Drawing on Experience: Using Rich Pictures to explore Health Professions Education Leadership

Background
Health professions education (HPE) leadership is advocated as necessary to promote success at the individual, team, and institutional level. Whilst many leadership models exist, they are based mainly on Western perspectives. Simultaneously, however, it is suggested that leadership is influenced by the culture and context in which it is practiced. Furthermore, faculty development seeking to enhance leadership capabilities often lacks clear foundations in theoretical frameworks. Moreover, most studies exploring HPE leader identity in order to develop substantive theory have relied on interviews only. In the Pacific, HPE is emerging and HPE leaders require support and development that is theoretically based in this culture and context. Therefore, this research aimed to address this deficit by developing theory using Rich Pictures and interviews to investigate HPE leadership in the Pacific context to guide faculty development and add a fresh perspective to the international literature.
Methods
This research used an interpretivist methodology. Seven HPE leaders were recruited through purposeful sampling following ethics approval. The Rich Picture method was piloted and instructions developed. Rich Pictures are recommended to investigate a phenomenon’s social, emotional, and cultural aspects as they cause a ‘disruption in thinking’ and allow tacit perspectives to be explored. Accordingly, participants were requested to draw a picture on ‘Being an HPE leader’, which was followed by a Zoom interview to expand on the participants perspectives about their picture and being an HPE leader. Each interview was transcribed verbatim and analysed using Miles and Huberman’s approach. The codes and themes generated were further conceptualised into three types of leaders. Composite narratives were written for each leadership type identified and were checked for accuracy by the participants.
Results
Three leadership types were identified based on the Rich Picture and interview interpretation. Metaphors were assigned to each leadership type, namely, the ‘Bridge’, ‘Coconut Tree’ and ‘Drua Canoe’ of HPE leadership. All participant leaders have the common aim of developing competent and compassionate graduates, however, their other aims, strategies, and attributes differ.
The ‘Bridge’ aims to develop competent and compassionate graduates who will improve healthcare at the patient and community level. The ‘Bridge’ achieves this by assisting students cross from the novice to the competent field by sharing knowledge and skills, scaffolding learning, and role modelling good practice. These leaders are passionate and motivated with a strong sense of responsibility. The ‘Coconut Tree’ leader recognises their multiple roles of being an HPE leader and aims to develop the curriculum along with their faculty, enabling them to educate graduates focused on improving patient outcomes. These leaders achieve this through cultivating relationships and collaborations, nurturing peers’ educational skills, and actively searching for solutions to challenges. They are sturdy, committed, and always seeking to improve themselves whilst being adaptable; bending with the winds of change. The ‘Drua Canoe’ leader aims to steer the institution towards the common vision through succession planning, accreditation, and seeking external assistance. They are innovative, fair, and committed to the cause whilst keeping steady in the storm.
Discussion
Rich Pictures afforded the participants time and space to reflect on ‘Being an HPE Leader’. The Rich Pictures and subsequent interviews revealed tacit reflections that the participants stated they would not have disclosed in an interview alone. Furthermore, the metaphors of the ‘Bridge’, ‘Coconut Tree’ and ‘Drua Canoe’ are culturally significant in the Pacific by, respectively, enabling people to travel to new places, providing nutrition and shelter, and allowing navigation to distant horizons. Thus, the interpretation of the data was aligned with the participants’ perspectives about HPE leadership in the Pacific context, allowing HPE leadership to be viewed through a different lens.
Leadership in HPE is often viewed as a single phenomenon, but this study suggests that in the Pacific culture and context, there may be several types of leadership depending on the aims, strategies, and attributes of different HPE leaders. However, as this research was set in the Pacific the ‘Bridge, Coconut Tree and Drua Canoe’ may not be applicable to other HPE leadership contexts. Nevertheless, some aspects may resonate and Rich Pictures with interviews could be considered to expand current understandings of HPE leadership in other cultural contexts.
Conclusion
The main take-home messages from this research are that first, Rich Pictures constitutes an effective method to explore perspectives on complex phenomena such as HPE leadership. Rich Pictures allow participants to disrupt their thinking and reveal tacit thoughts and therefore should be considered for use in research and educational contexts. Second, the three types of leader identified in this research provide a theoretical framework to guide culturally relevant faculty development in Pacific HPE leadership and to assist faculty find fulfilling positions based on their aims, strategies and attributes. Finally, the Bridge, Coconut Tree and Drua Canoe provide a different perspective in the HPE leadership arena and may enable others to view leadership through a different lens in their own cultural context.