest this occurs commonly in the clinical setting. The aim of this paper is to describe a new model which utilises ILT and followership theory to inform our understanding of doctors' PIF. Methods: Following a literature review, we applied the core concepts of ILT and followership theories to theories underlying PIF by developing a mapping framework. We identified core themes, similarities and differences between the three perspectives and constructed a new model of PIF incorporating elements from ILT and followership. The model can be used to explain and inform understanding of medical practice and leadership situations. Conclusion: The model offers insight into how concepts such as self-efficacy, prototypicality, implicit theories of self, power, authority and control and cultural competence result in PIF. Bringing together the theoretical frameworks of ILT and followership theory with PIF theories helps us understand and explain the unique dynamic of the clinical environment in a new light; prompting new ways of thinking about teams, interprofessional working, leadership and social identity in medicine. It also offers the potential for new ways of teaching, curriculum design, learning and assessment.

The leadership and followership challenges of doctors in training during the COVID-19 pandemic

“…In practical terms, this means that some leaders may have to work much harder to overcome deeply held (but not always articulated) beliefs about what leaders should look like, and how they should behave" (Mannion et al, 2015). As we have seen however, the doctor's own beliefs about themselves as a leader or follower may also influence (positively or negatively) their own perceptions of their impact on followers (McKimm et al, 2017). Such implicit leadership theories (ILTs) are very powerful and when these doctors in training feel they do not measure up to these high standards, then it can be damaging to their evolving (sometimes fragile) identities.…”

A comparison of four models of professionalism in medical education

“…Providing doctors with professional models as they move from novice to expert in their professional career will be instrumental as a framework for education. One clear example is the professional identity model that incorporated leadership, followership and team-working roles A more rounded and mature professional identity eventually develops that would set these doctors as models of professionalism for other health workers (McKimm et al, 2017).…”

Exploring medical leader identity and its formation

“…For example, the four levels of Miller's pyramid of assessing medical competence (Miller, 1990) -"knows", "knows how", "shows how" and "does"have been expanded to include a fifth level ("is"), which acknowledges the presence or absence of an MPI (Cruess et al, 2016). The "novice to expert model of professional competence" (Flower, 1999) has also been adapted to map leadership, implicit leadership theory, social identity, self-efficacy, theories of self, followership and teamwork to the model, acting as a framework for medical educators to design and facilitate activities which enable these areas to be explored and assessed and MPI to be developed (McKimm et al, 2017). The Professional Identity Essay (Bebeau and Monson, 2012) measures the extent to which individuals understand their professional role and the Professional Identity Scale (Adams et al, 2006) indicates that a strong sense of MPI is associated with lower levels of burnout (Monrouxe et al, 2017).…”