During the pandemic, Early Career Professionals (ECPs) worked on the frontline, navigating high-pressure, resource-limited environments to deliver patient-centred care (1). For many, this involved stepping into unexpected leadership roles to make critical decisions, coordinate teams, and support colleagues to deliver quality care. This demonstrates that leadership can emerge at all levels of the workforce. As healthcare systems continue to face complex challenges, there is a need to shift from rigid hierarchical structures to a more collective approach that promotes shared decision-making across all levels (2,3).

Nurturing leadership in ECPs benefits not only their teams, but entire organisations. While working in a short-staffed Nigerian hospital during the pandemic, I collaborated with fellow ECPs to develop a Standard Operating Procedure (SOP) that helped frontline staff provide safer, more structured care. The support from established senior leaders, both managerial and clinical, was critical to the conceptualisation and implementation of our initiative. This showed that ECPs, when supported, can provide practical insights into complex problems.

By drawing on their diverse backgrounds and personal experiences, ECPs can contribute new ways of thinking to support teams and improve training environments for colleagues (4). In my Trust, a group of us designed a simulation workshop to help newly inducted foundation year one doctors develop essential skills such as prioritisation and communication. We also created a foundation doctor buddy scheme to support newly qualified doctors during their transition, while enabling second-year foundation doctors to cultivate their leadership skills. These initiatives grew from reflecting on our personal experiences and recognising their potential to drive improvement at both individual and system levels, while fostering leadership skills among junior staff.

Challenges to Early Career Leadership Development

Tackling large-scale complex problems requires not just experience but a nuanced understanding of how systems work, their interdependencies, and the different stakeholders involved (5,6). Early career professionals may first require an understanding of broader contexts, supplemented by work-based leadership development opportunities (6).

Emerging leaders are also at different stages in their careers, building clinical skills. While early involvement in leadership roles is beneficial, it can become overwhelming as many ECPs are still learning to manage clinical responsibilities effectively, often under senior support (7).

These individual and system-level challenges are further exacerbated by organisational cultures, particularly those operating hierarchical leadership (3). In such environments, decisions are made by a select few, leaving others as ‘compelled followers,’ which can breed negative values such as bullying, discrimination, and linear thinking (8). They also lack the psychological safety needed for ECP leaders to exchange ideas, implement, and refine their leadership skills (3).

While ECPs face many challenges in growing as leaders, overcoming these barriers begins with creating systems that identify, support, and develop emerging leaders. (5,12)

Spotting and Nurturing Emerging Leaders

A crucial step in supporting emerging leaders is being able to identify them. Within teams, experienced leaders should put structures in place, whether formal or informal, to support spotting emerging leaders (9). Tools, such as the NHS Leadership Academy’s Talent Management Conversation Tool, help leaders assess their staff’s performance relative to their potential and determine the appropriate support (10).

It is also key that senior leaders provide ECPs access to development opportunities that they may require senior support to obtain or be unaware of (11,12).

Mentorship as a Bridge to Leadership Growth

Mentorship plays a key role in nurturing emerging leaders, strengthening systems, and improving succession planning (13). Mentees are imparted with knowledge and values from experienced leaders, which improves their confidence, work performance, and leadership abilities (13). Similarly, mentors leverage the opportunity to refine skills such as communication and active listening. Innovative mentorship models, such as reverse mentoring, allow mentors to learn from their mentees’ perspectives and experiences (14).

Accessing mentorship opportunities can be challenging. Common barriers include limited opportunities, a lack of formal structures to facilitate mentoring, and capacity constraints among senior staff (15). Similar to my experience, new or internationally trained doctors may find it difficult to identify or connect with potential mentors due to limited networks or unfamiliarity with the organisational culture. This underscores the need for structured and accessible pathways, ensuring that emerging leaders receive the required support (15).

Building Leadership Through Experience and Structured Programmes

Leadership, like any skill, must be cultivated. In my team, our leaders adopt a collective leadership approach, where all voices are heard, allowing us to contribute to quality improvement projects and team decisions. Engaging in such activities helps ECPs build confidence, sharpen judgment, and broaden perspectives on innovation (16,17).

Structured leadership programmes, such as those delivered by the NHS Leadership Academy and the Faculty of Medical Leadership and Management, as well as locally developed initiatives, equip ECPs with the skills and tools needed to succeed as healthcare leaders(11,12).

In conclusion, we choose careers in healthcare driven by a passion to help and improve patient care. As ‘hidden leaders,’ we are already stepping up on the frontline. But to maximise our impact, we need to be spotted, guided, and supported.

To my fellow ECPs: Do not wait for the title of ‘leader.’ When you see a problem, build the solution, just as we did with the buddy scheme, and believe in your ability to lead meaningful change.

To senior leaders: Look for the ECPs who are already solving problems. Provide mentorship that helps us translate frontline experience into broader system understanding and create structured pathways to make leadership opportunities accessible. By investing in us, health systems aren’t just cultivating a future workforce, they are unlocking the leaders who already exist.

References

1. Koontalay, A., Suksatan, W., Prabsangob, K., & Sadang, J. M. (2021). Healthcare Workers’ Burdens During the COVID-19 Pandemic: A Qualitative Systematic Review. Journal of Multidisciplinary Healthcare, 14, 3015–3025. https://doi.org/10.2147/JMDH.S330041
2. Department of Health & Social Care. Road to recovery: the government’s 2025 mandate to NHS England [Internet]. London: GOV.UK; 2025 Jan 30. Available from: https://www.gov.uk/government/publications/road-to-recovery-the-governments-2025-mandate-to-nhs-england/road-to-recovery-the-governments-2025-mandate-to-nhs-england
3. NHS Leadership Academy. The Leadership Framework [Internet]. Coventry (UK): NHS Institute for Innovation and Improvement; 2011. Available from: https://www.leadershipacademy.nhs.uk/wp-content/uploads/2014/11/Leadership-Framework.pdf
4. NHS England. Science in healthcare: Delivering the NHS Long Term Plan – The Chief Scientific Officer’s strategy [Internet]. London: NHS England; 2020 Mar 10. Available from: https://www.england.nhs.uk/wp-content/uploads/2020/03/science-in-healthcare-delivering-the-nhs-long-term-plan.pdf
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13. Burgess A, van Diggele C, Mellis C. Mentorship in the Health professions: a Review. The Clinical Teacher [Internet]. 2018;15(3):197–202. Available from: https://pubmed.ncbi.nlm.nih.gov/29318730/
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Author

Alessandra Ucheoma

Alessandra Ucheoma is a Medical Education Fellow at Southern Health and Social Care Trust, involved in the delivery of undergraduate and postgraduate education using different teaching approaches, including simulation-based learning. She holds a Postgraduate Certificate in Clinical Education and is completing a Postgraduate Diploma. She has contributed to quality improvement projects in medical education and supports resident doctors to develop their leadership and teaching skills. She also volunteers with the Aspiring Leaders in Healthcare Network (ALIHN) and Doctors’ Training.

Declaration of Interests

No conflicts of interest to disclose.

Aspiring Leaders in Healthcare

Aspiring Leaders in Healthcare Network aims to foster a multiprofessional community of practice, united by the common goal of nurturing future healthcare leaders across the globe. Our regular online meetings, social media communities and conference huddles connect members to a wider network passionate about leading positive change and improvement in healthcare. 

In this blog series, we showcase our member’s diverse experience of leading with impact at the earliest stages of their careers to empower and inspire the BMJ Leader Blog readership.