Dimensions, discourses and differences: trainees conceptualising health care leadership and followership

Lisi J Gordon, Charlotte E Rees, Jean S Ker, Jennifer Cleland

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44 Citations (Scopus)
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CONTEXT: As doctors in all specialties are expected to undertake leadership within health care organisations, leadership development has become an inherent part of medical education. Whereas the leadership literature within medical education remains mostly focused on individual, hierarchical leadership, contemporary theory posits leadership as a group process, which should be distributed across all levels of health care organisation. This gap between theory and practice indicates that there is a need to understand what leadership and followership mean to medical trainees working in today's interprofessional health care workplace.

METHODS: Epistemologically grounded in social constructionism, this research involved 19 individual and 11 group interviews with 65 UK medical trainees across all stages of training and a range of specialties. Semi-structured interviewing techniques were employed to capture medical trainees' conceptualisations of leadership and followership. Interviews were audiotaped, transcribed verbatim and analysed using thematic framework analysis to identify leadership and followership dimensions which were subsequently mapped onto leadership discourses found in the literature.

RESULTS: Although diversity existed in terms of medical trainees' understandings of leadership and followership, unsophisticated conceptualisations focusing on individual behaviours, hierarchy and personality were commonplace in trainees' understandings. This indicated the dominance of an individualist discourse. Patterns in understandings across all stages of training and specialties, and whether definitions were solicited or unsolicited, illustrated that context heavily influenced trainees' conceptualisations of leadership and followership.

CONCLUSIONS: Our findings suggest that UK trainees typically hold traditional understandings of leadership and followership, which are clearly influenced by the organisational structures in which they work. Although education may change these understandings to some extent, changes in leadership practices to reflect contemporary theory are unlikely to be sustained if leadership experiences in the workplace continue to be based on individualist models.

Original languageEnglish
Pages (from-to)1248-1262
Number of pages15
JournalMedical Education
Issue number12
Early online date27 Nov 2015
Publication statusPublished - Dec 2015

Bibliographical note

Contributors:all authors contributed to the study conception and design. LJG contributed to data collection and analysis, wrote the first draft of the paper and edited various iterations. All but one interview were undertaken by LJG. CER undertook one of the group interviews and listened to the audio-recordings of several initial inter-views in order to provide feedback on interview technique to LJG. CER also contributed to the data analysis and edi-ted each iteration of the article. JSK and JC contributed to data analysis and commented on various iterations ofthe paper. All authors approved the final manuscript for submission.
Acknowledgements:the authors wish to thank all participants in this study, the Scottish Medical Education Research Consortium (SMERC), NHS Education for Scotland (Scottish Deanery) and Tim Dornan, Queens University Belfast,who contributed to the initial stages of data analysis in his role as visiting professor for SMERC.
Funding: this research was part of LJG’s PhD research at the Centre for Medical Education, Dundee, which was generously funded by NHS Education for Scotland through SMERC.
Conflicts of interest: none.
Ethical approval: this study was approved by the University of Dundee Human Research Ethics Committee


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