Alec Martschenko, PharmD
As
anyone who has embarked on an educational journey can attest, not everyone
reaches the same level of educational achievement at the same time. Even within
the same class or the same cohort, an educator may find that his or her
students are at vastly different stages of their educational journey. At this
point in the 21st Century, it is well known that trying to apply a
one-size-fits-all method to education will invariably lead to the exclusion of a
subset of learners. Those who struggle and are left behind or those who excel and
feel unchallenged—or both—will not have their needs met by such a strategy.
Situational leadership is a framework
that aims to identify a followers readiness level and provide leadership
strategies most applicable to that particular stage in development. While
originally developed for and most commonly used in corporate settings, situational
leadership has generalizable applicability outside of executive board rooms and
managerial development retreats. In particular, situational leadership can be
applied to the experiential education of healthcare professional students.
While the basics of situational leadership
theory are explained below, the interested reader is encouraged to consult the
references for further information.1,2 In brief, situational
leadership ranks a follower (or student) on two broad categories: task
readiness and psychological readiness. Task readiness refers to a student’s
ability to perform a task, for example, a pharmacy student’s ability to recall
important drug information or a nursing student’s ability to start an IV in a
patient. Psychological readiness, on the other hand, refers to a student’s
willingness to perform a task, including the desire, motivation, energy, and
confidence to do so. For example, a medical student may know that a patient
with asymptomatic bacteriuria does not always require antibiotics but may lack
the confidence to contradict his or her attending physician in saying so. On
the flip side, a learner can be psychologically ready, but not task ready—think
of a pharmacy technician happy to work in the IV lab, but unaware that he or
she does not know the difference in technique required between vertical and
horizontal laminar flow hoods.
In the attached visualization, an altogether
unready learner falls under D1, a psychologically ready but task unready
learner falls under D2, a task ready but psychologically unready learner falls
under D3, and a psychologically and task ready learner falls under D4.
Variations in the model exist, and each individual learner is unique. Some may
skip steps or regress at times, so it is important to continually assess where
a learner is on the continuum to tailor their educational experience. More
important, however, is knowing how to adapt your educational methods.
The method most appropriate for learners in
the first domain (psychologically and task unready) is often described as directing.
It often involves step-by-step directions, close supervision, and a certain
level of coercion. For example, a pharmacy student may be tasked with making an
intervention with a provider and receive direction on how best to phrase the
recommendation.
For learners in the second domain (psychologically
ready, but task unready), coaching is the preferred leadership style.
This involves a high level of directive behavior and psychologically supportive
behavior. A highly motivated student may best learn by doing but would require
close supervision as he or she as of yet lacks the skills necessary to do so
independently.
The third domain (task ready, but psychologically
unready) requires a supporting teaching strategy. While a student may
possess the skills to perform a task, they may require supportive confirmation
that their knowledge is correct before building up the confidence to follow
through on that assignment.
Finally, learners in the fourth domain (task
ready and psychologically ready) can best be managed by a delegating
approach. Students can be trusted to perform tasks accurately and have the
motivation and confidence to do so independently. A senior resident, for
example, would be able to trust the assessment of an intern in this domain
before examining the patient independently.
The terms used above may vary, but the
principles remain the same. By performing continual assessments of a learner’s
willingness and capabilities, their education can be individualized and adapted
to best meet their needs. However, caution must be made to acknowledge the limitations
and pitfalls of the situational leadership model. There are certainly more than
four types of learners, and an educator must realize that students can fall
under different domains in different circumstances. A more granular approach,
taking into account a student’s area of strength or weakness, could more
appropriately address these variances.
It should also be noted that, while
situational leadership has been used in various aspects of healthcare delivery,
real outcomes data on its efficacy are sparse and unconvincing.3,4 It
would be a mistake to take situational leadership, or any teaching philosophy,
as an immutable gospel that cannot be deviated from. Rather, a wise educator
and leader should study this theory and incorporate it into their vast armament
of didactic strategies, wielding it only when it suits the situation at hand. In
combination with other teaching strategies, situational leadership can be a
powerful tool to make healthcare learning more adaptable, specific, and
successful.
References:
1. de Bruin L. Hersey and Blanchard Situational Leadership Model explained: B2U. Business-to-you. https://www.business-to-you.com/hersey-blanchard-situational-leadership-model/. Published March 28, 2020. Accessed August 28, 2022.2. Hersey P, Angelini AL, Carakushansky S. The Impact of Situational Leadership and Classroom Structure on Learning Effectiveness. Group & Organization Studies. 1982;7(2):216-224. doi:10.1177/105960118200700209
3. Johansen, B.-C. P. (1990). Situational leadership: A review of the research. Human Resource Development Quarterly, 1(1), 73–85.doi:10.1002/hrdq.3920010109
4. Walls, Elaine (2019) The Value of Situational Leadership. Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association, 92 (2). pp. 31- 33. ISSN 1462-2815
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