COVID-19 and the Need for Leadership Training in Psychiatry

In their recent article, Hawke and colleagues discussed the impacts of COVID-19 on youth mental health, substance use, and well-being. ¹ Their message emphasizes the need for dynamic medical leadership to respond to rapidly changing health care demands in the rapidly evolving landscape associated with COVID-19. While leadership is considered an essential skill for all physicians, only a fraction of medical schools and residency programs incorporate leadership training. ^2,3 A recent Canadian residency program survey indicated only 38% included assessing resident leadership knowledge and skills, despite 77% reporting its importance. ³ As we prepare for future waves of the COVID-19 pandemic, we must be ready as clinicians but, more importantly, as leaders to address the unknown and often surprising future.

The practice of modern psychiatry is rapidly evolving. Alongside being diagnosticians and consultants, psychiatrists must demonstrate competency in various interconnected domains, including the manager, health-advocate, researcher, and quality improvement leader. As a result, psychiatrists increasingly find themselves in mental health team leaders, without experience or leadership training. For these reasons, leadership training in psychiatry is an increasingly important—and often underrecognized—skill.

There are a variety of ways in which psychiatry trainees can obtain training in leadership. Some residents find experiential learning helpful and gain exposure through leadership positions such as committee roles, chief residencies, executive boards, and clinical team leadership. Several locally developed online modules, such as Joule (developed by the Canadian Medical Association), provide free leadership training resources. ⁴ Formal leadership training opportunities, including the American Psychiatric Association leadership fellowship, tend to select residents with preexisting leadership experience preferentially. Existing opportunities only foster leadership in a handful of residents each year and are not available to most trainees. Hence, there remains a large unmet need in developing leadership competency in the next generation of psychiatrists.

There is a need for psychiatry programs to increase leadership training for all trainees. While some programs may be reluctant to dedicate additional time to heed this call, residents must be equipped with a full scope of skills to practice in the evolving medical landscape. ³ As psychiatry residency programs transition to competency-based models, leadership training must follow suit. Although previous research has outlined the benefits of standard leadership models, implementation of leadership training in psychiatry residency will need to consider trainees’ individual needs and competing clinical and administrative demands. ⁵ Integrated leadership training may be more helpful for trainees with a clear goal of pursuing formal leadership roles but less so for those in pursuit of individual private practice. Leadership training pathways may occur as “leadership tracks” in residency programs, paralleling clinician–scientist training pathways for trainees pursuing academic psychiatry positions.

COVID-19 has unambiguously demonstrated that the practice of medicine and psychiatry is rapidly evolving and complicated, necessitating influential medical leaders. In this context, training programs must finally take leadership training seriously, or as a field, we will be left behind or leave our patients behind.