Consider a registrar or medical student on a busy hospital ward round. The consultant asks a question to the group. Silence. Even though they think they know the answer, self-doubt and fear of being berated for being wrong in front of colleagues holds them back. When the answer is finally arrived at, they realise that in fact they would have responded correctly but the environment that would have allowed them to risk answering, and in doing so validate their own thinking, was never created. That moment, which is often invisible to the consultant, is where confidence either grows or quietly contracts.

This is not an unusual story. It plays out daily in clinical settings around the world and points to something that medical leadership has not yet fully addressed: not just how we develop clinical reasoning, but how we develop the person doing the reasoning.

Historically, medical leadership has often defaulted to directive or command-and-control approaches. Medicine typically rewards decisiveness, expertise, and rapid action under uncertainty, for example during medical emergencies. In these contexts, directive leadership is crucial: it structures decisions and reduces the mental burden of decision-making.

Outside of these contexts, however, when leaders consistently provide answers, opportunities for articulating reasoning, tolerating uncertainty, and developing ownership are reduced. Over time, teams may become more deferential, voice may diminish, and confidence may develop more slowly. Under pressure, this can create a self-reinforcing cycle in which systems become dependent on the expertise of a few rather than the capability of many.

An Ubuntu-informed perspective reframes this problem. Ubuntu, often expressed as “I am because we are,” is a relational philosophy rooted in sub-Saharan Africa that emphasises interconnectedness, mutual recognition, and shared humanity (Magadlela, 2023). In leadership, however, it extends further. Ubuntu can be understood as an embodied relational intelligence i.e. the capacity to be fully present with another person in a way that affirms their dignity and activates their thinking. This potentially repositions the medical leader as a coach, not as a method for improving individual performance, but as a relational practice expressed through how the leader is present, holds power while inviting reasoning, and engages others to create the conditions for thinking and development. 

Coaching is often described as a conversational approach, but from an Ubuntu perspective, its function is more fundamental. The leader’s role is not to hold and dispense expertise but to create conditions for connection, recognition, and shared thinking.

The medical leader-coach, through an Ubuntu lens, is doing two things at once: firstly, developing clinical reasoning by drawing out a trainee’s thinking before offering direction, and secondly, developing the person doing the reasoning through attention to identity, confidence, and voice. These are not separate tasks, and they are not achieved through technique. They emerge from the quality of the leader’s presence, which shapes whether someone experiences themselves as a participant in thinking or as a subject of evaluation. The first builds clinical capability; the second builds the clinician who will carry it forward.

This distinction becomes particularly relevant in the context of teaching. In medicine, questioning has often taken the form of rapid knowledge-testing under pressure e.g. during bedside teaching. While intended to assess understanding, it may be experienced as evaluative or diminishing, limiting participation and reinforcing self-doubt (Kost & Chen, 2015). A coaching-informed, Ubuntu-centric perspective aims to retain the value of questioning while shifting its purpose i.e. moving from assessment only to the active creation of conditions for thinking. 

While psychological safety reduces the perceived risk of speaking (Edmondson, 1999), Ubuntu affirms that the person speaking is worthy of being heard by actively validating dignity, mutual recognition, and co-created understanding. Where safety asks “Will I be punished for this?”Ubuntu asks “Am I seen as a thinking, contributing human being?”

The leader’s presence is therefore not neutral. It influences whether individuals remain engaged as thinking subjects, or become positioned as performers responding to evaluation.This function remains underutilised in medicine, yet it is central to progression from competence to capability, and from participation to leadership (Fraser & Greenhalgh, 2001). It speaks to how clinicians can become technically proficient yet remain uncertain of their own voice. It focuses on who the individual is becoming, not just what they are doing. In Ubuntu terms, system performance depends on recognising individuals as thinking contributors to the whole (Magadlela, 2023).

Medical leaders operate under sustained pressure, time scarcity, and resource-constrained environments where formal leadership development may be limited (Gazelle et al., 2015). In such contexts, system performance depends on shifting from individual expertise to collective thinking capacity. Coaching-informed leadership, grounded in Ubuntu, does not replace directive leadership, but requires discernment and the capacity to move between directing and enabling thinking.

In practice, this is enacted through subtle changes in clinical exchanges to create space for reflection and ownership without extending time. Inviting a trainee to articulate their reasoning before offering guidance, or briefly exploring what may be influencing a decision, can change the cognitive work taking place. For example, an Ubuntu-informed leader responds differently, and rather than filling the silence or calling on someone, they hold the space: “I am interested in your thinking, not just the correct answer.” At its core, this approach restores dignity by affirming individuals as thinking, contributing members of the system, thereby building self-confidence one interaction at a time.

A practical starting point for medical leaders is simple. In the next interaction during a ward round, pause before giving the answer and ask one question that helps someone think, not just respond. 

References

1. Edmondson AC. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44(2):350–383.
2. Fraser SW, Greenhalgh T. Coping with complexity: educating for capability. BMJ. 2001;323(7316):799–803.
3. Gazelle G, Liebschutz JM, Riess H. Physician burnout: coaching a way out. J Gen Intern Med. 2015;30(4):508–513.
4. Kost A, Chen FM. Socrates was not a pimp: changing the paradigm of questioning in medical education. Acad Med.2015;90(1):20–24.
5. Magadlela D. Ubuntu Coaching and Connection Practices for Leader-Managers. Johannesburg: Knowledge Resources; 2023.

Authors

Nondumiso Makhunga-Stevenson

Nondumiso is Founder and Executive Coach at Ubuntu Doctor Coaching. She specialises in Ubuntu-informed coaching for medical leaders and healthcare systems. 

Dumisani Magadlela

Dumisani is an internationally accredited executive coach, team coach, coach trainer, and leadership development facilitator, and is the originator of Ubuntu Intelligence (UbuQ). He is a Senior Faculty member at The Coaching Centre (TCC) in South Africa and co-founder of the Ubuntu Coaching Foundation. He previously served as Chair of the International Coaching Federation (ICF) Global Board of Directors. 

Declarations of Interest
Both authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Declaration of AI Use
During the preparation of this work, the authors used ChatGPT(OpenAI) and Claude (Anthropic) to support language editing and improve readability. The authors reviewed and edited all AI-assisted content and took full responsibility for the accuracy and integrity of the published work.