From Personal Readiness to Systems Change: Progressive Clinician Cross-Competency Development in the Robert Wood...

Clinicians are essential to transforming community health; however, traditional medical training does not provide needed multilevel, sequential, and equity-based leadership skills. The Robert Wood Johnson Foundation (RWJF) Clinical Scholars (CS) program was designed to fill this gap through interdisciplinary and applied competency training alongside an intensive community-based project. However, how clinicians operationalize and implement these competencies temporally and in their own terms has yet to be documented.

We conducted a qualitative, retrospective deductive content analysis of 1561 self-described competency entries by 130 clinicians in the CS program from 2016 to 2023. Participants bi-monthly recorded their application of one of 23 leadership self-reported competencies within their community project using STAR (Situation, Task, Actions, and Results), an accepted, structured response format. We also coded cross-competency co-occurrence and project context across personal, interpersonal, organizational, and community/system-level domains to demonstrate individual-level change preceding broader systemic transformation.

Hospital- and clinic-level initiatives made up the largest share of the projects (41.98%). "Communication" was the most coded competency (72.7%) and commonly co-occurred with collaboration, emotional intelligence, and self-awareness competencies. Competencies with the highest cross-domain co-occurrence-innovation, negotiation, social determinants of health, visioning, and advocacy-were distinct from the most prevalent competencies. Certain competencies appear in bundles alongside domain progression such as innovation emerging as a top co-occurring code only for organizational (8.69%) and systems-level (7.83%) domain entries.

The CS program provided clinicians with the opportunity to reflect on and apply equity-centered leadership competencies. The divergence in competencies that were most "prevalent" versus "co-occurring" indicates the complexity of equity-oriented projects that require different, yet integrated bundling of skills. Differences in the prevalence of competencies by domain indicate a need for progressively structured competency development, focusing on personal readiness as a precedent to organizational and community impact. Prioritizing equity-based leadership that acknowledges these bundles and sequenced development is required to address urgent, recalcitrant, and modern healthcare challenges.