Take a leaf out of the doctor's book

11th November 2011 at 00:00
Schools need more leadership by example, according to research comparing the education and medical professions

Teachers are less hierarchical than doctors, seeing colleagues as collaborators rather than competitors, according to new research.

However, the two professions share many similarities and face similar challenges, according to Clare Penlington, deputy head of education at Kent, Surrey and Sussex Deanery. She has conducted a comparative analysis of teaching and medicine, and believes that both benefit from leadership by example, or "practitioner leadership".

Teachers and doctors operate as autonomous individuals, whose working life takes place in relative isolation from colleagues. State regulation has led to a considerable erosion of professional freedom, but the nature of both jobs requires autonomy: in the classroom and in the surgery.

Because of this, individual practitioners wield considerable power within their professions: their collective action constitutes the main driving force of both medical and educational systems. As a result, the careers of individual doctors and teachers, and the organisational structures of hospitals and schools, are interdependent.

"The practitioner plays a crucial role in the improvement of practice in the clinical or classroom setting - a goal achieved through influenceship, role-modelling and negotiation between colleagues," Dr Penlington says. "It is assumed that engagement of the practitioners will influence the overall quality of organisational performance."

In both education and medicine, there is a split between policymakers and individual practitioners. For example, teachers often find that their efforts to assess and assist individual pupils are stymied by the need to teach to national tests. "At the same time that teachers are being told they have more responsibility, the testing regimes are reducing their authority as practitioners," Dr Penlington says.

Similarly, doctors find that broad quality-improvement projects take no account of their individual concerns and traditional methods of catering to patients' needs.

However, there are key differences in the ways in which doctors and teachers work towards improvement in their workplaces. While teachers and doctors both work in a hierarchical structure, school hierarchies are relatively flat: teachers are able to have direct and regular contact with their managers. "The more defining bonds of the profession are the strong affiliations teachers maintain to their teaching colleagues," Dr Penlington says. "This occasionally creates tensions when a teacher is promoted."

By contrast, doctors traditionally work in a very strict hierarchy, incorporating medical specialty and seniority. And the professional culture is competitive rather than collaborative. "Doctors taking on informal leadership roles are unlikely ... to experience a conflict in the same way as teachers do," she says. "The challenge for medical leaders is to work with colleagues in a way that encourages collaboration, rather than competition."

The NHS was established with the assumption that administrators would make administrative decisions, doctors would make medical decisions, and nurses would make nursing decisions. Central government, meanwhile, would make all funding decisions. Therefore, while teacher-leaders work together with school leaders, doctor-leaders' roles are usually defined in contrast to the roles performed by managers. And, in medicine, there is a more obvious divide between doctors and administrators.

While teachers and doctors both have specialised professional knowledge, teachers' knowledge tends to be expressed in language that is accessible to the general public. By contrast, doctors' knowledge is usually defined across the profession in language much less accessible to laypeople.

Although the advent of advanced-skills teachers has slightly improved the promotion prospects of classroom teachers, those inclined to leadership have tended to cut back on classroom work. For doctors, by contrast, mastery of clinical practice is the principal source of prestige and promotion.

Dr Penlington therefore suggests that education could learn from medicine here, allowing greater responsibility for practitioners.

"The picture that emerges from this comparative review ... is a call for doctors to lead other doctors and teachers to lead other teachers, in order to bring about improvements in medical and teaching practice," she says.


Learning From Each Other: a comparative analysis of the teacher-leadership and medical-leadership movements, by Clare Penlington and Kristi Holmstrom

Dr Clare Penlington: http:kssdeanery.orgpersondr-clare-penlington

Dr Kristi Holmstrom: www.soe.umich.edupeopleprofilekristin_ holmstrom


Education could learn from the medical profession, creating a greater role for the practitioner-leader, Clare Penlington believes.

Dr Penlington, deputy head of education at Kent, Surrey and Sussex Deanery, argues that teachers should not have to leave the classroom and take on formal leadership roles in order to gain the authority to influence colleagues and introduce school improvements. For example, she says, teacher-leaders should be given a reduced timetable to allow them to learn necessary leadership skills. Such organisational changes, she believes, would "support practitioner leadership and also allow teachers to remain in the practice of teaching".

Equally, headteachers could be persuaded to surrender particular areas of responsibility to their staff. For example, teacher-leaders could compile and analyse assessment data, and discuss the implications of this data with colleagues. This would allow teachers "to develop a vision, new knowledge and a practice that goes beyond their classroom, and to have time to engage with colleagues".

Similarly, Dr Penlington advises headteachers to provide hands-off strategic direction for their schools while teacher-leaders offer day-to-day pedagogical direction and guidance. "Doctors have always taken on strong informal leadership roles in the ... teams and systems in which they traditionally work," she says.

But she acknowledges that such a position - mid-way between practitioner and leader - can be uncomfortable. Doctors and teachers in such roles need their responsibilities, and their level of authority, to be outlined clearly by senior management. They also need to be allowed to develop new skills, which will then engender respect from practitioner colleagues. "Without followership, there is no such thing as leadership," Dr Penlington says. "Thus, one's legitimacy and authority as an informal leader is founded in a reputation for being an exemplary practitioner."

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