Physicians’ Perceptions and Experiences Regarding Leadership: A Link Between Beliefs and Identity Formation

Abstract

Introduction

Despite the development of national recommendations and training programs for effective leadership, junior and senior medical leaders often find themselves ill-prepared to take on these new responsibilities. This study aimed to explore physicians’ perceptions, feelings, and beliefs regarding leadership and to provide recommendations regarding appropriate training and institutional post-training support.

Methods

We conducted a qualitative study at the Geneva University Hospitals. A purposeful sample of residents (R), fellows (F), attending physicians (A), and chairpersons (CP) were invited to participate in focus groups (or semi-structured interviews) between April and June 2021. We investigated their understanding of leadership, self-perception as leaders, difficulties, and paths to improvement in their leadership skills. Focus groups were transcribed verbatim and analyzed both inductively and deductively using Fishbein’s model of behavior prediction and Irby’s professional identity formation framework.

Results

We conducted ten focus groups (R=3; F=4, A=2, and CP=1) and one interview (CP). Physicians expressed poor self-efficacy at all hierarchical levels: feelings of insecurity and confusion (R and F), frustration (A), and feeling stuck between divisional and institutional governance (CP). Such negative feelings were nurtured by personal beliefs with an intuitive and idealized representation of leadership. Beliefs focused more on personal characteristics rather than on skills, processes, or perceived institutional norms. Unclear expectations regarding physicians’ role as leaders, overemphasis on academic achievement, and silo professional organizations fueled their feelings. Participants reported developing their leadership through trial and error, observing role models, and turning to personal resources rather than formal training.

Conclusion

Our results show that physicians’ leadership skills are still mainly acquired intuitively and that institutional norms do not encourage clarification of leadership roles and processes. Physician training in leadership skills, together with more explicit and clear institutional processes, may help to improve physicians’ self-efficacy and develop their identity as leaders.

Keywords:

• leadership
• physicians
• identity formation
• beliefs
• perceptions
• qualitative

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participate

The study was granted a waiver from approval by the Ethical Committee of the canton of Geneva (https://www.ge.ch/lc/ccer). Approval by the Ethical Committee is not necessary under Swiss law on research for studies in which non personal health-related data are collected.⁶² Methods were performed in accordance to the relevant regulations and guidelines. Participants signed a consent form and were informed that the data would be analyzed anonymously and used for publication.

Consent for Publication

All authors accepted the publication of the manuscript.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The Private Foundation of the Geneva University Hospitals partially funded this study.