Introduction
Leadership is a crucial issue in every field of human activity. Leaders make a difference to the organizations as well as to the society. While leadership matters in every field, it is of great significance in medical education, which prepares the doctors to deal with life and death situation. The quality of health care and wellbeing of the people are largely determined by competent and caring medical professionals who lead the health team. In a complex, interdependent world, leadership is even more challenging. COVID pandemic has exposed the vulnerability of the medical profession and the need for change.
Of late, the regulators have recognized the need for strengthening leadership right from the undergraduate level. National Medical Commission has redefined the role of Indian Medical Graduate (IMG) as a team leader, interpersonal communicator, professional and lifelong learner besides serving as a clinician.1 These attributes underpin leadership training. The National Assessment and Accreditation Council (NAAC) and the National Education Policy, 2020 also emphasize the role of leadership training in health sciences universities.2, 3
However, explaining the dynamics of leadership has been a jigsaw puzzle. The field of leadership has been enriched by the theories of learning derived from behavioural sciences, sociology, psychology and management.4 A systematic review of leadership development programs reveals a narrow focus on individual-level rather than system-level outcomes.5 There has been no effort to blend the Western theories with the Indian Philosophy.
The Search for a New Formula
The S-5 Formula of Leadership Development is an attempt to view leadership as a long developmental journey (Fig 1). It identifies the process, and the major milestones in the development of leadership which begin with letter ‘S’ in English and Sanskrit. (Box)
Table 0
S-1 Set high Goal (Sankalpa)
Leadership begins by setting up a high goal which is tough and seemingly impossible. The word Sankalpa in Sanskrit means making a firm resolution.6 All leaders who made a difference to the mankind were self -determined to set a high goal (Sankalpa) and they chased their goals for a life time, braving innumerable odds and failures. While setting the goal, one should examine one’s purpose of life, unique identity and strengths. The second consideration is to foresee how the goal is going to benefit the society.
While every organization has its own vision and mission to guide its functioning, a young leader should check whether his/her goals are in alignment with the vision and mission of the organization. If not, it is better to quit the organization and join another service, which is more satisfying. Once the goal is set, it can be converted in to tangible objectives and short term outcomes. Prioritization becomes important here. The leader should put in cent percent of effort on the task in hand, achieve it and move forward. Hurdles are expected, but the leaders should have the learning agility which is the next aspect of leadership.
Table 1
Setting Goal (Sankalpa): Implications for medical education
S-2: Self-study (Swadhyaya)
The term Self-study is used in a wider context to include all activities which are self-driven or self-directed. It includes self – reflection, self-learning, self - practice, self-audit, self-accountability and self - assessment using one’s power of self-determination.
Most of these skills are developed during early childhood by emulating the behaviour of elders at home. It is nothing but good culture called ‘Sanskar’ in Sanskrit. Self-study builds a strong foundation for the development of personality including leadership skills. Among them are reflection, critical thinking, emotional control, empathetic listening, problem solving and creativity. Along-with the skills, one should inculcate human values such as truthfulness, honesty, forbearance, obedience, humility, kindness, compassion, fellow feeling, brotherhood and love.
Acquisition of self-study skills require a holistic approach to life style management by a) cultivating healthy food habits (Aahar), b) exercise and relaxation (Vihar), c) control over the mind (Vichar) and d) good practices (Vyavhaar). The ancient Indian wisdom of Bhagawad Gita and the practical techniques such as Yoga, meditation, and prayer can play a key role.7
Table 2
Self- study (Swadhyaya): Implications for medical education
S-3: Synergy building (Satsanga)
Self-study is inadequate and incomplete without the socialization or collaboration with peers and support from mentors. The learning gets synergy in schools and colleges with formal and informal methods of interaction. Collaborative learning using blended learning (combination of formal and e-learning modalities) can be used effectively to develop technical skills as well as soft skills like interpersonal communication, team building, and networking. Group assignments, projects and field work should form a part and parcel of the curriculum at all levels of education. Extensive feedback combined with mentoring arrangement goes a long way in building up the synergy.8, 9 The concept of Community of Practice (CoP) proposed by Lave and Wenger is highly relevant here to support and motivate the young minds.10 Mentoring practice dates back to the ancient Indian practice of Satsanga where the saints and philosophers sat together and shared their insights to create a mass movement.
Table 3
Synergy building by Collaborative learning (Satsanga): Implications for medical educators
S-4: Service (Seva)
As the journey continues, it is now time for the leader to apply the knowledge and skills learnt through Self-study (Swadhyaya) and Synergy (Satsanga) to life situations. The word Seva refers to self-less service, which is the core element of leadership. The attainment of goal requires engagement in service by a large number of people with different skill sets. It is therefore necessary for a leader to extend his/her network within the profession as well as beyond the profession. The crucial issue is how to transform others. Transforming oneself and demonstrating success is perhaps the most effective intervention while dealing with team building, effective communication and delegation of tasks.
For performing quality service, resource mobilization is an essential requirement. In a knowledge society of today, resource generation is much easier if the products and services can be converted in to Intellectual Property Rights. With the shift in the emphasis from routine research to innovations leading to copyrights, patents and technology transfer to industries, the leaders in the future can exploit these developments to their great advantage.3 Another value addition is the power of information technologies, thanks to the developments such as digital India, use of Artificial Intelligence (AI), Big data analytics, Machine Language (ML) besides a host of social media.
This stage may pose a lot of challenges because of the ‘silos’ in the system and resistance to the change which is inherent in any organization. A leader has to use appropriate conflict management strategy to anticipate, prevent, and resolve conflicts.11 Failures and setbacks are most likely at this stage, mainly due to the competition coming from within as well as outside. A leader should be able to resolve conflict, and demonstrate good governance.
Table 4
Service (Seva): Implications for medical educators
S- 5: Surrender (Samarpan)
This is the final stage of leadership development which many leaders find it difficult to handle. This is because of ‘attachment to the post or position’ which is often addictive. Change is the only unchangeable feature of any society and leadership is not an exception to it. Surrender in S-5 formula has two meanings. One, it refers to shedding ego, and sharing the expertise with the next level. The more profound meaning of Samarpan is the spirit of offering to the universe or almighty becoming a mere instrument of change. At this stage, the leader becomes detached to the success or failure, a state which is described as Sthitaprajna by Lord Krishna in Bhagawad Gita.7
Table 5
Surrender (Samarpan): Implications for Medical Education
Evidence for S-5 Formula
S-5 Formula is backed by well- established learning theories, at the same enriched by ancient Indian perspective of holistic living. The setting of high goals is backed by the theories of motivation.12 According to the theory of self-determination (Ryan and Deci, 2000), there are three key factors which govern the motivation and performance: autonomy or freedom given to the learner, perceived competency and relatedness, or the extent of support available to the learner.13
Self-study, through reflection and reflective practice have been supported by the works of Schon14 and experiential learning cycle proposed by Kolb.15 Further, S-5 formula gives a holistic view by connecting self-study with the Indian concept of Swadhyaya which is a part of Ashtanga Yoga (Eight limbs of Yoga) propounded by Sage Patanjali.16
The concept of Synergy (Satsanga) is backed by theories which suggest collaborative learning via social construction.17, 18 The theory of Zonal Proximal Development (ZPD) by Vygotsky, supports mentoring.19 The concept of Community of Practice (CoP) by Lave and Wenger10 supports the Synergy component of S-5 formula. Looking back to Indian wisdom, the Gurukul system practiced in ancient India is a fine example of Community of Practice.
Service or Seva is at the heart of Indian philosophy. While taking care of one’s body is the supreme duty or Dharma (Shareeramadyam khalu dharma sadhanam), it emphasizes that this body is meant for serving others (Paropakararthamidam shareeram). Finally, the stage of surrender (Samarpan) is the essence of Bhagavad Gita which believes in doing ones’ duty for sake of duty, without expecting results, which of course follow automatically as per the law of Karma.
Conclusion
S-5 Formula is just a step forward to shift the attention of scholars towards a holistic approach. The potential leaders should recognize the dynamics of leadership as a long journey of setting their goals (Sankalpa), pursuing self- study (Swadhyaya), gaining synergy (Satsanga), performing self-less service (Seva) and finally surrendering (Samarpan) to the society whatever wisdom they have gained in life. Medical education should underline leadership as a longitudinal curricular thread. However, the training has to begin at homes and schools.
Any formula will require practice and testing before it becomes established as a theory to guide further practice. What is needed is integration of these concepts in to the medical education, rather than grafting isolated pieces of information.20 S-5 formula therefore, requires further deliberations by the academic fraternity to see whether it makes sense or merely a rhetoric.
In conclusion, S-5 Formula is a shift from reductionistic approach to a more holistic approach. When the world is undergoing most difficult times, it is prudent to bank upon our strengths and wisdom, which we gained in the past.