Singh P K, Singh S, Ahmad S, Singh V K, Kumar R
Department of Surgery, All India Institute of Medical Sciences, Patna, Bihar, India.
Department of Medical Education, All India Institute of Medical Sciences, Patna, Bihar, India.
J Postgrad Med. 2025 Apr 1;71(2):82-90. doi: 10.4103/jpgm.jpgm_728_24. Epub 2025 Jun 9.
Power dynamics in medical education, driven by leadership roles, significantly influence patient care, learning, research, and institutional growth. Hierarchies provide essential structure and mentorship, but can also suppress communication and ethical behaviour through intimidation and exclusion. This duality underscores the importance of addressing hierarchical dynamics in academic medicine. This narrative review evaluates the impact of hierarchical dynamics on faculty experiences, focusing on both positive and negative leadership behaviours. A comprehensive literature search was conducted across PubMed, Google Scholar, and ScienceDirect using terms such as "power dynamics," "hierarchical structures," and "faculty development." Articles published within the last 20 years were prioritised, with studies selected based on their empirical contribution and relevance to medical education. A thematic synthesis approach was used to identify key themes and strategies for fostering a supportive and inclusive academic culture. Hierarchies in medical education can positively influence faculty by offering structure, mentorship, and clear role expectations, which are critical for professional development. However, pervasive negative behaviours, including micromanagement, favouritism, and exclusion, were identified as major contributors to stress, burnout, and hindered professional growth among junior faculty and colleagues. Hierarchical dynamics are pivotal in shaping faculty experiences in medical education. Mitigating the adverse impacts of power imbalances requires regular behavioural audits, leadership training, and robust mentorship programs. These initiatives can foster an inclusive academic culture that prioritises open communication and equitable professional development. Future research should develop and evaluate targeted interventions to address power imbalances and improve institutional culture.
由领导角色驱动的医学教育中的权力动态，对患者护理、学习、研究和机构发展有着重大影响。层级制度提供了必要的结构和指导，但也可能通过恐吓和排斥来抑制沟通和道德行为。这种双重性凸显了在学术医学中应对层级动态的重要性。这篇叙述性综述评估了层级动态对教师经历的影响，重点关注积极和消极的领导行为。通过在PubMed、谷歌学术和科学Direct上使用“权力动态”“层级结构”和“教师发展”等术语进行了全面的文献检索。优先考虑过去20年内发表的文章，根据其实证贡献和与医学教育的相关性来选择研究。采用主题综合方法来确定关键主题和促进支持性和包容性学术文化的策略。医学教育中的层级制度可以通过提供结构、指导和明确的角色期望对教师产生积极影响，这对职业发展至关重要。然而，普遍存在的负面行为，包括微观管理、偏袒和排斥，被确定为导致初级教师和同事压力、倦怠和职业发展受阻的主要因素。层级动态在塑造医学教育中教师的经历方面起着关键作用。减轻权力不平衡的不利影响需要定期进行行为审计、领导力培训和强大的指导计划。这些举措可以促进一种包容性的学术文化，这种文化优先考虑开放沟通和公平的职业发展。未来的研究应该开发和评估有针对性的干预措施，以解决权力不平衡问题并改善机构文化。
