To celebrate the beginning of Spring and the official countdown to my completion of clinical training (CCT), I would like to share my reflections on self-leadership as a clinician working within the NHS in the UK. Self-leadership is a concept I first came across from Dr Kemi Doll - an inspirational academic gynaeoncology consultant and career coach. As a practice, it has been foundational in my journey towards successfully building a diverse career portfolio.

What is self-leadership?

Self-leadership is the ability to influence and direct your own thoughts and actions to successfully reach goals and build a satisfying life.

It is a practice of consistent strategic decision-making using the lens of one’s personal value system and aspirations. It is informed by deep self-awareness, courage and maturity. Self-leadership is a way to practice authenticity, recognise your values and worth and make decisions that are in line with them.

In medicine, we receive both informal and formal training on team leadership. We are expected to demonstrate examples of good leadership by mentoring junior colleagues and leading clinical, research and managerial teams. Little focus is paid to self-leadership. People can find themselves in leadership positions because they excel clinically or academically, without knowing if they can successfully lead a team, let alone themselves.

Medicine as a profession is a culture.

Medical training is long, with high stakes and a rigour comparable to elite athletic and military training. Despite this, preparation for the psychological and emotional intelligence required to support sustainable, healthy medical careers is often lacking. Whilst we are trained on critical reflection in the context of biomedicine and research, there is less consistent high-quality training on critical self-reflection and self-leadership.

We are taught through the formal curriculum and the hidden curriculum of medicine. Objectivity is the goal, with subjectivity and emotions generally viewed as weaknesses. This is in spite of the evidence in favour of the critical role of emotional intelligence in high performance, decision-making, and positive work cultures.

We are not taught to understand and explore our ikigai-the driving force of daily lives. The run-through nature of our training enables doctors to abdicate the role of critical reflection on long-term personal and professional development to chance, check boxes and superiors.

This is why I believe all doctors in training should take time out to explore areas of interest that reflect their values and aspirations in addition to medicine.

Self-leadership as a clinician can be challenging, because we are trained to conform, excel at pattern recognition and abdicate career decisions to pre-existing paths.

Guidelines, and evidence-based medicine are our bread and butter. Our training strips away our individual identity replacing it with a new collective professional identity - ‘the medic’, who is objective, respectful, resilient and compassionate towards, but also distanced from patients. Conformity is further enforced by our workload. We are anaesthetised by overwork due to staff shortages, low morale, and burnout.

There is little headspace or capacity to reflect in the face of exhaustion-but remember resting is our superpower!

Why is Self-Leadership Important?

I believe that self-leadership is the key to career longevity, success and joy in work. It allows you to identify, own and protect your value by bravely and consistently acting to create a career that brings you fulfilment. Self-leadership allows you to take control of your career when circumstances appear seemingly out of your control. As an NHS clinician, I have found this concept transformational and will be forever grateful for the work of Dr Kemi Doll.

Medicine as a career is a beast of a marathon, not a sprint. Many of us will work in conditions where we have dwindling autonomy on our rotas, operating schedules and clinic lists. Additionally, in the wake of the COVID-19 pandemic, globally, the healthcare workforce is experiencing extreme strain with record levels of burnout, attrition and poor mental health. Increasing workforce capacity will not happen overnight. As a profession, I believe we must prioritise and enable self-leadership in the wake of these pressures.

I have learnt about self-leadership initially by failing at it woefully, then by studying and learning through career coaching. It is a skill that I continue to improve on with daily practice. I hope you find some of these tips of good use. If you fail at it, just try again.

1.    Identify your IKIGAI. You must identify your core values, aspirations, strengths and weaknesses in order to lead yourself effectively. What do you stand for? What are you absolutely not willing to compromise on? Read my previous blog on discovering your Ikigai before coming back to the last 4 steps. Working with a career coach may also help you begin with step 1.

2.   Surround yourself with informed believers. Informed believers ( a term coined by Dr Kemi Doll) are people in your life who understand your context and believe in your cause. You do not need to convince them. They do not belittle your ideas or offer alternative pathways based on their own fears and standards. They are distinct from uninformed believers ( like friends or family) because they have specific knowledge of your professional context. Informed believers are mentors who strategise with you and sponsors who endorse you by speaking your name in rooms when you are absent. Find them, share your Ikigai with them and make them part of your accountability circle. Be wary of taking advice from informed non-believers who may advise you based on their own standards, fears and aspirations. You have no business taking advice from someone who cannot see or understand your vision.

3. Take Action. Acting is a self-leadership skill that requires us to move beyond contemplation in the face of uncertainty. It means getting started by taking direct steps towards a goal you are trying to achieve. To take action, we must overcome imposter syndrome, perfectionism and procrastination. After completing steps 1 and 2, take a leap of (informed) faith and create your path by walking the path. Set up the meeting, write the proposal, sign up for that course, update your LinkedIn profile and reach out to that contact today!

4. Learn how to change your mind. Being a good leader requires regular self-auditing, adaptability and humility. We must be willing to recognise, admit then pivot when a certain path (partnership, project, mentorship) is not working or fails because an assumption we made is incorrect. Changing your mind does not automatically mean you are unreliable and fickle. It indicates that you have a consistent value system and are reflecting and responding appropriately when you find yourself in circumstances in conflict with that value system.

5. Hold your vision. This may seem in direct conflict with step 4. However, holding your vision is a skill in managing uncertainty when things do not go as planned. It is being steadfast after performing the self audit that tells you you’re still on track but can't quite see the path. As a leadership skill, it helps us manage the discomfort of failure, rejection, unexpected pushback and challenges. It requires us to continue walking the path even when we come across a muddy patch because we are armed with the knowledge of our core values and aspirations and surrounded by a tribe of informed believers who have our backs.

To further cement this concept of self-leadership, think back to a time when you were part of a team led by someone who seemed to have no awareness of the team’s core values, mission, strengths or weaknesses. Have you worked under a leader who was crippled with indecision and could not take action? What if your team leader refused to change course even when the project was headed for a clear disaster? You can imagine how confusing, frustrating and challenging it must be to be part of such a team.

I have found that at the most challenging points in my career, the main source of discomfort has been decision-making. All five steps of self-leadership involve making different decisions using a consistent lens. This lens is executing a career based on your value and aligning your work with your purpose. Go forth and lead yourself.

Good luck!

P.S

As always, if my thoughts this week struck a cord, piqued your interest, or you’d like to explore some of these ideas further or have questions, leave a comment and write to me HERE.