의과대학생 중 잠재적 관계-지향적 리더 찾아내기: 동료에 대한 긍정적 영향의 역할(Med Teach, 2015)
Identifying potential engaging leaders within medical education: The role of positive influence on peers
BARRET MICHALEC1, J. JON VELOSKI2, MOHAMMADREZA HOJAT2 & MARK L. TYKOCINSKI2
1University of Delaware, USA, 2Sidney Kimmel Medical College at Thomas Jefferson University, USA
앞선 연구에서 의과대학생들 사이에서의 리더십을 배양하는 것이 가치있고 필요한 일임을 지속적으로 강조한 바 있다. 중요한 특징들
Previous research consistently highlights the value and neces- sity of cultivating leadership qualities among medical students (O’Connell & Pascoe 2004; Veronesi & Gunderman 2012).
- Emotional intelligence,
- confidence,
- creativity,
- practical know- ledge and competence,
- interpersonal communication,
- motiv- ation and encouragement of others,
- fostering a sense of community,
- social appraisal skills, and
- cognitive abilities among others
are frequently offered as vital leadership skills and characteristics
이전 연구들은 주로 교과목, 전략, 프로그램, 세미나 등을 통해서 의과대학생들에게 리더로서의 기술과 리더십의 특성 등을 '가르치는' 것에 초점을 두어 왔다. 그러나 연구결과를 보면 프로페셔널리즘과 관련된 긍정적 특성들을 향상시키려는 시도들은 (거의 틀림없이 리더십에 대한 것도) 학생들의 반발push-back, 과목 스케쥴 조정의 딜레마, 더 포괄적 차원에서의 조직문화와 관련된 장애 등을 겪게 된다.
The focus on this research has been almost exclusively on developing courses, strategies, programs, and seminars to ‘‘teach’’ medical students the traits, characteristics, and skills of leaders and leadership (Crites et al. 2008; Goldstein et al. 2009; Varkey et al. 2009; Long et al. 2011; Straus et al. 2013). Studies have shown, however, that attempts to foster positive attributes such as those related to professionalism (which are arguably akin to attributes related to leadership) are met with push-back from students, course scheduling dilemmas, and barriers related to the overarching organizational culture (West & Shanafelt 2007; Finn et al. 2010; Michalec & Hafferty 2013).
'탐색-기반identification-based' 접근법을 통해서 의과대학생 중 '리더'를 이해하려는 시도는, '양성-기반cultivation-based' 접근법과 달리 이미 근본적인 리더십 자질과 능력을 보여주고 있는 학생들을 더 격려하여 더 발전할 수 있게 해주는 것에 노력을 쏟는다. 따라서 탐색-기반 접근법은 전체 학생을 대상으로 하는 프로그램이나 과목을 통해서 이미 포화상태인 교육과정에 리더십을 '배양farming'해야 하는 필요를 없애주거나, 적어도 최소화시켜줄 수 있다.
An identification-based approach to understanding‘‘leaders’’ within medical school, as compared with what appears to be an engrained cultivation-based approach, would concentrate efforts to encourage and further advance individ-uals that have already exhibited fundamental leadership qualities and capabilities. An identification-based approach would thereby eliminate, or at least minimize, the need of leadership ‘‘farming’’ that is proposed through grade cohort-wide programs and classes, and lift some of the burden on already saturated curriculums
유사하게, 현재의 '의학교육에서의 리더십'에서는 동료들에게 좋은 영향을 미치고 있는 학생들을 어떻게 효과적으로 찾아낼 수 있는지가 빠져있다. 이것의 핵심에는, '리더십은 영향력에 관한 것이다'라는 명제가 있다. 예를 들면 "다른사람들이 무엇을 해야 하고 그것을 어떻게 해야 하는지 이해하고, 거기에 동의할 수 있는 영향력 프로세스" 혹은 "공동의 목표를 달성하기 위해서 개인이 다른 개인들에게 영향을 미치는 프로세스"라는 말로 설명된다.
Similarly, what appears to also be absent from the current state of the leadership-in-medical-education literature is an emphasis on constructing effective mechanisms to identify those with the ability to be influential with others (peers).At its core, leadership is about influence – as showcased in prominent conceptualizations of the term: (a) ‘‘...the process of influencing others to understand and agree about what needs to be done and how to do it ...’’ (Yukl 2006), and(b) ‘‘...a process whereby an individual influences a group of individuals to achieve a common goal’’ (Northhouse 2007).
리더십에 있어서 타인-지향성other-orientation은 Alimo-Metcalfe와 Alban-Metcalfe가 제안한 관계-형성적engaging 모델에서도 보여진 바 있다. Alimo-Metcalfe는 리더십의 가장 중요한 영역은 "타인에 대한 진정한 관심genuine concern"이라고 하였다. 전통적인 리더십이 '영웅적', 카리스마잇는, 고독한distant 리더십과 같이 리더(개인 수준)의 가장 중요한 파워를 강조했다면, 관계-형성적 관점에서의 리더십은 리더가 다른 사람을 향하고, 개개인의 접근가능성, 열망, 지지, 다른 사람들로 하여금 스스로의 영향력과 모험심을 표현할 수 있게 해주는 능력 등에 가치를 둔다.
The emphasis of other-orientation in regard to leadership qualities and capabilities is showcased in the engaging model of leadership proposed by Alimo-Metcalfe and Alban-Metcalfe(2005, 2006) and Alimo-Metcalfe et al. (2008) who argue that perhaps the most significant dimension to leadership can be classified as showing ‘‘genuine concern for others’’. Whereas traditional leadership ‘‘heroic’’, charismatic, and ‘‘distant’’ models of place the crux of power with the leader(individual-based), the engaging perspective of leadership emphasizes an individual’s other orientation and promotes the value of the individual’s accessibility, inspiration, support, and their ability to enable and encourage others to express their own influence and enterprise.
Methods
Study setting
Sample
766명 학생 중 630명
A total of 630 (82%) of 766 students in three fourth-year classes(2011, 2012, and 2013) responded.
Measurements and procedure
상위 10%를 '고긍정영향' 으로 구분하고, 80명이 해당됨
Students in the top 10% of this distribution for each class were designated as ‘‘high positive influence’’ and these 80 students were compared with 686 classmates.
'긍정영향'의 개념이 어떠한지 주관식으로 응답하게 함. 다음의 네 가지가 나옴.
(a) support,
(b) academic/organizational competence,
(c) role model, and
(d) fostering a positive/fun climate.
To examine how medical students’ conceptualized thenotion of the ‘‘positive influence’’ they experienced fromthose they selected, we added an open-ended item to the2013 survey. Students were asked to think about who theyselected as having a significant positive influence, andrespond to the question, ‘‘In what way(s) have they [thestudent(s) they selected] had the a positive influence?’’Approximately one-half of students provided words,phrases, or short sentences. These were read by one of theauthors to identify the most frequently appearing conceptsand categories. Four categories were identified: (a) support,(b) academic/organizational competence, (c) role model, and(d) fostering a positive/fun climate.
Results
고긍정영향 집단은 공감점수가 더 높았음
High positive influencers were found to have a significantly higher (p50.01) mean empathy score (mean¼117.1, SD¼9) compared with that of other students (mean¼113.5, SD¼11).
'긍정영향'의 개념에 대해서 모든 응답은 친사회적 행동과 학업/조직 이해에 대한 것이었다. 58%는 지지Support로 분류되었고, ‘‘helpful’’, ‘‘supportive’’, ‘‘encouraging’’, ‘‘listening’’, and ‘‘offering advice.’’ 등으로 묘사됨. 두 번째로 많은 것은 '학업/조직 역량.
Regarding students’ conceptualization of the ‘‘positive influence’’, all the comments referred to types of prosocial behavior and academic/organizational understanding. The majority (58%) of terms were categorized as
- Support, as the comments related to substantive personal interactions such as being ‘‘helpful’’, ‘‘supportive’’, ‘‘encouraging’’, ‘‘listening’’, and ‘‘offering advice.’’ The second most occurring categories (15%) were
- Academic/Organizational Competence (e.g., ‘‘brilliant’’, ‘‘challenging’’, and ‘‘shared knowledge’’) and
- Role Model (e.g., ‘‘positive role model’’, ‘‘ability to balance work/life’’, and ‘‘exemplified commitment’’).
Finally, 12% of the terms were categorized as
- Fostering a Positive/Fun Climate, as comments related to ‘‘fun’’, ‘‘enthusiasm’’, ‘‘great team member’’ and ‘‘positive attitude’’.
Discussion
인구통계학적, 학업적 차이
Demographics and academic performance differences
남성-여성에는 차이 없었음. 리더십의 핵심이 '영향력'에 근간을 둔다는 것을 고려하면, 이것은 약간 놀라운데, 왜냐하면 기존 연구에서는 전문직이나 대학의학에서 여성이 리더십 지위에 있는 경우가 드물다고 보고하고 있기 때문이다. 그러나 교실/학교/대학에서는 남성과 여성 중 누가 더 '공적official' 지위에 있을 가능성이 더 높은가에 차이가 있을 수 있다. 또한 여성의 리더십 역할과 지위에 대한 무의식중의(종종 의식적인) 편견이 잇을 수 있다.
Interestingly, there were no significant differences found in the rates of being designated as a positive influence between men or women. Given that the crux of leadership is rooted in influence, this finding somewhat surprising as the literature consistently points to the glaring lack of females in leadership positions in professional and academic medicine (Morahan et al. 2011; Rosenthal et al. 2013; Valantine & Sandborg 2013; Bell et al. 2014). However, there could be differences between the men and the women in regard to which sex is more likely to serve in ‘‘official’’ (nominated and elected) positions within the classes, school, and University. Perhaps there continues to be an unconscious (and even at times conscious) bias towards women regarding leadership roles and positions.
더 나이가 많은 학생들의 어떤 생애경험이 동료들에게 더 도움을 주고 지지해주고자 하는 의지를 높여주었을 수도 있다. 이는 더 나이가 많은 학생이 결혼을 하였거나 자녀가 있거나 하여 이러한 추가적인 사회적 관계가 그들의 타인-지향성을 배양시켜주고 다른 사람에 대한 encouragement, engagement 특성을 강화해주었을 수 있다.
Perhaps certain life experiences these older with students gained (compared the age-typical medical student) cultivated their willingness and ability to be support- ive and helpful to their peers. It could also be suggested that because older students may be more likely to be married and/ or have children that these possible additional social relation- ships have cultivated their other-orientation, enhancing their attributes of encouragement of and engagement with others.
타인에 대한 진정한 관심
Genuine concern for others
고긍정영향 그룹이 평균 공감점수가 더 높았다. 이는 Pohl등의 보고와도 일치하는데, 여기서는 동료들에게 '프로페셔널리즘'에 있어서 더 많이 지명당한 학생일수록 더 공감점수가 높았다. 고긍정영향그룹은 모의환자시험에서 환자들에게 더 높은 점수를 받았는데, Berg등은 (JSE점수에서) 대인관계 기술이 더 높은 학생이 모의환자에서 더 높은 평가를 받았음을 보고한 바 있다.
Students within the high positive influence group had a significantly higher average empathy score than all other students in the sample. This finding is consistent with that reported by Pohl et al. (2011) who found that medical students who were nominated by their peers on professionalism attributes obtained a significantly higher mean empathy High scores than their other classmates. influencers also received significantly higher scores from the ‘‘patients’’ during their simulated patient experiences. Similar findings are reported by Berg et al. (2011) who found that medical students with higher interpersonal skills (reflected in their scores on the JSE) received higher ratings of competence by simulated patients.
종합하면, 동료들에게 고긍정영향자로 인식되는 학생은 타인에 대한 진정한 관심을 보이며, 이는 관계-형성적 리더십 모델의 토대이다.
Taken together these findings suggest that indeed students perceived by their peers as being a positive influence also reflect a genuine concern for others – the foundation of the engaging leadership model.
이 자료에 따르면 고긍정영향자는 타인에 대한 진정한 관심을 보이고, 동료에 의해서 영향력이 높은 학생으로 인정받는 학생들은 Alimo-Metcalfe and Alban-Metcalfe’s model of engaging leadership 을 잘 반영한다. 이러한 관점에서 높은 영향력을 미치는 이들 학생들은 조직변화의 에이전트로서 가능성이 있다.
The data suggest that high positive influencers do show both a genuine concern for others and that students identified by their peers have the ability to be influential do indeed reflect the tenets of Alimo-Metcalfe and Alban-Metcalfe’s model of engaging leadership – and in this sense these influential students could in fact be agents of organizational change waiting to be tapped.
리더십에 있어서 '영향력'의 역할을 보여주며, 의과대학 기간 내에 관계-형성적 리더를 찾을 수 있음을 보여준다. 비록 의과대학 입학위원회가 뛰어난 GPA나 MCAT점수를 완전히 무시하지는 않더라도, 이와 같은 시험점수에서 뛰어나지는 않아도 추천서 등을 통해서 팀-지향적, 협동적, 동료에 대한 격려 peer-encouragement, 일반적 지지적 행동 등을 보이는가를 유심히 볼 필요가 있다. 더 나아가서 동료평가가 의학교육에서 리더를 찾는데 유용하고 가치있는 도구임을 보여준다. 다른 연구에서도 동료-평가, 동료-지명 방식이 프로페셔널리즘과 프로페셔널 개발과 관련하여 타당한 지표임을 보여준 바 있다.
The findings featured in this specific study promote the role of influence as it relates leadership and that engaging leaders can be identified during their years in medical school. Although we are not suggesting that medical school admis- sions committees completely disregard applicants with stellar GPAs and MCAT scores, there is something to be said to possibly paying special attention to those students who may not stand-out test-wise but present letters of recommendation that speak of team-orientation, cooperation, peer-encourage- ment, and general supportive behavior. Furthermore, we argue that peer-assessment appears to be a worthwhile and reliable tool to identify leaders within medical education. This inference has also been reached in other studies that have also found peer-assessment/nomination to be a valid indicator of attributes related to professionalism and professional development (Holmboe & Hawkins 1998; Pohl et al. 2011).
이 연구는 단면적 연구이다.
Similarly, this study was cross-sectional, only a longitudinal approach would identify whether these high influencers/leaders possess these other- oriented and organizational knowledge-based attributes and characteristics when they arrive at medical school (or even before), and if/how these attributes are sustained.
Identifying potential engaging leaders within medical education: The role of positive influence on peers.
Author information
- 1University of Delaware , USA .
Abstract
- PMID:
- 25155553
- [PubMed - as supplied by publisher]
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