Clinical leadership for interns and new doctors
Table of contents
First shift as a newly graduated doctor. The patient in bed 4 gets worse, the nurse asks what to do, the technician waits for the prescription, the family wants news and the most senior resident is in the operating room. Nobody named you leader of anything, but in that moment the team looks in your direction. Clinical leadership starts like this: less as a title and more as a responsibility that appears suddenly.
NEXO is a daily medical diagnosis game: one clinical case a day, six progressive clues, and ICD-10 proximity feedback across five levels.
Medical school teaches you to diagnose and to treat, and usually says little about how to organize people around a patient. This guide shows what the studies say about leadership in medical training, why knowing how to follow well is part of the same subject, and how interns and newly graduated doctors can lead without a title, organize the shift and learn from every situation.
Key points
- Students recognize the need to learn leadership, but the topic has little space in curricula.
- Leadership programs in undergraduate training show positive results, almost always measured by the participants' own perception.
- For every article about followers in the medical literature, there are about 60 about leaders.
- Engaged and critical followers are associated with more satisfaction and less burnout at work.
- Teams that know each other work better together, and that is also the job of whoever leads.
What clinical leadership is
A practical definition
Clinical leadership is the ability to guide a team toward the best possible care for the patient. It includes deciding, but also communicating the decision, distributing tasks, listening to those who see what you did not see and correcting course when something changes. It happens at the bedside, in an emergency room or at the shift handover, long before any management position.
Leadership and management
Management takes care of schedules, resources and processes. Leadership takes care of people and direction. The two mix, and curricula usually teach them together, but for the intern and the newly graduated doctor what appears first is day-to-day leadership: who does what, in what order and why.
Three levels of competence
A scoping review on leadership and management competencies in undergraduate medical training analyzed 16 publications and organized the competencies into three groups: personal, interpersonal and organizational (Alhadithi and Almansour, 2025). The curricula used mostly interactive and hands-on methods, such as simulation and projects, but organizational competencies, such as systems thinking and strategy, still appeared little (Alhadithi and Almansour, 2025).
For the intern, the personal level is the starting point: knowing your own reactions under pressure, organizing your own work and asking for help at the right time. The interpersonal level comes right after, in daily contact with the team.
What the studies show
Students want to learn
A systematic review of 26 studies on medical students' attitudes toward leadership and management found positive attitudes toward clinical guidelines, quality improvement and multiprofessional teamwork (Abbas et al., 2011). Students recognized the need to learn leadership and management, and pointed to lack of time in the curriculum and disinterest in some activities as barriers (Abbas et al., 2011).
Do the programs work?
A systematic review of leadership programs for medical students included 11 studies, very different from each other in duration and content (Lyons et al., 2018). The results were generally positive, but most evaluations used questionnaires before and after, and few studies measured effects on the health system or on patients (Lyons et al., 2018). Even short interventions showed an effect perceived by participants (Lyons et al., 2018).
A review of programs in the United Kingdom reached a similar conclusion: students gained understanding of leadership and practiced skills, but long-term effectiveness in preparing newly graduated doctors could not be determined (Hemmati and Harris, 2023). The same review notes that newly graduated doctors often arrive unprepared for the leadership responsibilities of clinical practice (Hemmati and Harris, 2023).
What remains from these reviews
The evidence supports that it is worth teaching and practicing leadership from undergraduate training onward, and it shows that we still know little about the lasting effect of these programs. For the student, the practical consequence is simple: leadership is learned above all through reflected practice, and the internship is the place to start.
Knowing how to follow is also leading
The forgotten side
A review on the role of follower in health care found one article about followers for every 60 articles about leadership in the medical literature (Leung et al., 2018). The 14 observational studies included suggest that followers with active engagement and independent critical thinking are associated with more job satisfaction, less burnout and better performance (Leung et al., 2018).
What residents report
In a study with physicians in training in the United Kingdom, researchers analyzed 171 personal accounts about leadership and followership (Gordon et al., 2015). Participants narrated experiences in the follower position more often, and the accounts showed that medical and interprofessional hierarchies remain strong and that the system itself can hinder shared leadership (Gordon et al., 2015).
The good follower
Being a good follower means participating actively: bringing useful information, raising a doubt with respect, carefully carrying out what was agreed and speaking up when something is not going as expected. The intern spends most of the time in this position, and it is in it that they learn to recognize a good leader and to prepare to be one.
When to disagree
Disagreeing with whoever is leading the case is part of safe care. Do it with data and at the right moment: "Doctor, the blood pressure dropped again ten minutes ago; is it worth reassessing before we continue?" The objective question, with the data up front, protects the patient and preserves the relationship with the team. In a situation of immediate risk, speak clearly and repeat if needed.
Leading without a title
Knowing the team
A randomized clinical trial in a general medicine service of an American university hospital had some first-year residents always work on the same floor, with the same nursing team (Iyasere et al., 2022). In simulations done after 12 months, the teams with more time together had higher scores in leadership and management, and worked as a single unit in 100% of the simulations, against 62% in the control group (Iyasere et al., 2022). In this group, nursing was also more present in patient visits, in 47% of observations against 28% (Iyasere et al., 2022).
The recent graduate does not always control the schedule, but can do their part: learn the name of those who work with them, call nursing to the visit and ask what they observed during the night. Interprofessional reasoning has its own guide in this series; here it is enough to remember that knowing the team is the basis for leading it.
Clear communication
In tense situations, closed-loop communication prevents errors: the person asking says the person's name and the task, and the person receiving repeats it and says when it is done. "Ana, please collect the blood gas now." "Blood gas now, doctor." It seems too formal until the day two people do the same thing and nobody does the other.
Distributing tasks
Whoever leads does not need to do everything. Say out loud what is happening, what needs to be done and who will do each part. Keep an overview of the case and avoid diving into a procedure while the rest of the team waits for guidance.
Giving and receiving feedback
Leading includes telling a colleague what they did well and what they can improve, and hearing the same about yourself. Do it in private, soon after the fact and with concrete examples: "During the code, your counting out loud helped everyone keep the pace; next time, say something before switching roles." When you receive a comment, thank the person, ask whatever is needed to understand and resist the urge to justify yourself on the spot. Think about it calmly after the shift.
Asking for help
Asking for help early is a leadership decision. Define for yourself, before the shift, the signs that require calling the senior resident or the attending. The fear of seeming insecure is common among recent graduates, and the feeling of not being up to the task has its own guide in this series. The patient gains more from a request for help at the right time than from courage at the wrong time.
The shift as a laboratory
Before you start
Receive the handover calmly, note the patients who need attention and agree with the team on the priorities for the first hours. Ask whether there is anything the nursing staff has already noticed that is not yet in the chart.
During
Review priorities every few hours. When a complication arises, stop, organize the team in a few sentences and only then act. Record decisions clearly for whoever comes next.
After a difficult situation
A short conversation with the team after a complication, even five minutes, helps to understand what worked, what was missing and what to change next time. Start with what went right, move on to what can improve and end with a concrete action.
Learning from those who lead well
Observe the attendings and residents you admire: how they talk to the team, how they decide under pressure, how they acknowledge a mistake. Note what they do. Also observe the opposite and ask yourself what you would do differently.
Taking care of yourself
Leading is tiring. Sleeping, eating and having someone to talk to about the hard shifts protect the doctor and the team that depends on them. Burnout in medical training has its own guide in this series.
Reasoning that supports leadership with NEXO
The team trusts more those who reason clearly. The NEXO case of the day is fictional, with a real clinical presentation, and the diagnosis arrives in up to six clues, with proximity in ICD-10 showing how far each guess was. Practicing reasoning on short cases helps you explain your own hypothesis in a few sentences, a skill every shift demands.
The guide what NEXO is explains the whole game, and the release of the modes is on the NEXO Economy page.
If you coordinate a medical school, a student league or a residency and want cases to train teams, get to know NEXO Closer. Researchers in medical education can propose studies through NEXO Researcher. Doctors who review cases take part through NEXO Curator, and those who create health content on social media can take part through NEXO Creators.
Frequently asked questions
Can an intern be a leader?
They can and often are, in small moments: when organizing the rounds, when communicating a worsening or when distributing tasks during an attendance.
Do leadership programs in undergraduate education work?
The results are generally positive, but measured mainly by the participants' perception (Lyons et al., 2018).
Why talk about followers?
Because engaged and critical followers are associated with more satisfaction and less burnout (Leung et al., 2018).
Does knowing the team make a difference?
In a randomized trial, teams with more time together scored better on leadership in the simulations (Iyasere et al., 2022).
How do you disagree with a superior?
With data, at the right moment and with an objective question. In immediate risk, with clarity and repetition.
When to ask for help?
Early, based on signs you defined before the shift.
Shift checklist
- Receive the handover calmly and note priorities.
- Learn the name of those who work with you.
- Call the nursing staff for the rounds.
- Communicate in a closed loop in tense situations.
- Distribute tasks out loud.
- Define in advance when you will ask for help.
- Talk with the team after a complication.
- Take care of yourself between shifts.
Want to train the reasoning that supports your decisions? Play the case of the day on NEXO.
References
- Alhadithi A, Almansour M. Leadership and management competency frameworks in undergraduate medical education: a scoping review. BMC Med Educ. 2025. https://pubmed.ncbi.nlm.nih.gov/41457205/
- Abbas MR, Quince TA, Wood DF, Benson JA. Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development. BMC Med Educ. 2011. https://pubmed.ncbi.nlm.nih.gov/22082174/
- Lyons O, Su'a B, Locke M, Hill A. A systematic review of leadership training for medical students. N Z Med J. 2018. https://pubmed.ncbi.nlm.nih.gov/29346359/
- Hemmati Z, Harris S. Integrating leadership into the undergraduate medical curriculum in the UK: a systematic review. BMJ Lead. 2023. https://pubmed.ncbi.nlm.nih.gov/37192125/
- Leung C, Lucas A, Brindley P, Anderson S, Park J, Vergis A, et al. Followership: A review of the literature in healthcare and beyond. J Crit Care. 2018. https://pubmed.ncbi.nlm.nih.gov/29779828/
- Gordon LJ, Rees CE, Ker JS, Cleland J. Leadership and followership in the healthcare workplace: exploring medical trainees' experiences through narrative inquiry. BMJ Open. 2015. https://pubmed.ncbi.nlm.nih.gov/26628525/
- Iyasere CA, Wing J, Martel JN, Healy MG, Park YS, Finn KM. Effect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams: A Randomized Clinical Trial. JAMA Intern Med. 2022. https://pubmed.ncbi.nlm.nih.gov/36215043/