Building a ramp into leadership: Exploring resident doctors’ experiences of a workplace embedded leadership intervention

Building a ramp into leadership: Exploring resident doctors’ experiences of a workplace embedded leadership intervention | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Building a ramp into leadership: Exploring resident doctors’ experiences of a workplace embedded leadership intervention Hannah Headon, Joseph Lipton, Anna Jones This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7591986/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Leadership development is a recognised priority for the postgraduate medical curricula in the UK. However, unlike technical clinical skills, leadership skills are challenging to define, impart and assess because they are highly contextual and relational. While there have been a range of approaches to leadership development, these have had mixed success. This paper explores a new approach to leadership development for resident doctors, the GPC Hub. This approach follows an apprenticeship model, enabling junior doctors to take on real leadership in a safe and low stakes setting. Methods This study utilises a phenomenographic approach which focuses on the lived experience of resident doctors who participated in the GPC Hub. The study focuses on how participants responded to their experience with the GPC Hub, how they made meaning of their experience, what they learned how they responded to both the gains and challenges of their involvement. The study is based on in depth interviews with 10 participants. Analysis was thematic and based on a process of initial inductive code generation, theme identification, review and revision, definition, and finalisation. Results The study found that participants gained a great deal from involvement in the GPC Hub. It found that involvement offered them opportunities for collaboration, access, insight and legitimised involvement in real leadership and a scaffolded approach to more senior roles. They were able to contribute in authentic and meaningful ways. Participants developed skills in communication, organisation, collaboration and diplomacy. Yet this involvement was not without challenges, primarily the difficulty in balancing their clinical skill development and personal lives with the time required. Conclusions The study concludes that the GPC Hub offers an approach to leadership development that can be utilised across a range of settings. Through an apprenticeship approach it provided legitimated access to engagement with real leadership practice through observation of and enactment of organisational structures and relationships and the challenges of negotiation, collaboration, engagement and delivery. leadership professional skill development experiential learning Figures Figure 1 Introduction Leadership and management development is a recognised priority across postgraduate medical curricula in the UK. This emphasis has grown following the introduction of the Generic Professional Capabilities (GPC) Framework by the General Medical Council (1), which sets out essential values and behaviours expected of all doctors. Now embedded in all postgraduate curricula, the framework mandates the acquisition of non-clinical capabilities and yet how to best deliver these is less clear. Unlike technical clinical skills, leadership is context-sensitive, relational, and challenging to define or assess. Traditional didactic methods often struggle to impart these skills effectively, particularly when delivered in decontextualised settings. Previous approaches—such as competency frameworks, talent management schemes, clinical fellowships, and secondments—have met with varying success (2). Recent literature highlights the greater impact of experiential learning embedded in the workplace, compared with more passive, classroom-based models (3). Integrated programmes of this type are rare, and leadership ‘apprenticeship’ experiences are notably lacking. Unlike clinical training—where legitimate peripheral participation (4) allows junior doctors to gradually take on more complex tasks under supervision—non-clinical leadership development rarely offers such low-stakes, preparatory opportunities in a real apprenticeship setting. As a result, many doctors encounter their first true leadership responsibilities only when stepping into high-stakes, formal roles, often without prior hands-on experience. In response to this, the Generic Professional Capabilities (GPC) Hub was developed as a ‘bottom-up’ model to support leadership development for resident doctors working within Anaesthetic departments (5). The Hub provides a structured framework that supports real-world contextualised learning, allowing doctors to engage with leadership in an authentic and supported environment. It facilitates the collection of evidence aligned with curricular expectations, fosters professional growth, and strengthens integration with local leadership and governance systems. This paper examines participants’ experiences with GPC Hub. It explores the ways in which it develops the leadership capabilities within postgraduate training. This study demonstrates that the GPC Hub does more than deliver leadership theory or a checklist of competencies—it legitimises the active participation of resident doctors in leadership activities through a contextualised, active apprenticeship model. It provides a mentored, experiential platform where residents are not merely learning about leadership, but practising it—positioning leadership as a dynamic action, not just a role or set of tasks. In doing so, it offers a replicable model for leadership development that could be adapted across specialties. The study concludes that GPC Hub enriches the training experience, empowers resident voices, and supports impactful, real-world professional growth. Background The GPC Hub is structured across three tiers (see Figure 1), each aligned with key GPC domains: Quality Improvement, Clinical Governance, Research, and Medical Education (6). Participation can range from attending educational symposia focused on core content, to holding formal leadership roles within a domain, supported by mentorship from senior clinical and non-clinical leaders. Since its inception, the GPC Hub has expanded across the South East London School of Anaesthesia and has been adopted by other regions. It offers participants a conceptual framework for understanding their professional roles, the structure of the NHS, and the leadership opportunities available within it. The Hub promotes project-based learning and network-building beyond doctors’ usual clinical settings. Those involved in the higher tiers gain access to experiences and responsibilities that would typically be beyond the reach of non-consultant doctors. Figure 1: GPC Hub Structure Tier 1 - Educational Content Delivery Monthly symposium programme and journal club, delivered within resident doctor rotas in protected teaching time - open to all resident anaesthetists in South-East London. GPC-themed learning resources, including recordings and slide-decks from symposia, catalogued on the GPC Hub Future NHS workspace Tier 2 - GPC Hub Project Support Departmental and system-wide project opportunities are catalogued using databases stored on the Future NHS website. Projects align with local and system strategic priorities and include senior mentorship and support Project advertisement templates are used to standardise the process for recruiting residents to available opportunities. These are shared regularly through school-wide communication channels and stored on project databases. Supported handover of projects to reduce the adverse impact of rotation on resident-led work Completed project phases can be reported and published as case-studies on the Future NHS website Tier 3 - GPC Hub Leadership Roles Enhanced roles are available to resident doctors, both as local leads for departmental work streams (e.g. Research, Quality Improvement etc) and as representatives for each department on the South-east London Anaesthesia Network Board. Over subsequent years, the Hub structure has expanded to the surrounding hospitals comprising the South-East London School of Anaesthesia. It has partnered with the South-East London Anaesthesia Network, the clinical group overseeing perioperative care within the South-East London Acute Provider Collaborative. Resident Doctors at each Trust have joined the Network Board as resident representatives, offering unique access to service design and improvement opportunities through working with medical, nursing and operational leaders across the sector. A bespoke leadership development programme for resident doctors in leadership roles has been devised and delivered by the Faculty of Medical Leadership and Management. A GPC Hub workspace has been created using the Future NHS collaboration platform, where learning opportunities, educational resources and project case studies are published. The GPC Hub provides participants with ways of conceptualising the role of the doctor, and the structure and workings of the NHS, combined with leadership opportunities. It aims to develop generic capabilities, particularly leadership, through active, project-based learning, and enables participants to build a network of communication and observation beyond their regular settings. Participants who are involved in the higher tiers of the GPC Hub (see Figure 1) have opportunities that expose them to people, experiences and responsibilities that they are unlikely to be otherwise involved in at their level. This research explores the nature of that experience. It seeks to unpack the ways in which participants in GPC Hub leadership roles (Tier 3), explained and made meaning of their experience; what they learned, how they responded and the gains and the costs of involvement. We have chosen to examine this project by focusing on the lived experiences of participants because of the individual ways in which involvement impacted their professional, and sometimes personal, development. Methods This study considers trainees’ perceptions of their experience of participation in the GPC Hub. The focus of our study is to explore the ways in which they understand and explain this particular experience and as such our work is grounded within the interpretivist paradigm, more specifically that of phenomenology: the study of experience (7,8). A Husserlian approach aims to describe the essence of a phenomenon, by seeking to understand through interpretation (9), acknowledging that the researcher is an integral part of the research process (10). Building upon this, Gadamerian phenomenology suggests that the researchers’ interest in the study and their previous understandings add to the meaningfulness of the research (11). In our study, one of the researchers is the instigator and lead for the GPC Hub, another a former participant (and both anaesthetists) and the third is a clinical educator and hence our range of experience and knowledge are integral to the research. This study provides a detailed description and interpretation of the experiences of the participants. We seek to describe the phenomenon (the GPC Hub) from the perspective of the participants and in so doing to provide an interpretation of the role of the Hub in the professional and personal development of the participants. A central concept is how the participants make meaning out of the experience: how they explain it and identify key elements of the experience. To achieve an in-depth understanding of participants’ thoughts we conducted open, in-depth, semi-structured interviews. Interview questions were devised specifically for this study to explore the ways in which participants interpreted, explained and made sense of their involvement in the GPC Hub. Please see supplementary file 1 for an outline of interview questions used. Participants were recruited because they had participated in the GPC Hub. Ethics clearance was granted by King’s College London. Each interview was between 45 and 60 minutes and 10 participants took part in the study. Involvement in the study was entirely voluntary and interviews were de-identified prior to analysis. Interviews were audio recorded and transcribed in full. Analysis was emergent and was carried out by two members of the research team. The analysis followed Brain and Clarke’s (12) six-phase framework for thematic analysis: familiarisation with the data, initial inductive code generation, identifying themes, reviewing and revising themes, defining themes, refining and finalising themes. Coding involved re-reading and validation through cross-checking across all transcripts. Themes or patterns were identified and the coding refined. The coding categories were confirmed, modified or rejected in a collaborative process between the researchers. The aim of the analysis was to consider the range of ways in which the GPC Hub was understood while keeping the particular experiences and voices of the participants to the forefront. This study is a snapshot and investigates the Hub in the second year of operation and we acknowledge that the project is evolving and developing. Results The participants spoke warmly and in detail about the many advantages of the programme, including the overall structure, resources, leadership provided by the programme, the opportunities it allowed them to access and empowerment that it enabled. Opportunities for Development There was overwhelming commendation for the structure of the GPC Hub. Participants spoke of their appreciation for the organisation of the programme, with a clear, easily navigated structure that allowed them to easily appreciate their role despite minimal previous experience. The symposia days were described as accessible and relevant and online resources were highlighted as a bank of valuable and accessible material. The handover structure built into the Hub was also useful, facilitating continuity of longer-term projects. Leadership of the GPC Hub was praised by participants, particularly the Consultant Lead. His approach was: ‘hands on and approachable without micromanaging in an annoying way’. Further, he was accessible, he listened, ran regular drop-in sessions and ended each session with ‘what can I do to help?’ – and then followed through when necessary. Participants also appreciated regular updates and information about other teams’ successes and challenges. Participants focussed on opportunities afforded by the GPC Hub: collaboration and opportunities to work with new groups, attend meetings and ‘have access to people and places you would not otherwise have had access to’. The programme enabled them to observe decision-making in action and to see this at a managerial level through ‘attending meetings where things are decided’, a novel experience that enabled a better understanding of Trust structures: ‘I felt trapped in the treadmill of training – there’s interesting stuff going on but you don’t have access to it’. One participant remarked that better understanding the systemic structure meant that they were more relaxed in their clinical work. Other opportunities included a good support network, expanded links, feedback, mentoring and access to people who can help. One participant described it as ‘scaffolding them to consultant level’ and they ‘would not have had these opportunities without the Hub’ stating they would ‘not have been able to do it on my own’. Personal development was a central theme in describing the GPC Hub. Participants spoke of the ‘soft skills’ gained from the programme, such as communication skills and the ability to work with senior colleagues, giving an insight into senior roles and providing an additional skills base. At a more pragmatic level, participants felt the programme offered short-term opportunities to ‘box-tick’: to build a CV, gain points, publish, whilst also providing a ‘rewarding’ experience and so went well beyond the pragmatic. One of the real strengths of the project was the way in which it gave residents a voice and the ability to initiate change. Participants felt empowered to contribute to meetings and for others to ‘hear your voice’. One participant explained, ‘the officialness of it has helped me, given me a springboard’. Another pointed out that the Hub was legitimising their role, and that “having a title attached to it has much more weight”, increasing stakeholder engagement. The Hub empowered participants to lead and ‘changed the way I think about affecting change’. Importantly, participants suggested ‘things actually change because of it [GPC Hub]’. One of the real motivations for getting involved was the perceived opportunity to do something meaningful: ‘I am drawn to the idea of meaningful work and…projects that make a difference’, with many stating that they wanted ‘something more in depth’ One participant explained how it felt in the past they had been driven towards projects that were not difficult but had a high chance of success, whereas they felt more drawn to more difficult, in-depth projects with a higher impact which the GPC Hub provided. Challenges Despite the clear strengths of the programme, it was not without challenges. Whilst other issues were identified, the most commonly identified and important challenge reported by participants was the issue of wellbeing and time management. ‘…what I found particularly challenging … is there are these opportunities you want to get involved in and to be as responsive to these changes and to fully understand it is actually huge time commitment .’ Participants spoke of the challenge of balancing the GPC Hub responsibilities with their clinical role, finding it was having an impact on both their personal time and their clinical development time. Participants described how ‘doing a lot of stuff outside of clinical practice meant that it ate into my own time and that it definitely meant it ate into my evenings’, and there being a struggle to do everything around a busy clinical rota resulting in ‘spinning plates’. This had an impact on their wellbeing: ‘It’s challenging, I’m really tired’. Whilst participants discussed the benefits of Educational Development Time, many expressed concern that this did not reflect the amount of time they were putting into the GPC Hub: ‘EDT doesn’t reflect the amount of extra stuff I’m doing because the EDT is related to your rank’. As one person said (referring to all the demands on their time, not just the GPC Hub), ‘we are expected to do so much, all in our free time. One half day every two weeks is not enough’. Participants described taking annual leave to ‘stay sane’ using that time for the GPC Hub with one participant attending three meetings in a week of annual leave. The issue with time was not restricted to resident doctors since consultants also had little time to dedicate to supporting residents with projects. Balancing GPC Hub responsibilities and clinical skill development was also highlighted as an issue: ‘I’m a bit distracted, I would say, from the clinical side of things and not able to focus on that quite as much. I’ve definitely found it challenging’. Participants felt conflicted, even when taking EDT as it meant ‘you’re removing the opportunity to be on a clinical list that you really want to be on’. There was concern of de-skilling due to a reduced exposure to clinical opportunities: ‘if we prioritise non-clinical responsibilities, there is a risk that people finish their training without clinical confidence’. Structural organisation was identified as a challenge, with difficulties in recruiting others into projects, motivating team members to complete work or difficulties in interpersonal communication with one participant stating, ‘You know, there were political things, that was, like, a good example of a place where I probably haven’t done the necessary groundwork to create … to sort of prepare the ground for them…, I haven’t built a good relationship myself with the manager.’ They explained that it was a process of learning who and how to include people without alienating key stakeholders. Getting a project up and running in the initial period was also identified as a difficulty, as was a sense of isolation for participants who felt they were working alone. Others identified structural issues as adding to the difficulty of the project, for example management structures that were difficult to navigate. A further structural problem was rotational contracts, meaning that team-members move after a short time, making continuity difficult. Learning Participants spoke at some length about the learning undertaken through involvement in the GPC Hub and it was clear that it had been a valuable developmental experience. The chief areas of learning include communication, personal skills, diplomacy, organisational skills, strategic skills and a better understanding of organisational structures. These overlap to some extent but have been separated out here for clarity of analysis. Achieving balance between GPC Hub work, clinical work and personal time (discussed above) was a major learning point. Whilst challenging, participants became more selective in how they spent their time following their experience within the Hub, being able to pace themselves, feeling less time-pressured and having an ‘acceptance [that] things will happen when they happen’. ‘[I am more] specific about what I choose to do because like there’s this whole buffet of things to choose, and it’s quite tempting to go for like, oh, I could do a bit of this bit of that. But actually, you can’t really do all of those things at once and so like it’s definitely taught me that we do need more time in our like clinical lives to do this stuff as well’ Participants spoke of understanding their own personal interests and career aspirations, with one coming to the realisation that they did not want to do research due to the additional time demands on top of clinical commitments. One participant spoke of having gained a better understanding of things that affect people, realising that not everyone is the same or wants the same things: ‘you can’t make everyone do everything they might be doing their exams. They might be having a baby, they might be getting married, there are all of these work and non-work factors that affect them’. Many had gained a better understanding of when to say yes - and no - and how to set boundaries. Participants also spoke of a growing confidence and optimism, suggesting that the project had ‘lessened my worry about the hierarchy’ and that people ‘will say yes, will give you their time, will speak to you, will give you opportunities. Others gained analytic skills and an ability to ‘think outside the box’. Personal skills development including growth in organisational skills and communication skills was discussed by participants, who reported a better ability to prepare and organise programmes. They reported improvement in task organisation, such as breaking a project down into specific tasks allowing them to change focus if needed. Many had developed skills in seeing a project through: ‘Keep it small and do it well’. There was increased understanding of management tasks, such as minuting meetings and personnel management through motivation. Communication skills such as collaboration, developing contacts and communication with colleagues from other professions was another learning point. Participants spoke of learning diplomacy: ‘I’ve learned loads about communication with difficult groups, people that don’t want to be involved’, as well as how to be ‘both diplomatic and stubborn’ by understanding a common goal and approaching people more than once. One person spoke of learning ‘how people swim in the water without making enemies but still trying to get their point across’. Others discussed being aware of ‘who you might be annoying’ or how to keep key stakeholders part of the conversation. A key factor in developing increased confidence stemmed from a better understanding of the organisational structures. While some spoke of this in a positive way, others felt that they now saw why ‘things don’t happen in the NHS’. Some participants spoke of realising how ‘deeply flawed the Trust is’ while acknowledging that imperfections exist in any organisation. Participants discussed their increased understanding of ‘who is calling the shots’ and their realisation that there is a very ‘top down’ approach to decision-making, and the realisation that their Consultant colleagues did not hold all the power. Leadership Leadership is the key focus of the GPC Hub and participants had a rich and nuanced view of leadership and the role that the GPC Hub played in their leadership development. Leadership was described in terms of results and ‘getting things done’ and in terms of support, guidance and development of personal connections. Through their experience in the Hub, they described leadership characteristics as mentoring, guiding, delegating, teamwork, networking, building relationships and fostering talent and enthusiasm. Leadership behaviours focussed on transformational and personal aspects of leadership. Participants spoke of having experience in dealing with management roles with bidirectional feedback. Leadership was seen as horizontal as well as vertical. As one participant explained ‘it was more trying to coordinate who was actually yes or no and how to work it, without upsetting anybody, but also being mindful of if you have to wait for yes to come back from everybody’. Participants described how these experiences gave them ‘insights into people management, how to delegate, how to work in a team like that, how to link in with one another’ and ‘how to manage situations’ as well as people. These experiences highlight how participants did not lose sight of either the delivery or personal sides of leadership, describing the use of multiple avenues or approaches to attain a goal. Along similar lines, participants described their leadership role as being an advocate, allowing people to feel that they can do something, encouraging, providing supervision but not micromanaging. Yet they also understood that leadership can involve waiting as well as action. ‘I think there’s this perception. I’ve always had that …, you have an idea. You get people to you. You tell people about it and then they’ll just do it. I think I’ve really learned through this process that that doesn’t happen. I need to, try different avenues, re-engage. Do lots of things like that. So that’s been a definitely part of my leadership journey’ Participants saw their leadership roles as providing a voice to residents. They were conscious that their role in the GPC Hub meant they had the ability to influence their environment: ‘My experience will shape things going forward’. Knowledge was a key aspect of leadership development and that by gaining a better knowledge of their Trust had gained confidence to introduce change. They had gained a better understanding of the communication pathways, had learnt that people who disagree do so because they believe something different. They had gained confidence in communicating with senior staff: ‘before I would have been worried to send an email to a group of consultants – now it’s fine’. They described knowing how to seek people out and approach senior colleagues with confidence. Discussion So-called ‘soft skills’ are notoriously difficult to teach in a decontextualised manner ( 13 , 14 ). However, the GPC Hub provides a form of experiential learning for participants that is highly contextualised. It enables clear legitimate peripheral participation ( 4 ) so that participants are able to both see and do leadership in a real, active, legitimised but supported way. It provides access to networks and senior staff, exposure, opportunities to be involved in higher level decision-making, and to put in place changes that have the potential to make both short- and long-term impactful change. The GPC Hub addresses some of the difficulties faced by resident doctors in developing key leadership skills alongside their clinical training through an apprenticeship model that could be utilised in other areas. This research demonstrates the impact that involvement in the GPC Hub has had on the development of these skills and considers how it can evolve in the future to remain relevant and useful. This change to an active developmental approach to leadership is essential because medical professionals within leadership roles in the National Health Service (NHS) have a positive impact on patient outcomes and care quality ( 15 ). Clinicians have considerable influence on resource allocation and healthcare expenditure, having insight into the problems faced on the frontline of clinical care ( 2 ). The NHS therefore presents an almost unique model whereby leadership roles are dispersed amongst many members of staff with numerous different workforce positions, rather than limited to those in formal managerial roles ( 16 ). Resident doctors represent a huge proportion of the NHS frontline workforce, making up roughly half of the medical workforce ( 17 ) but have previously been underutilised as a group with only a minority being able to affect actual change ( 18 ), despite being in an ideal position to enact change through their real-time insight into the problems faced with patient care ( 19 ). The reasons for this are multiple. Rotational contracts may result in insufficient time to enact change as well as feelings of transience, with participants within our study expressing a realisation of the timescales involved in enacting change. Further, leadership skill development may be considered less relevant for residents than clinical skills ( 20 ). However, our findings suggest that resident doctors are keen to develop leadership skills if given the structure and opportunity to do so. One of the strengths of the GPC Hub is its layered and embedded approach to leadership. Participants expressed a highly nuanced understanding, seeing leadership in terms of personal connections, delivery, and transformation through developing communication skills and organisational and structural understanding. Having participated in the GPC hub, participants had an understanding of leadership that encompassed the personal, communicative and structural and was skills, knowledge, values and task based. Distributed leadership ( 21 ) allows for leadership to break away from a linear, hierarchical pattern and distributes responsibility across an organisation allowing people to take responsibility across levels. One of the key strengths of the GPC hub is that it enables distributed leadership in a safe and controlled manner. Within this broad frame of distributed leadership, we can understand the leadership development provided by the GPC Hub in terms of transactional and transformational leadership ( 22 , 23 ) and an interplay between the two. The transactional aspect of leadership can be seen through the focus on delivery, such as completed projects and CV ‘points’. Participants’ understanding of the importance of multiple approaches to achieve a goal, the need for follow through and the understanding of personnel that should be involved demonstrated a strategic, transactional understanding of communication. Yet much of the additional value was in the transformational aspect of leadership. Many saw the value of involvement in sustainable projects, relationship building, advocating for others, and developing lasting change. They spoke of the value of encouraging others proactively and finding allies. Participants spoke of the value of meaningful change, as well as a growing understanding of why change was difficult, particularly, perhaps, in an organisation such as the NHS. An often-overlooked aspect of leadership development is an understanding of organisational structures (24). Participants in the GPC Hub both engaged in and observed leadership in action. Involvement within the GPC Hub enabled the development of contact networks, improving confidence in developing new contacts underpinned by an increased understanding of the workings of the NHS and their Trust. In observing decision-making, attending meetings, spear-heading projects and interacting with others outside of a purely clinical role, participants were able to peep behind the curtain. They could see, for example, the way in which people they may have viewed as powerful were constrained within a system, as well as the informal ways of gaining influence through diplomacy and persistence. Understanding organisational structures is important when we consider evidence that increased involvement of doctors within senior management positions is statistically associated with improved performance ( 15 ). The inherent structure of the GPC Hub mirrors departmental governance structure in order to promote understanding of how such a structure works. Through this familiarisation, participants have been able to break down the traditional silos that often separate resident doctors from management structures, enabling residents to ‘better understand how things happen’ and appreciate the work involved in making impactful change. The programme has not come without barriers. Participants discussed the difficulties in balancing their roles within the Hub with their clinical roles as resident doctors. This is not an isolated experience: residents throughout training are constantly attempting to balance service provision and training opportunities ( 25 ), and clinical skill and ‘softer’ skill acquisition. One of the main barriers to engagement in leadership development is a lack of time and resources ( 2 ). Leadership is a nebulous concept without the immediacy of clinical skill procurement. Rewards are longer term, often with weak incentives ( 26 ). Many of the participants felt this strain on their time. The incursion of GPC Hub activity into resident’s personal time is cause for concern, especially given high rates of burnout reported by UK Anaesthesia residents ( 27 ). Encouragingly, system wide changes such as the introduction of Educational Development Time ( 28 ), which is paid time away from clinical work, were identified by participants as helpful in addressing this balance. The tension and strength of the GPC Hub is that it provides both opportunity and challenges. The opportunities, as set out here, are great and participants were clear that they had gained a great deal. Yet this came with costs, in terms of time pressure and difficulty in striking a balance with both clinical and personal time. While the two do not necessarily sit comfortably together it is helpful to acknowledge the pressures on participants. The challenge will be to balance this tension without losing the strength of the programme. Conclusion Implementation of the Generic Professional Capabilities framework in UK postgraduate curricula has been a catalyst for change, drawing non-clinical skill acquisition from the periphery into the core of training programme delivery. Using an apprenticeship model, the GPC Hub enables and legitimises resident doctors’ leadership development through roles and projects undertaken in the workplace. Resident doctors in GPC Hub leadership roles gain both transactional and transformational leadership experience, which enhances their understanding of the system, enabling personal and professional development while expanding and diversifying professional networks. The GPC Hub educational framework is applicable to other postgraduate training contexts and should be considered alongside traditional approaches to leadership training, whose focus and delivery is often parallel to clinical training. While this research suggests potential advantages of a more integrated model, we must exercise some caution that the wealth of opportunities that the GPC Hub affords do not become overwhelming, placing still greater strain on the delicate balance that residents must strike between both clinical and generic professional learning, and their own personal lives. More broadly, our findings reflect the challenges and tensions inherent in training the medical workforce to perform and thrive across the multiplicity of their professional roles. Declarations Ethics approval and consent to participate: Ethics clearance was granted by King’s College London (Ethical Clearance Reference Number: MRA-23/24-40406). Informed consent for participation was gained from all participants in the study through a written consent form and all participants received an information sheet about the study. This research was in compliance with the Helsinki Declaration. Consent for publication: Not applicable. Availability of data and materials: Interview questions, interview transcripts and coding documentation available on request. Competing interests: The authors declare that they have no competing interests. Funding: No funding was obtained for this research. Authors’ contributions: HH co-designed the interview questions, conducted interviews with participants, transcribed and coded the transcripts and performed thematic analysis, and co-wrote the manuscript. JL had the original idea for the project, co-designed the interview questions, had an overview of thematic analysis and co-wrote the manuscript. AJ co-designed the project and interview questions, assisted with interviews with participants, co-performed the thematic analysis and co-wrote the manuscript. Acknowledgements: The authors would like to acknowledge the time and contributions of the resident doctors who took part in this study, the departments of Anaesthesia in South-East London for supporting the Generic Professional Capabilities Hub initiative and Professor Gabe Reedy for his valuable notes on this manuscript. Clinical trial number: not applicable. References General Medical Council. Generic Professional Capabilities Framework. GMC Manchester; 2017. Aggarwal R, Swanwick T. Clinical leadership development in postgraduate medical education and training: policy, strategy, and delivery in the UK National Health Service. J Healthc Leadersh. 2015 Nov 17;7:109–22. Lyons O, George R, Galante JR, Mafi A, Fordwoh T, Frich J, et al. Evidence-based medical leadership development: a systematic review. BMJ Lead [Internet]. 2021 [cited 2025 Aug 10];5(3). Available from: https://ora.ox.ac.uk/objects/uuid:ed5ff28e-510d-4186-ba8c-9e194d4c1cc8 Lave J. 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Available from: http://www.scopus.com/inward/record.url?scp=85196951269&partnerID=8YFLogxK Veronesi G, Kirkpatrick I, Altanlar A. Clinical Leadership and the Changing Governance of Public Hospitals: Implications for Patient Experience. Public Adm. 2015;93(4):1031–48. Swanwick T, McKimm J. Faculty Development for Leadership and Management. In: Steinert Y, editor. Faculty Development in the Health Professions: A Focus on Research and Practice [Internet]. Dordrecht: Springer Netherlands; 2014 [cited 2025 Aug 10]. p. 53–78. Available from: https://doi.org/10.1007/978-94-007-7612-8_3 NHS England Digital [Internet]. [cited 2025 Aug 10]. NHS Workforce Statistics - September 2024 (Including selected provisional statistics for October 2024). Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/september-2024 Gilbert A, Hockey P, Vaithianathan R, Curzen N, Lees P. Perceptions of junior doctors in the NHS about their training: results of a regional questionnaire. BMJ Qual Saf. 2012 Mar 1;21(3):234–8. Keogh B, McCay SL. A junior doctor’s guide to the NHS. Foreword Br Med J Group Lond. 2009;28. Brown B, Ahmed-Little Y, Stanton E. Why we cannot afford not to engage junior doctors in NHS leadership. J R Soc Med. 2012 Mar 1;105(3):105–10. Bolden R. Distributed Leadership in Organizations: A Review of Theory and Research. Int J Manag Rev. 2011;13(3):251–69. Bolden R. What is Leadership? [Internet]. Centre for Leadership Studies, University of Exeter; 2004 July [cited 2025 Aug 10]. Available from: https://ore.exeter.ac.uk/repository/handle/10036/17493 Gabel S. Transformational Leadership and Healthcare. Med Sci Educ. 2013 Mar 1;23(1):55–60. Bhardwaj A. Organizational Culture and Effective Leadership in Academic Medical Institutions. J Healthc Leadersh. 2022 Mar 10;14:25–30. Swanwick T. Postgraduate medical education: the same, but different. Postgrad Med J. 2015 Apr 1;91(1074):179–81. Mountford J, Webb C. When clinicians lead: the McKinsey Quarterly. Healthc Leadersh Rev. 2009 May 1;28(5):1–4. Royal College of Anaesthetists. A report on the welfare, morale and experiences of anaesthetists in training: the need to listen. 2017. Royal College of Anaesthetists. Guidance for Educational Development Time | The Royal College of Anaesthetists [Internet]. 2021 [cited 2025 Aug 10]. Available from: https://www.rcoa.ac.uk/training-careers/training-hub/2021-curriculum/guidance-educational-development-time Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile1interviewquestions.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 Nov, 2025 Reviewers agreed at journal 30 Oct, 2025 Reviewers invited by journal 27 Oct, 2025 Editor assigned by journal 23 Oct, 2025 Editor invited by journal 01 Oct, 2025 Submission checks completed at journal 30 Sep, 2025 First submitted to journal 30 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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intervention","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLeadership and management development is a recognised priority across postgraduate medical curricula in the UK. This emphasis has grown following the introduction of the Generic Professional Capabilities (GPC) Framework by the General Medical Council (1), which sets out essential values and behaviours expected of all doctors. Now embedded in all postgraduate curricula, the framework mandates the acquisition of non-clinical capabilities and yet how to best deliver these is less clear.\u003c/p\u003e\n\u003cp\u003eUnlike technical clinical skills, leadership is context-sensitive, relational, and challenging to define or assess. Traditional didactic methods often struggle to impart these skills effectively, particularly when delivered in decontextualised settings. Previous approaches\u0026mdash;such as competency frameworks, talent management schemes, clinical fellowships, and secondments\u0026mdash;have met with varying success (2). Recent literature highlights the greater impact of experiential learning embedded in the workplace, compared with more passive, classroom-based models (3). Integrated programmes of this type are rare, and leadership \u0026lsquo;apprenticeship\u0026rsquo; experiences are notably lacking. Unlike clinical training\u0026mdash;where legitimate peripheral participation (4) allows junior doctors to gradually take on more complex tasks under supervision\u0026mdash;non-clinical leadership development rarely offers such low-stakes, preparatory opportunities in a real apprenticeship setting. As a result, many doctors encounter their first true leadership responsibilities only when stepping into high-stakes, formal roles, often without prior hands-on experience.\u003c/p\u003e\n\u003cp\u003eIn response to this, the Generic Professional Capabilities (GPC) Hub was developed as a \u0026lsquo;bottom-up\u0026rsquo; model to support leadership development for resident doctors working within Anaesthetic departments (5). The Hub provides a structured framework that supports real-world contextualised learning, allowing doctors to engage with leadership in an authentic and supported environment. It facilitates the collection of evidence aligned with curricular expectations, fosters professional growth, and strengthens integration with local leadership and governance systems. This paper examines participants\u0026rsquo; experiences with GPC Hub. It explores the ways in which it develops the leadership capabilities within postgraduate training.\u003c/p\u003e\n\u003cp\u003eThis study demonstrates that the GPC Hub does more than deliver leadership theory or a checklist of competencies\u0026mdash;it legitimises the active participation of resident doctors in leadership activities through a contextualised, active apprenticeship model. It provides a mentored, experiential platform where residents are not merely learning about leadership, but practising it\u0026mdash;positioning leadership as a dynamic action, not just a role or set of tasks. In doing so, it offers a replicable model for leadership development that could be adapted across specialties. The study concludes that GPC Hub enriches the training experience, empowers resident voices, and supports impactful, real-world professional growth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe GPC Hub is structured across three tiers (see Figure 1), each aligned with key GPC domains: Quality Improvement, Clinical Governance, Research, and Medical Education (6). Participation can range from attending educational symposia focused on core content, to holding formal leadership roles within a domain, supported by mentorship from senior clinical and non-clinical leaders.\u003c/p\u003e\n\u003cp\u003eSince its inception, the GPC Hub has expanded across the South East London School of Anaesthesia and has been adopted by other regions. It offers participants a conceptual framework for understanding their professional roles, the structure of the NHS, and the leadership opportunities available within it. The Hub promotes project-based learning and network-building beyond doctors\u0026rsquo; usual clinical settings. Those involved in the higher tiers gain access to experiences and responsibilities that would typically be beyond the reach of non-consultant doctors.\u003c/p\u003e\n\u003cp\u003eFigure 1: GPC Hub Structure\u0026nbsp;\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eTier 1 - Educational Content Delivery\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eMonthly symposium programme and journal club, delivered within resident doctor rotas in protected teaching time - open to all resident anaesthetists in South-East London.\u003c/li\u003e\n \u003cli\u003eGPC-themed learning resources, including recordings and slide-decks from symposia, catalogued on the GPC Hub Future NHS workspace\u003cbr\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTier 2 - GPC Hub Project Support\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eDepartmental and system-wide project opportunities are catalogued using databases stored on the Future NHS website.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eProjects align with local and system strategic priorities and include senior mentorship and support\u003c/li\u003e\n \u003cli\u003eProject advertisement templates are used to standardise the process for recruiting residents to available opportunities. These are shared regularly through school-wide communication channels and stored on project databases.\u003c/li\u003e\n \u003cli\u003eSupported handover of projects to reduce the adverse impact of rotation on resident-led work\u003c/li\u003e\n \u003cli\u003eCompleted project phases can be reported and published as case-studies on the Future NHS website\u003cbr\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTier 3 - GPC Hub Leadership Roles\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eEnhanced roles are available to resident doctors, both as local leads for departmental work streams (e.g. Research, Quality Improvement etc) and as representatives for each department on the South-east London Anaesthesia Network Board.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOver subsequent years, the Hub structure has expanded to the surrounding hospitals comprising the South-East London School of Anaesthesia. It has partnered with the South-East London Anaesthesia Network, the clinical group overseeing perioperative care within the South-East London Acute Provider Collaborative. Resident Doctors at each Trust have joined the Network Board as resident representatives, offering unique access to service design and improvement opportunities through working with medical, nursing and operational leaders across the sector. A bespoke leadership development programme for resident doctors in leadership roles has been devised and delivered by the Faculty of Medical Leadership and Management. A GPC Hub workspace has been created using the Future NHS collaboration platform, where learning opportunities, educational resources and project case studies are published.\u003c/p\u003e\n\u003cp\u003eThe GPC Hub provides participants with ways of conceptualising the role of the doctor, and the structure and workings of the NHS, combined with leadership opportunities. It aims to develop generic capabilities, particularly leadership, through active, project-based learning, and enables participants to build a network of communication and observation beyond their regular settings. Participants who are involved in the higher tiers of the GPC Hub (see Figure 1) have opportunities that expose them to people, experiences and responsibilities that they are unlikely to be otherwise involved in at their level. This research explores the nature of that experience. It seeks to unpack the ways in which participants in GPC Hub leadership roles (Tier 3), explained and made meaning of their experience; what they learned, how they responded and the gains and the costs of involvement. We have chosen to examine this project by focusing on the lived experiences of participants because of the individual ways in which involvement impacted their professional, and sometimes personal, development.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study considers trainees\u0026rsquo; perceptions of their experience of participation in the GPC Hub. \u0026nbsp;The focus of our study is to explore the ways in which they understand and explain this particular experience and as such our work is grounded within the interpretivist paradigm, more specifically that of phenomenology: the study of experience (7,8). A Husserlian approach aims to describe the essence of a phenomenon, by seeking to understand through interpretation (9), acknowledging that the researcher is an integral part of the research process (10). Building upon this, Gadamerian phenomenology suggests that the researchers\u0026rsquo; interest in the study and their previous understandings add to the meaningfulness of the research (11). \u0026nbsp;In our study, one of the researchers is the instigator and lead for the GPC Hub, another a former participant (and both anaesthetists) and the third is a clinical educator and hence our range of experience and knowledge are integral to the research.\u003c/p\u003e\n\u003cp\u003eThis study provides a detailed description and interpretation of the experiences of the participants. We seek to describe the phenomenon (the GPC Hub) from the perspective of the participants and in so doing to provide an interpretation of the role of the Hub in the professional and personal development of the participants. A central concept is how the participants make meaning out of the experience: how they explain it and identify key elements of the experience. To achieve an in-depth understanding of participants\u0026rsquo; thoughts we conducted open, in-depth, semi-structured interviews. Interview questions were devised specifically for this study \u0026nbsp;to explore the ways in which participants interpreted, explained and made sense of their involvement in the GPC Hub. \u0026nbsp;Please see supplementary file 1 for an outline of interview questions used. Participants were recruited because they had participated in the GPC Hub. \u0026nbsp;Ethics clearance was granted by King\u0026rsquo;s College London.\u003c/p\u003e\n\u003cp\u003eEach interview was between 45 and 60 minutes and 10 participants took part in the study. \u0026nbsp;Involvement in the study was entirely voluntary and interviews were de-identified prior to analysis. \u0026nbsp;Interviews were audio recorded and transcribed in full.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnalysis was emergent and was carried out by two members of the research team. The analysis followed Brain and Clarke\u0026rsquo;s (12) six-phase framework for thematic analysis: familiarisation with the data, initial inductive code generation, identifying themes, reviewing and revising themes, defining themes, refining and finalising themes. Coding involved re-reading and validation through cross-checking across all transcripts. Themes or patterns were identified and the coding refined. \u0026nbsp;The coding categories were confirmed, modified or rejected in a collaborative process between the researchers. The aim of the analysis was to consider the range of ways in which the GPC Hub was understood while keeping the particular experiences and voices of the participants to the forefront. This study is a snapshot and investigates the Hub in the second year of operation and we acknowledge that the project is evolving and developing.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe participants spoke warmly and in detail about the many advantages of the programme, including the overall structure, resources, leadership provided by the programme, the opportunities it allowed them to access and empowerment that it enabled.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eOpportunities for Development\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThere was overwhelming commendation for the structure of the GPC Hub. Participants spoke of their appreciation for the organisation of the programme, with a clear, easily navigated structure that allowed them to easily appreciate their role despite minimal previous experience. The symposia days were described as accessible and relevant and online resources were highlighted as a bank of valuable and accessible material. The handover structure built into the Hub was also useful, facilitating continuity of longer-term projects.\u003c/p\u003e\n\u003cp\u003eLeadership of the GPC Hub was praised by participants, particularly the Consultant Lead. His approach was: \u0026lsquo;hands on and approachable without micromanaging in an annoying way\u0026rsquo;. Further, he was accessible, he listened, ran regular drop-in sessions and ended each session with \u0026lsquo;what can I do to help?\u0026rsquo; \u0026ndash; and then followed through when necessary. Participants also appreciated regular updates and information about other teams\u0026rsquo; successes and challenges.\u003c/p\u003e\n\u003cp\u003eParticipants focussed on opportunities afforded by the GPC Hub: collaboration and opportunities to work with new groups, attend meetings and \u0026lsquo;have access to people and places you would not otherwise have had access to\u0026rsquo;. The programme enabled them to observe decision-making in action and to see this at a managerial level through \u0026lsquo;attending meetings where things are decided\u0026rsquo;, a novel experience that enabled a better understanding of Trust structures: \u0026lsquo;I felt trapped in the treadmill of training \u0026ndash; there\u0026rsquo;s interesting stuff going on but you don\u0026rsquo;t have access to it\u0026rsquo;. \u0026nbsp;One participant remarked that better understanding the systemic structure meant that they were more relaxed in their clinical work. Other opportunities included a good support network, expanded links, feedback, mentoring and access to people who can help. \u0026nbsp;One participant described it as \u0026lsquo;scaffolding them to consultant level\u0026rsquo; and they \u0026lsquo;would not have had these opportunities without the Hub\u0026rsquo; stating they would \u0026lsquo;not have been able to do it on my own\u0026rsquo;.\u003c/p\u003e\n\u003cp\u003ePersonal development was a central theme in describing the GPC Hub. Participants spoke of the \u0026lsquo;soft skills\u0026rsquo; gained from the programme, such as communication skills and the ability to work with senior colleagues, giving an insight into senior roles and providing an additional skills base. At a more pragmatic level, participants felt the programme offered short-term opportunities to \u0026lsquo;box-tick\u0026rsquo;: to build a CV, gain points, publish, whilst also providing a \u0026lsquo;rewarding\u0026rsquo; experience and so went well beyond the pragmatic.\u003c/p\u003e\n\u003cp\u003eOne of the real strengths of the project was the way in which it gave residents a voice and the ability to initiate change. Participants felt empowered to contribute to meetings and for others to \u0026lsquo;hear your voice\u0026rsquo;. \u0026nbsp;One participant explained, \u0026lsquo;the officialness of it has helped me, given me a springboard\u0026rsquo;. \u0026nbsp;Another pointed out that the Hub was legitimising their role, and that \u0026ldquo;having a title attached to it has much more weight\u0026rdquo;, increasing stakeholder engagement. \u0026nbsp;The Hub empowered participants to lead and \u0026lsquo;changed the way I think about affecting change\u0026rsquo;. Importantly, participants suggested \u0026lsquo;things \u003cu\u003eactually\u003c/u\u003e change because of it [GPC Hub]\u0026rsquo;. One of the real motivations for getting involved was the perceived opportunity to do something meaningful: \u0026lsquo;I am drawn to the idea of meaningful work and\u0026hellip;projects that make a difference\u0026rsquo;, with many stating that they wanted \u0026lsquo;something more in depth\u0026rsquo; One participant explained how it felt in the past they had been driven towards projects that were not difficult but had a high chance of success, whereas they felt more drawn to more difficult, in-depth projects with a higher impact which the GPC Hub provided.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eChallenges\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eDespite the clear strengths of the programme, it was not without challenges. Whilst other issues were identified, the most commonly identified and important challenge reported by participants was the issue of wellbeing and time management.\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;\u0026hellip;what I found particularly challenging \u0026hellip; is there are these opportunities you want to get involved in and to be as responsive to these changes and to fully understand it is actually huge time commitment\u003cem\u003e.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants spoke of the challenge of balancing the GPC Hub responsibilities with their clinical role, finding it was having an impact on both their personal time and their clinical development time. Participants described how \u0026lsquo;doing a lot of stuff outside of clinical practice meant that it ate into my own time and that it definitely meant it ate into my evenings\u0026rsquo;, and there being a struggle to do everything around a busy clinical rota resulting in \u0026lsquo;spinning plates\u0026rsquo;. This had an impact on their wellbeing: \u0026lsquo;It\u0026rsquo;s challenging, I\u0026rsquo;m really tired\u0026rsquo;. Whilst participants discussed the benefits of Educational Development Time, many expressed concern that this did not reflect the amount of time they were putting into the GPC Hub: \u0026lsquo;EDT doesn\u0026rsquo;t reflect the amount of extra stuff I\u0026rsquo;m doing because the EDT is related to your rank\u0026rsquo;. As one person said (referring to all the demands on their time, not just the GPC Hub), \u0026lsquo;we are expected to do so much, all in our free time. One half day every two weeks is not enough\u0026rsquo;. Participants described taking annual leave to \u0026lsquo;stay sane\u0026rsquo; using that time for the GPC Hub with one participant attending three meetings in a week of annual leave. The issue with time was not restricted to resident doctors since consultants also had little time to dedicate to supporting residents with projects.\u003c/p\u003e\n\u003cp\u003eBalancing GPC Hub responsibilities and clinical skill development was also highlighted as an issue: \u0026lsquo;I\u0026rsquo;m a bit distracted, I would say, from the clinical side of things and not able to focus on that quite as much. I\u0026rsquo;ve definitely found it challenging\u0026rsquo;. Participants felt conflicted, even when taking EDT as it meant \u0026lsquo;you\u0026rsquo;re removing the opportunity to be on a clinical list that you really want to be on\u0026rsquo;. There was concern of de-skilling due to a reduced exposure to clinical opportunities: \u0026lsquo;if we prioritise non-clinical responsibilities, there is a risk that people finish their training without clinical confidence\u0026rsquo;.\u003c/p\u003e\n\u003cp\u003eStructural organisation was identified as a challenge, with difficulties in recruiting others into projects, motivating team members to complete work or difficulties in interpersonal communication with one participant stating,\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;You know, there were political things, that was, like, a good example of a place where I probably haven\u0026rsquo;t done the necessary groundwork to create \u0026hellip; to sort of prepare the ground for them\u0026hellip;, I haven\u0026rsquo;t built a good relationship myself with the manager.\u0026rsquo;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThey explained that it was a process of learning who and how to include people without alienating key stakeholders. Getting a project up and running in the initial period was also identified as a difficulty, as was a sense of isolation for participants who felt they were working alone. Others identified structural issues as adding to the difficulty of the project, for example management structures that were difficult to navigate. \u0026nbsp;A further structural problem was rotational contracts, meaning that team-members move after a short time, making continuity difficult.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eLearning\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eParticipants spoke at some length about the learning undertaken through involvement in the GPC Hub and it was clear that it had been a valuable developmental experience. The chief areas of learning include communication, personal skills, diplomacy, organisational skills, strategic skills and a better understanding of organisational structures. These overlap to some extent but have been separated out here for clarity of analysis.\u003c/p\u003e\n\u003cp\u003eAchieving balance between GPC Hub work, clinical work and personal time (discussed above) was a major learning point. Whilst challenging, participants became more selective in how they spent their time following their experience within the Hub, being able to pace themselves, feeling less time-pressured and having an \u0026lsquo;acceptance [that] things will happen when they happen\u0026rsquo;.\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;[I am more] specific about what I choose to do because like there\u0026rsquo;s this whole buffet of things to choose, and it\u0026rsquo;s quite tempting to go for like, oh, I could do a bit of this bit of that. But actually, you can\u0026rsquo;t really do all of those things at once and so like it\u0026rsquo;s definitely taught me that we do need more time in our like clinical lives to do this stuff as well\u0026rsquo;\u003c/p\u003e\n\u003cp\u003eParticipants spoke of understanding their own personal interests and career aspirations, with one coming to the realisation that they did not want to do research due to the additional time demands on top of clinical commitments. \u0026nbsp;One participant spoke of having gained a better understanding of things that affect people, realising that not everyone is the same or wants the same things: \u0026lsquo;you can\u0026rsquo;t make everyone do everything they might be doing their exams. They might be having a baby, they might be getting married, there are all of these work and non-work factors that affect them\u0026rsquo;. Many had gained a better understanding of when to say yes - and no - and how to set boundaries. \u0026nbsp;Participants also spoke of a growing confidence and optimism, suggesting that the project had \u0026lsquo;lessened my worry about the hierarchy\u0026rsquo; and that people \u0026lsquo;will say yes, will give you their time, will speak to you, will give you opportunities. Others gained analytic skills and an ability to \u0026lsquo;think outside the box\u0026rsquo;.\u003c/p\u003e\n\u003cp\u003ePersonal skills development including growth in organisational skills and communication skills was discussed by participants, who reported a better ability to prepare and organise programmes. They reported improvement in task organisation, such as breaking a project down into specific tasks allowing them to change focus if needed. Many had developed skills in seeing a project through: \u0026lsquo;Keep it small and do it well\u0026rsquo;. There was increased understanding of management tasks, such as minuting meetings and personnel management through motivation. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCommunication skills such as collaboration, developing contacts and communication with colleagues from other professions was another learning point. Participants spoke of learning diplomacy: \u0026lsquo;I\u0026rsquo;ve learned loads about communication with difficult groups, people that don\u0026rsquo;t want to be involved\u0026rsquo;, as well as how to be \u0026lsquo;both diplomatic and stubborn\u0026rsquo; by understanding a common goal and approaching people more than once. One person spoke of learning \u0026lsquo;how people swim in the water without making enemies but still trying to get their point across\u0026rsquo;. Others discussed being aware of \u0026lsquo;who you might be annoying\u0026rsquo; or how to keep key stakeholders part of the conversation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA key factor in developing increased confidence stemmed from a better understanding of the organisational structures. While some spoke of this in a positive way, others felt that they now saw why \u0026lsquo;things don\u0026rsquo;t happen in the NHS\u0026rsquo;. Some participants spoke of realising how \u0026lsquo;deeply flawed the Trust is\u0026rsquo; while acknowledging that imperfections exist in any organisation. Participants discussed their increased understanding of \u0026lsquo;who is calling the shots\u0026rsquo; and their realisation that there is a very \u0026lsquo;top down\u0026rsquo; approach to decision-making, and the realisation that their Consultant colleagues did not hold all the power.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cu\u003eLeadership\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eLeadership is the key focus of the GPC Hub and participants had a rich and nuanced view of leadership and the role that the GPC Hub played in their leadership development. Leadership was described in terms of results and \u0026lsquo;getting things done\u0026rsquo; and in terms of support, guidance and development of personal connections. Through their experience in the Hub, they described leadership characteristics as mentoring, guiding, delegating, teamwork, networking, building relationships and fostering talent and enthusiasm.\u003c/p\u003e\n\u003cp\u003eLeadership behaviours focussed on transformational and personal aspects of leadership. Participants spoke of having experience in dealing with management roles with bidirectional feedback. \u0026nbsp;Leadership was seen as horizontal as well as vertical. As one participant explained \u0026lsquo;it was more trying to coordinate who was actually yes or no and how to work it, without upsetting anybody, but also being mindful of if you have to wait for yes to come back from everybody\u0026rsquo;. Participants described how these experiences gave them \u0026lsquo;insights into people management, how to delegate, how to work in a team like that, how to link in with one another\u0026rsquo; and \u0026lsquo;how to manage situations\u0026rsquo; as well as people. These experiences highlight how participants did not lose sight of either the delivery or personal sides of leadership, describing the use of multiple avenues or approaches to attain a goal. Along similar lines, participants described their leadership role as being an advocate, allowing people to feel that they can do something, encouraging, providing supervision but not micromanaging. Yet they also understood that leadership can involve waiting as well as action.\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;I think there\u0026rsquo;s this perception. I\u0026rsquo;ve always had that \u0026hellip;, you have an idea. You get people to you. You tell people about it and then they\u0026rsquo;ll just do it. I think I\u0026rsquo;ve really learned through this process that that doesn\u0026rsquo;t happen. I need to, try different avenues, re-engage. Do lots of things like that. So that\u0026rsquo;s been a definitely part of my leadership journey\u0026rsquo;\u003c/p\u003e\n\u003cp\u003eParticipants saw their leadership roles as providing a voice to residents. \u0026nbsp;They were conscious that their role in the GPC Hub meant they had the ability to influence their environment: \u0026lsquo;My experience will shape things going forward\u0026rsquo;. Knowledge was a key aspect of leadership development and that by gaining a better knowledge of their Trust had gained confidence to introduce change. They had gained a better understanding of the communication pathways, had learnt that people who disagree do so because they believe something different. They had gained confidence in communicating with senior staff: \u0026lsquo;before I would have been worried to send an email to a group of consultants \u0026ndash; now it\u0026rsquo;s fine\u0026rsquo;. They described knowing how to seek people out and approach senior colleagues with confidence.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSo-called \u0026lsquo;soft skills\u0026rsquo; are notoriously difficult to teach in a decontextualised manner (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, the GPC Hub provides a form of experiential learning for participants that is highly contextualised. It enables clear legitimate peripheral participation (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) so that participants are able to both see and do leadership in a real, active, legitimised but supported way. It provides access to networks and senior staff, exposure, opportunities to be involved in higher level decision-making, and to put in place changes that have the potential to make both short- and long-term impactful change. The GPC Hub addresses some of the difficulties faced by resident doctors in developing key leadership skills alongside their clinical training through an apprenticeship model that could be utilised in other areas. This research demonstrates the impact that involvement in the GPC Hub has had on the development of these skills and considers how it can evolve in the future to remain relevant and useful.\u003c/p\u003e\u003cp\u003eThis change to an active developmental approach to leadership is essential because medical professionals within leadership roles in the National Health Service (NHS) have a positive impact on patient outcomes and care quality (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Clinicians have considerable influence on resource allocation and healthcare expenditure, having insight into the problems faced on the frontline of clinical care (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The NHS therefore presents an almost unique model whereby leadership roles are dispersed amongst many members of staff with numerous different workforce positions, rather than limited to those in formal managerial roles (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Resident doctors represent a huge proportion of the NHS frontline workforce, making up roughly half of the medical workforce (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) but have previously been underutilised as a group with only a minority being able to affect actual change (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), despite being in an ideal position to enact change through their real-time insight into the problems faced with patient care (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The reasons for this are multiple. Rotational contracts may result in insufficient time to enact change as well as feelings of transience, with participants within our study expressing a realisation of the timescales involved in enacting change. Further, leadership skill development may be considered less relevant for residents than clinical skills (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, our findings suggest that resident doctors are keen to develop leadership skills if given the structure and opportunity to do so.\u003c/p\u003e\u003cp\u003eOne of the strengths of the GPC Hub is its layered and embedded approach to leadership. Participants expressed a highly nuanced understanding, seeing leadership in terms of personal connections, delivery, and transformation through developing communication skills and organisational and structural understanding. Having participated in the GPC hub, participants had an understanding of leadership that encompassed the personal, communicative and structural and was skills, knowledge, values and task based. Distributed leadership (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) allows for leadership to break away from a linear, hierarchical pattern and distributes responsibility across an organisation allowing people to take responsibility across levels. One of the key strengths of the GPC hub is that it enables distributed leadership in a safe and controlled manner.\u003c/p\u003e\u003cp\u003eWithin this broad frame of distributed leadership, we can understand the leadership development provided by the GPC Hub in terms of transactional and transformational leadership (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and an interplay between the two. The transactional aspect of leadership can be seen through the focus on delivery, such as completed projects and CV \u0026lsquo;points\u0026rsquo;. Participants\u0026rsquo; understanding of the importance of multiple approaches to achieve a goal, the need for follow through and the understanding of personnel that should be involved demonstrated a strategic, transactional understanding of communication.\u003c/p\u003e\u003cp\u003eYet much of the additional value was in the transformational aspect of leadership. Many saw the value of involvement in sustainable projects, relationship building, advocating for others, and developing lasting change. They spoke of the value of encouraging others proactively and finding allies. Participants spoke of the value of meaningful change, as well as a growing understanding of why change was difficult, particularly, perhaps, in an organisation such as the NHS.\u003c/p\u003e\u003cp\u003eAn often-overlooked aspect of leadership development is an understanding of organisational structures (24). Participants in the GPC Hub both engaged in and observed leadership in action. Involvement within the GPC Hub enabled the development of contact networks, improving confidence in developing new contacts underpinned by an increased understanding of the workings of the NHS and their Trust. In observing decision-making, attending meetings, spear-heading projects and interacting with others outside of a purely clinical role, participants were able to peep behind the curtain. They could see, for example, the way in which people they may have viewed as powerful were constrained within a system, as well as the informal ways of gaining influence through diplomacy and persistence.\u003c/p\u003e\u003cp\u003eUnderstanding organisational structures is important when we consider evidence that increased involvement of doctors within senior management positions is statistically associated with improved performance (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The inherent structure of the GPC Hub mirrors departmental governance structure in order to promote understanding of how such a structure works. Through this familiarisation, participants have been able to break down the traditional silos that often separate resident doctors from management structures, enabling residents to \u0026lsquo;better understand how things happen\u0026rsquo; and appreciate the work involved in making impactful change.\u003c/p\u003e\u003cp\u003eThe programme has not come without barriers. Participants discussed the difficulties in balancing their roles within the Hub with their clinical roles as resident doctors. This is not an isolated experience: residents throughout training are constantly attempting to balance service provision and training opportunities (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), and clinical skill and \u0026lsquo;softer\u0026rsquo; skill acquisition. One of the main barriers to engagement in leadership development is a lack of time and resources (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Leadership is a nebulous concept without the immediacy of clinical skill procurement. Rewards are longer term, often with weak incentives (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Many of the participants felt this strain on their time. The incursion of GPC Hub activity into resident\u0026rsquo;s personal time is cause for concern, especially given high rates of burnout reported by UK Anaesthesia residents (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Encouragingly, system wide changes such as the introduction of Educational Development Time (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), which is paid time away from clinical work, were identified by participants as helpful in addressing this balance.\u003c/p\u003e\u003cp\u003eThe tension and strength of the GPC Hub is that it provides both opportunity and challenges. The opportunities, as set out here, are great and participants were clear that they had gained a great deal. Yet this came with costs, in terms of time pressure and difficulty in striking a balance with both clinical and personal time. While the two do not necessarily sit comfortably together it is helpful to acknowledge the pressures on participants. The challenge will be to balance this tension without losing the strength of the programme.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eImplementation of the Generic Professional Capabilities framework in UK postgraduate curricula has been a catalyst for change, drawing non-clinical skill acquisition from the periphery into the core of training programme delivery. Using an apprenticeship model, the GPC Hub enables and legitimises resident doctors\u0026rsquo; leadership development through roles and projects undertaken in the workplace. Resident doctors in GPC Hub leadership roles gain both transactional and transformational leadership experience, which enhances their understanding of the system, enabling personal and professional development while expanding and diversifying professional networks. The GPC Hub educational framework is applicable to other postgraduate training contexts and should be considered alongside traditional approaches to leadership training, whose focus and delivery is often parallel to clinical training. While this research suggests potential advantages of a more integrated model, we must exercise some caution that the wealth of opportunities that the GPC Hub affords do not become overwhelming, placing still greater strain on the delicate balance that residents must strike between both clinical and generic professional learning, and their own personal lives. More broadly, our findings reflect the challenges and tensions inherent in training the medical workforce to perform and thrive across the multiplicity of their professional roles.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthics clearance was granted by King\u0026rsquo;s College London (Ethical Clearance Reference Number: MRA-23/24-40406).\u003c/p\u003e\n\u003cp\u003eInformed consent for participation was gained from all participants in the study through a written consent form and all participants received an information sheet about the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research was in compliance with the Helsinki Declaration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInterview questions, interview transcripts and coding documentation available on request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this research.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026rsquo; contributions:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHH co-designed the interview questions, conducted interviews with participants, transcribed and coded the transcripts and performed thematic analysis, and co-wrote the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJL had the original idea for the project, co-designed the interview questions, had an overview of thematic analysis and co-wrote the manuscript.\u003c/p\u003e\n\u003cp\u003eAJ co-designed the project and interview questions, assisted with interviews with participants, co-performed the thematic analysis and co-wrote the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the time and contributions of the resident doctors who took part in this study, the departments of Anaesthesia in South-East London for supporting the Generic Professional Capabilities Hub initiative and Professor Gabe Reedy for his valuable notes on this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical trial number:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGeneral Medical Council. Generic Professional Capabilities Framework. GMC Manchester; 2017. \u003c/li\u003e\n\u003cli\u003eAggarwal R, Swanwick T. Clinical leadership development in postgraduate medical education and training: policy, strategy, and delivery in the UK National Health Service. J Healthc Leadersh. 2015 Nov 17;7:109\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eLyons O, George R, Galante JR, Mafi A, Fordwoh T, Frich J, et al. Evidence-based medical leadership development: a systematic review. BMJ Lead [Internet]. 2021 [cited 2025 Aug 10];5(3). Available from: https://ora.ox.ac.uk/objects/uuid:ed5ff28e-510d-4186-ba8c-9e194d4c1cc8\u003c/li\u003e\n\u003cli\u003eLave J. Situating learning in communities of practice. In: Perspectives on socially shared cognition. Washington, DC, US: American Psychological Association; 1991. p. 63\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eMillar KR, James C, Headon H, Afzal A, Lipton J, Armit K, et al. Generic professional capabilities hub: developing leadership and management skills in trainees. BMJ Lead [Internet]. 2024 June 1 [cited 2025 Aug 10];8(2). Available from: https://bmjleader.bmj.com/content/8/2/171\u003c/li\u003e\n\u003cli\u003eRoyal College of Anaesthetists. 2021 Curriculum for a CCT in Anaesthetics [Internet]. 2021. Available from: https://www.rcoa.ac.uk/sites/default/files/documents/2025-05/2021%20Curriculum%20for%20a%20CCT%20in%20Anaesthetics%20v1.4_0.pdf\u003c/li\u003e\n\u003cli\u003eHeidegger M. The Basic Problems of Phenomenology, Revised Edition. Indiana University Press; 1988. 436 p. \u003c/li\u003e\n\u003cli\u003eHusserl E. Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy. First Book Gen Introd Pure Phenomenol. 1982; \u003c/li\u003e\n\u003cli\u003eSmith JA, Flower P, Larkin M. Interpretative Phenomenological Analysis: Theory, Method and Research. 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Nova Science Publshers; 2024 [cited 2025 Aug 10]. p. 139\u0026ndash;55. (Education in a Competitive and Globalizing World). Available from: http://www.scopus.com/inward/record.url?scp=85196951269\u0026amp;partnerID=8YFLogxK\u003c/li\u003e\n\u003cli\u003eVeronesi G, Kirkpatrick I, Altanlar A. Clinical Leadership and the Changing Governance of Public Hospitals: Implications for Patient Experience. Public Adm. 2015;93(4):1031\u0026ndash;48. \u003c/li\u003e\n\u003cli\u003eSwanwick T, McKimm J. Faculty Development for Leadership and Management. In: Steinert Y, editor. Faculty Development in the Health Professions: A Focus on Research and Practice [Internet]. Dordrecht: Springer Netherlands; 2014 [cited 2025 Aug 10]. p. 53\u0026ndash;78. Available from: https://doi.org/10.1007/978-94-007-7612-8_3\u003c/li\u003e\n\u003cli\u003eNHS England Digital [Internet]. [cited 2025 Aug 10]. NHS Workforce Statistics - September 2024 (Including selected provisional statistics for October 2024). Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/september-2024\u003c/li\u003e\n\u003cli\u003eGilbert A, Hockey P, Vaithianathan R, Curzen N, Lees P. Perceptions of junior doctors in the NHS about their training: results of a regional questionnaire. BMJ Qual Saf. 2012 Mar 1;21(3):234\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eKeogh B, McCay SL. A junior doctor\u0026rsquo;s guide to the NHS. Foreword Br Med J Group Lond. 2009;28. \u003c/li\u003e\n\u003cli\u003eBrown B, Ahmed-Little Y, Stanton E. Why we cannot afford not to engage junior doctors in NHS leadership. J R Soc Med. 2012 Mar 1;105(3):105\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eBolden R. Distributed Leadership in Organizations: A Review of Theory and Research. Int J Manag Rev. 2011;13(3):251\u0026ndash;69. \u003c/li\u003e\n\u003cli\u003eBolden R. What is Leadership? [Internet]. Centre for Leadership Studies, University of Exeter; 2004 July [cited 2025 Aug 10]. Available from: https://ore.exeter.ac.uk/repository/handle/10036/17493\u003c/li\u003e\n\u003cli\u003eGabel S. Transformational Leadership and Healthcare. Med Sci Educ. 2013 Mar 1;23(1):55\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eBhardwaj A. Organizational Culture and Effective Leadership in Academic Medical Institutions. J Healthc Leadersh. 2022 Mar 10;14:25\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eSwanwick T. Postgraduate medical education: the same, but different. Postgrad Med J. 2015 Apr 1;91(1074):179\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eMountford J, Webb C. When clinicians lead: the McKinsey Quarterly. Healthc Leadersh Rev. 2009 May 1;28(5):1\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eRoyal College of Anaesthetists. A report on the welfare, morale and experiences of anaesthetists in training: the need to listen. 2017. \u003c/li\u003e\n\u003cli\u003eRoyal College of Anaesthetists. Guidance for Educational Development Time | The Royal College of Anaesthetists [Internet]. 2021 [cited 2025 Aug 10]. Available from: https://www.rcoa.ac.uk/training-careers/training-hub/2021-curriculum/guidance-educational-development-time\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"leadership, professional skill development, experiential learning","lastPublishedDoi":"10.21203/rs.3.rs-7591986/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7591986/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eLeadership development is a recognised priority for the postgraduate medical curricula in the UK. However, unlike technical clinical skills, leadership skills are challenging to define, impart and assess because they are highly contextual and relational. While there have been a range of approaches to leadership development, these have had mixed success. This paper explores a new approach to leadership development for resident doctors, the GPC Hub. This approach follows an apprenticeship model, enabling junior doctors to take on real leadership in a safe and low stakes setting.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study utilises a phenomenographic approach which focuses on the lived experience of resident doctors who participated in the GPC Hub. The study focuses on how participants responded to their experience with the GPC Hub, how they made meaning of their experience, what they learned how they responded to both the gains and challenges of their involvement. The study is based on in depth interviews with 10 participants. Analysis was thematic and based on a process of initial inductive code generation, theme identification, review and revision, definition, and finalisation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe study found that participants gained a great deal from involvement in the GPC Hub. It found that involvement offered them opportunities for collaboration, access, insight and legitimised involvement in real leadership and a scaffolded approach to more senior roles. They were able to contribute in authentic and meaningful ways. Participants developed skills in communication, organisation, collaboration and diplomacy. Yet this involvement was not without challenges, primarily the difficulty in balancing their clinical skill development and personal lives with the time required.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe study concludes that the GPC Hub offers an approach to leadership development that can be utilised across a range of settings. Through an apprenticeship approach it provided legitimated access to engagement with real leadership practice through observation of and enactment of organisational structures and relationships and the challenges of negotiation, collaboration, engagement and delivery.\u003c/p\u003e","manuscriptTitle":"Building a ramp into leadership: Exploring resident doctors’ experiences of a workplace embedded leadership intervention","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-06 09:37:41","doi":"10.21203/rs.3.rs-7591986/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-10T00:26:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"200328760185329293239244022856593850694","date":"2025-10-30T11:32:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-27T10:29:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-23T09:53:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-01T07:23:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-30T19:16:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-09-30T18:10:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"32714faf-0345-41a1-b59f-02362aa1eb05","owner":[],"postedDate":"November 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-06T09:37:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-06 09:37:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7591986","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7591986","identity":"rs-7591986","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}