EJBO Electronic Journal of Business Ethics and Organization Studies

Vol. 29, No. 1 (2024)

Tomorrow’s Physicians’ Perceptions of How
Physicians Should Be Led and Their Interest in
Pursuing Leadership Positions
Sari Huikko-Tarvainen
Timo Tuovinen
Petri Kulmala

Abstract
This qualitative study investigatedtomorrow’s physicians’ - medical
students’ - perceptions of
how physicians should be led
and their interest in pursuingleadership positions as theseissues have never been studiedin Finland. In 2020, an online
questionnaire was distributed to
final-year medical students (n= 162, response rate 110/68%).
Students’ level of interest in
working as physician leaders in
the future was also investigated.
An inductive content analysis bythematization was the chosen
method. To make leadership
successful in the medical
profession, both leadership andmanagement skills are required.
Physicians should be seen as
individuals and should be led bya trustable, reachable, innovative,and visionary physician leader
who participates in patient workin addition to leadership workwith good social, communication,and problem-solving skills as wellas common sense and emotional
intelligence. Furthermore, a good
leader ensures that physicians
can focus on their medical workwith appropriate resources inwell-functioning conditions.
Our study revealed three novel
results: (1) A good physician
leader reflects the virtues of agood physician; (2) physicians’
workload should be customized
according to factors such as
physicians’ diversity and work
23

competence; and (3) the interestin future leadership among
medical students was greatercompared to the findings ofprevious literature.
Key Words: Physician, physician
leadership, medical student,
medical education

Introduction
Leadership competence is expected to
become a great priority for physicians inmedical education as well as healthcare
settings (Lindgren and Gordon, 2016;
Rotenstein et al., 2019, 2021). Furthermore, physician engagement in healthcare leadership has been associated withimproved organizational performanceand patient care (Goodall, 2011; Sarto
and Veronesi, 2016; Tasi et al., 2019)and demonstrated to have a positive impact on workforce and patient outcomes(Onyura et al., 2019) as well as staff wellbeing (Päätalo and Kauppi, 2016).
Even though not every physician will
pursue a formal leadership position in
health organizations, most will likely
serve as informal leaders in their community or practice (Maddalena, 2016)
and will consequently influence their organizations as informal leaders (HuikkoTarvainen, 2022; Wilson et al., 2020).
Surprisingly, however, it has been foundthat numerous medical students are notparticularly interested in leadership work
(Abbas et al., 2011). Moreover, resident
physicians do not consider formal leadership positions as very appealing, primarily
due to the competing duties of physicians
and leaders, as they feel that one can beeither a skilled physician or a skilled leader, but not both. Such contradictory logic
may lead to situations in which promising
younger physicians with leadership qualities turn down offers of taking on leadership positions as they are a threat to theidentity of a practicing physician. (Styhre
et al., 2016.)
Nevertheless, medical students haveemphasized the need to incorporate leadership and management into undergraduate education (Abbas et al., 2011; Alzahrani et al., 2021) but simultaneously, they
have identified associated obstacles, suchas a lack of given time, competing educational demands, and a potential disinterest in leadership skills and training
by some students and faculty (Abbas etal., 2011). These results are in line withthe study on working-age physicians (n= 1,233), which revealed that although
22% of women and 25% of men were inhttp://ejbo.jyu.fi/

EJBO Electronic Journal of Business Ethics and Organization Studies

terested in leadership, more leadership training was required(Ministry of Social Affairs and Health., 2020). To inform andimprove the leadership curriculum in medical education, considering that generational perceptions change over time, thevoices of medical students—tomorrow’s physicians and leaders—should be heard in terms of how they expect themselves
to be led and what they expect from their leaders.
Theoretical Framework
Good physician leadership in light of previous literature

Numerous leadership studies reveal the importance of bothleadership and management in the leadership work. The goalof managing is to achieve efficiency, predictability, and order,
while that of leading is to achieve change—the importance ofeach also depends on the case. In leadership, subordinates are
influenced by a leader to understand and accept what needs tobe done as well as to make concerted efforts to accomplish it.
(Kotter, 1990, pp. 4-5;Yukl, 2013, pp. 22–26.)
Nevertheless, in physician leadership, the leader’s role is often a hybrid role that combines not only leadership and management work but also requires a knowledge of medicine (Berghout
et al., 2017, 2020; Huikko-Tarvainen, 2022; Huikko-Tarvainen
et al., 2021; Quinn and Perelli, 2016; Sartirana et al., 2019;
Spehar et al., 2015). Physicians who possess an appropriatebalance of medical skills and a proper work ethic and etiquette
have been seen to succeed more in the role of a physician leader.
Further, physician leaders are also expected to be trustworthy,
fair, empathic, sociable, and communicative, with a capacity toprovide proper feedback, show collegial respect, and display
emotional intelligence. Beyond this, they must be familiar with
the impacts that the daily work of physicians has on physicians’
lives. (Alzahrani et al., 2021; Huikko-Tarvainen, 2022). In addition, good physician leaders must master a wide variety of leadership styles as well as have sufficient knowledge to select whichleadership approach is appropriate in each situation (HuikkoTarvainen, 2022; Saxena et al., 2017).
In most professional organizations, the people being led
and those who are leading them are both experts (Mintzberg,
1998). Consequently, working-age physicians prefer leaders
who are also physicians (Berghout et al., 2017; Goodall, 2011;
Huikko-Tarvainen, 2022), and numerous medical students statethat physicians should be leaders of multi-professional teams in
the health care (Abbas et al., 2011). The characteristics of good
physicians—as perceived by physicians, medical students, medical teachers, and patients—include good social communicationand leadership skills as well as a strong and consistent moral
character. Furthermore, physicians ought to be compassionate,empathic, honest, humble, responsive, persistent, trustworthy,
and inspirational. Additionally, they must be those who employ
clinically sound practices, are good listeners, are patient-oriented, contribute to scientific knowledge of medicine, and possess
the most current knowledge in their general and specialized
fields. (Chen et al., 2017; O’Donnabhain and Friedman, 2018;
Schattner et al., 2004; Sehiralti et al., 2010;Warm et al., 2022.)
To succeed in fast-paced work and, simultaneously, be capable of accomplishing long-term goals, physicians with leadership intentions must possess interpersonal skills (team leading,active listening, conflict resolution, and the capacity to provide
constructive yet fair feedback), systems management skills (theabilities to analyze processes and improvements, oversee logistics and supply chains, offer incentives, administer organizational planning, and perform measurements and data analytics),
and effective communication and planning skills (the abilities to24Vol. 29, No. 1 (2024)

communicate, plan, discuss, make decisions, devise strategies,
cultivate a beneficial work culture, and handle contingencies).
(Rotenstein et al., 2021.)
However, research on medical students’ perceptions of physician leadership is rare and partially controversial. On one hand,
medical students have been found to have a traditional understanding of leadership and followership, according to which
followers—as receivers of leadership—operate in accordancewith the leader’s vision and goals. (Gordon et al., 2015). Similarly, hospital-based second-year medical residents have beenfound to perceive a clear separation between leadership andmanagement as well as consider management inferior to leadership, which reflects a more traditional perception of the twodomains (Barrow et al., 2011). On the other hand, medical students consider communication, ethics, conflict resolution, timeorganization, managed care, management priorities, bookkeeping, quality development, public speaking, and risk control to
be more important in determining good physician leadership
than the capacity to negotiate, write proposals, and investment
principles (Abbas et al., 2011; Mintz and Stoller, 2014; Varkey
et al., 2009).
Methods
An online questionnaire was sent to 162 final-year medical students at the University of Oulu, Finland in November 2020.The
response rate was 68% (n =110). We also collected relevant
background information (Table 1, p. 25). Initially, the potential
participants received an invitation letter, which provided detailed information on the purpose of the study. The letter clearly
indicated that their participation would be entirely voluntary
and that they had the right to withdraw from the study at any
time as well as deny access to the use of their data. Anonymity was also guaranteed. All the participants gave permission for
their data to be collected and used for research purposes. This
study was conducted in accordance with the instructions of theFinnish Advisory Board on Research Integrity and in compliancewith European Union’s data protection regulations as well as
the established research practices of the University of Oulu andits Faculty of Medicine. Full consideration was given to mattersrelated to data protection in accordance with the ethical principles applicable to research subjects (Finnish Advisory Board on
Research Integrity, 2012).
A qualitative approach (Gibbs, 2018) was employed because
the goal of the research was to further our understanding ofwhat constitutes good leaders and good physician leadershipaccording to final-year medical students. The participants wereasked to freely respond to three main questions: (1) How should
physicians be led? (2) How would you describe a good physician
leader? (3) Would you be interested in working as a physician
leader in the future? The answers to these questions were digitally saved and coded to make the data more analytically accessible. The answers yielded data that was equivalent to nine A4sized pages (Arial font, 12 point, single spacing).
An inductive content analysis utilizing thematization was selected, as this method is well suited for qualitative research. The
purpose of the content analysis was to obtain descriptions of thephenomenon that would enable us to connect the findings to awider context and compare them to those of prior studies. The
analysis was based on the systematic examination of the collected data and focused on relevant themes and patterns by selecting common or exceptional statements or viewpoints. (Eriksson
and Kovalainen, 2008.)
The analysis was conducted sequentially. First, we familiarhttp://ejbo.jyu.fi/

EJBO Electronic Journal of Business Ethics and Organization Studies

ized ourselves with the data by iteratively reading the content
until we were confident that we had gained a thorough understanding of it. The elemental codes (words and phrases)—
which represented the most basic form of the raw data—weregrouped, combined, and organized into categories that indicated the expectations of (1) a good physician leader and (2)good physician leadership. In the next step, these findings werecategorized to create potential subcategories. Then, the subcategories were reviewed and refined until they became consistentand identifiable distinctions appeared between them. Next, thesub-themes were named: (1) traits, (2) education, (3) communication and support, (4) working culture, and (5) workload.
These sub-themes were combined into main themes to create aunifying concept: (1) virtues of a good physician leader and (2)working conditions. These themes were analyzed both separately and in the context of the overall thematic structure. Our datadriven analysis was repeated twice by the first author and thenevaluated by all the authors to avoid bias. During the analysis
and coding phases, the first author met regularly with the otherauthors to receive feedback on the coding system. At the endof the process, we added the carefully selected and anonymized
excerpts to the findings to illustrate our interpretations (Eriksson and Kovalainen, 2008) and arranged the material in tabularformat (see Table 2, pp. 26-27).
Results
The information of the participants is provided in Table 1 (p.
25).
Female53% (n=58)

Male

46% (n=51)

No indication of gender

1% (n=1)

Worked as a doctor during
medical studies

98% (n=108)<25 years of age

8% (n=9)25-30 years of age

65% (n=71)

31-35 years of age

14% (n=16)36-40 years of age

4% (n=4)>41 years of age

9% (n=10)High school as the highest
educational background

70% (n=77)

A prior higher educational
background

30% (n=33)

Interested in working as aphysician leader

32.0% (n=33)

Might be interested inworking as a physician leader

20.4% (n=21)

Not interested in working as aphysician leader

47.5% (n=49)

Did not expressed interested
in working as a physician
leader

0.1%% (n=7)

Table 1. The information of participants.

Our study generated two main thematic categories: (1) virtues of a good physician leader and (2) working conditions. The
virtues of a good physician leader were divided into three subthemes: (1) traits, (2) education, and (3) communication andsupport. The main theme of the working conditions was divided
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Vol. 29, No. 1 (2024)

into two sub-themes: (1) working culture and (2) workload (Table 2, pp. 26-27).
The results pertaining to what makes leadership successful inthe medical profession reveal that both leadership and management skills are required. The led physicians should be seen as
individuals and be led by a trustworthy, approachable, innovative, and visionary physician leader who participates in patient
work alongside leadership work and possesses good social, communication, and problem-solving skills as well as common sense
and emotional intelligence. Furthermore, a good leader ensuresthat physicians can focus on their medical work by providingthem with appropriate resources in well-functioning conditions.
Thus, a good physician leader reflects the virtues of a good physician.
Discussion
In the following account, the results of our study are discussed
in more detail in the light of the three novel findings of the study.
Virtues of a good physician leader

According to our findings, when good physician leadership isin place, the led physicians should be viewed as individuals andshould be led by a trustworthy, approachable, and visionary physician leader who possesses good social, communication, andproblem-solving skills as well as emotional intelligence, common sense, and an innovative mindset. The leader participates
not only in leadership work but also in clinical patient work.
A good physician leader is visible without drawing attention tothemselves and voluntarily pursues leadership positions. Moreover, the participants considered collegiality and professionalism
as mandatory. These findings are in line with those of previous
literature (see e.g., Abbas et al., 2011; Alzahrani et al., 2021;
Huikko-Tarvainen, 2022; Mintz and Stoller, 2014).
Although a medical background and participation in patient
work were seen as requirements for leaders, they were not considered sufficient on their own; an additional leadership training
was considered necessary. Leaders understand the functioningof healthcare organizations, economics, and law and know how
to prioritize but do not lead only by looking at costs. Leadershipwork is based on evidence-based information, and the culture ofwork is built on trust. These findings resemble those of previous
studies, which have found that good physician leaders need topossess the capability of mastering a wide variety of leadershipstyles as well as to select the appropriate approach for every
situation (Huikko-Tarvainen, 2022; Saxena et al., 2017).
Considering that the participants were medical students withlimited experience of working as physicians, their expectations
regarding the virtues of good leaders were, interestingly, rather
similar to those expressed by more experienced physicians (Abbas et al., 2011; Huikko-Tarvainen, 2022; Mintz and Stoller,2014) and partially comparable to those revealed in studies ofgeneral leadership (see e.g.,Yukl, 2013, p. 18). In all these contexts, the expectation was that (good) leaders should possessgood communication and social skills and should be honest, fair,and empathic; they should also provide constructive feedback,maintain a collegial attitude, and possess emotional intelligence(see e.g., Abbas et al., 2011; Huikko-Tarvainen, 2022; Mintz
and Stoller, 2014).
It is already well known that physicians prefer their leaders tobe physicians (Berghout et al., 2017; Goodall, 2011; HuikkoTarvainen, 2022) and that medical ethic and work etiquette,
combined with the appropriate balance of medical skills, are agood foundation for success in physician leadership (Huikkohttp://ejbo.jyu.fi/

SUBTHEMESEXCERPTSGood leaders are trustworthy, honest,
empathetic, easy to approach, reachable, openminded, collegial and have good social andproblem-solving skills. They also possess proper
etiquette, are visible without drawing attention
to themselves and pursue leadership positions
voluntarily.

- [The leader] makes himself/herself visible…
asks how employees are doing, and about thework situation – for example, are there enoughappointment times and enough time for officework?
- [The leader] is interested in the well-being of
employees and occasionally appears, even in
the coffee room, without isolating herself/himself
in her/his office.
- Expert, good role model, approachable, well
behaving, reliable, collegial.
- The leader should voluntarily approach [theleading position] and not be forced [to be aleader].

The classic characteristics of a good physician
are a model for a good physician leader. Most
participants believed that to understandsubordinates better and be able to teach andcoach, physician leaders should have botha medical education and work experience
as physicians in addition to possessing
updated medical knowledge. Leaders’ medical
background and participation in patient work
were seen as mandatory but not sufficientsolely; leadership training was also expected.
Good leaders have a good knowledge of
economics, law and research, and their work
must be both effective and efficient in termsof costs to the public. Knowledge of how toprioritise healthcare costs is expected, but
leading only with cost in mind is not accepted;
evidence-based information should be used.
Good leaders act both as role models and peers
for physicians, but they are also expected toserve as a bridge between physicians and theadministration of the healthcare organisation.
This requires an understanding of the healthcareorganisation not only as a whole but also interms of its multiple levels and professionalfeatures.

- [A good leader has] pretty much the same
qualities as a good doctor. They listen and strive
to solve problems and do not avoid difficulties.
- [A good leader leads] with determination andprofessionalism.
- The leader must understand the peculiaritiesof doctors’ work but also possess leadershiptraining.
- [A good leader] understands both medicine
and economics.
-Leading is not driven only by saving from thecosts and leading is not separated from reality.
- [A leader is] thorough, endowed with goodsocial skills, fair and efficient, but they do notlead only based on financial considerations.
- In healthcare, the supervisor/leader
must understand not only jurisprudence
and economics but also leadership andmanagement.
- [A leader] understands economics, medicine
and how things work in real life.
- In addition to leadership work, leaders also
participate in clinical work. This way, theyknow how the work community and workplace
operate and how to relate doctors’ development
proposals to the administration.

Good leaders use communication, facts,
common sense, and evidence-based
information as the foundations of their decisions
and do not lead just by feelings. Responsibility
and readiness to explain one’s decisions are
required. In certain situations, it might beadvisable for leadership to be shared with peers.
Even though physician leaders should respect
their peers as human beings and experts –that is, respect their autonomy and opinions– they should also provide clear and confident
guidance and supervision when and if asked bythem. Leaders should give their subordinates
sufficient time to complete their work and show
an interest in their well-being and success.
Good leaders do not just hear their employees –they listen to them. This encourages employees
to feel heard and valued. Good leaders support
subordinates in their work and careers and backthem in tough situations.

- Leadership based on facts and wisdom rather
than emotions. Leaders must be able to justify
their opinions.
- By listening to doctors, the leader gainsa (preferably personal) comprehensive
understanding of the realities of their work.
- [A leader is] part of the team, an experienced
clinician with up-to-date knowledge and abackground in research work.
- [A leader] leads with evidence-based
management and actively participates innecessary research.
- Adequate resources must be allocated toworkplace well-being, the rational pace of work
and, especially, the training and guidance ofyoung colleagues. Therefore, it would be good if
the leader was also a doctor.

WORKING CONDITIONSVIRTUES OF A GOOD PHYSICIAN LEADER

TraitsRESULTS

Education

MAIN
THEMES

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Communication and support

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Working culture
Workload

WORKING CONDITIONSEJBO Electronic Journal of Business Ethics and Organization Studies

Vol. 29, No. 1 (2024)

The development of a well-functioning workcommunity and working culture built on trust –including understanding physicians’ autonomy– was expected. This could be achieved bytaking the lead in operations but also respecting
other people by understanding each person’s
mindset and capability to work. The leadershipapproach should be flexible and patient but also
firm when needed. Alongside respecting others
and their ideas, leaders must retain and enforce
their authority; thus, their leader role should be
strengthened in tight or demanding situations.

- [Leadership work should be done] collegiallybut firmly. Fair manner. Purposefully. Innovatively.
By listening to others.
- There must be certain common rules for thework; however, at the same time, doctors mustbe given an autonomy in their decision-making.
- [A leader] strives to create an organisationthat works as smoothly and cost-effectively as
possible without burdening the employees.

Good leaders organise working conditions inways that properly allocate time, resources,
and tasks, thereby bolstering organisational
performance and outcomes. Physicians mustbe allowed to focus on their own specialised
work; that is, physicians should not be assigned
duties related to other fields or departmentsof the healthcare organisation (e.g., the workof secretaries, nurses, cleaners, or IT staff). It isnecessary for good leaders to appreciate and to
take into account physicians’ diversity and work
competence. In practice, this means considering
each employee’s workload and educational
needs. Consequently, a fair and equal workload
allocation is the preferred aim, as is correcting
imbalances.

- In physician leadership, frameworks for thework must be provided, development ideas mustbe heard, and operations must be developed.
- [A good leader] does not tolerate physicians
being burdened with the work of others (nurses,
practical nurses, secretaries, cleaners, and IT
staff).
- [A good leader should treat] everyone equally,
but the characteristics of individuals should betaken into account.
- Every doctor is different. Not everyone should
be required exactly the same, e.g., have thesame schedule.
- A good physician leader takes into accountemployees’ personal preferences for the job andis able to offer different job descriptions while
always considering the legal obligations.

Table 2. The perceptions of the participants.

Tarvainen, 2022). But when results of the current study arecompared to those of the previous literature, it is a novel findingof our study that expected virtues of a good physician leader
resemble the classic characteristics of a good physician (seee.g., Chen et al., 2017; O’Donnabhain and Friedman, 2018;
Schattner et al., 2004; Sehiralti et al., 2010; Warm et al., 2022).
In practice, this implies that when medical students are beingtaught how to be good physicians, they are simultaneously being
educated on those elements that are vital to serving as a good
leader.
Going beyond the general definition of leadership as “an influential process for facilitating the performance of a commontask” (Yukl, 2013, p. 36), the participants believed that good
physician leaders (1) participate in clinical patient work, (2)provide them with teaching and coaching, and (3) respect themas both individuals and peers, which aligns with the previous
definition of physician leadership, according to which physician
leadership combines general leadership and management withmedical expertise (see e.g., Berghout et al., 2017; Huikko-Tarvainen, 2022; Quinn and Perelli, 2016; Spehar et al., 2015).
Moreover, the finding that physician leaders should have not
only a medical education but also experience working as a physician appears to be a universal, intrinsic requirement for all physicians, regardless of the length of their medical career (see e.g.,
Berghout et al., 2017; Huikko-Tarvainen, 2022); therefore, as acommon demand, must be associated with the medical profession. This is not entirely surprising because, in most professionalorganizations, the people being led and those who are leadingthem are both experts (Mintzberg, 1998).
Further, the finding of our study for that leaders must masterboth leadership work and physician work resembles the previous studies on the hybrid roles of physician leaders (see e.g.,
Berghout et al., 2020; Huikko-Tarvainen, 2022; Huikko-Tarvainen et al., 2021; Sartirana et al., 2019) and emphasizes theneed to possess both leadership and management skills, which27

is also supported by previous literature (see e.g., Yukl, 2013,
pp. 22–26).
A physician’s work with a customized workload

Based on our study, flexible and functional working conditions
are expected, and the led physicians should be allowed to focus on their own specialized work. In other words, physicians
should not be assigned duties related to other fields or departments of the healthcare organization (e.g., the work of secretaries, nurses, cleaners, or IT staff). In addition, the workload
should be customized to respect the diversity and work competence of the led physicians, which represents the second novel
finding of our study.
These results are contradictory to the previous findings inwhich residents made a clear distinction between management and leadership or considered management as inferior toleadership (see e.g., Barrow et al., 2011), and had a traditional
understanding of leadership where followers, as receivers ofleadership, act in accordance with the leader’s vision and goals(see e.g., Gordon et al., 2015) Instead, the medical students inthis study wanted the voices of the led physicians to be heard
and heeded. That is, our study emphasizes the need for leaders
to possess both leadership and management skills to maximize
the likelihood that their work as leaders will be successful,which is supported by previous literature on the perceptionsof more experienced physicians (see e.g., Huikko-Tarvainen,
2022; Rotenstein et al., 2019, 2021).
Greater interest in physician leadership

A majority of the participants (98%, n = 108) had alreadyworked as physicians during medical school, thereby implyingthat they were exposed to leadership and met physician leadersin person and, thus, had an informed perspective on what toexpect from a leader and leadership in general. Unlike in mostprior studies (see e.g., Abbas et al., 2011; Styhre et al., 2016),
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EJBO Electronic Journal of Business Ethics and Organization Studies

a significantly high proportion (52%) of the medical students inour study were interested in or might consider a formal leadership position in the future, which was the third novel findingof our study. Greater interest in leadership is a desirable trend
among medical students because, as noted by most of the participants, one foundation of successful physician leadership isthat the physician leaders are also physicians themselves. Greater interest in future leadership may also help overcome, or atleast mitigate, possible challenges confronting the hybrid workof physician leaders (see e.g., Berghout et al., 2020; HuikkoTarvainen et al., 2021; Sartirana et al., 2019)
Based on our study, it is recommended that—even though an
education of a good physician provides a good role model fora good physician leader—leadership education (including leadership and management skills) should be provided in medical
school, as has also been noted in previous literature (see e.g.,
Abbas et al., 2011; Alzahrani et al., 2021; Gordon et al., 2015;
Huikko-Tarvainen et al., 2021). This indicates that good leadersand leadership skills will continue to be valued in the future.
Thus, leadership education should play a prominent role in the
medical curriculum.
Limitations and future research
The findings of our study are limited because our sample wasderived from a single cohort of Finnish final-year medical students. However, the sample was sufficiently large, and the response rate was excellent. In the future, it would be worthwhile
to repeat our study every year and compare the results over along period of time. It would also be useful to compare the perceptions of medical students from different grades as well asof physicians at different career stages and from different specializations. This would enable a broader, more comprehensive
understanding of the phenomenon coupled with more in-depth
insights into the perceptions of medical students who are also
digital natives. Finally, even though the foundations of healthcare organizations worldwide are similar, contextual effects may
influence the transferability and/or generalizability of our findings on leadership practices (Onyura et al., 2019).
Conclusion
Our study reveals that the perceptions of what constitutes a good
leader and good leadership among final-year medical students
are wide-ranging and somewhat similar to the findings of previous studies on the topic. Beyond this, our study also produced

Vol. 29, No. 1 (2024)

three novel results. Although it is well known that physicians
prefer their leaders to come from the medical profession (seee.g., Berghout et al., 2017; Goodall, 2011; Huikko-Tarvainen,2022), the notion that the classic characteristics of a good physician can serve as a model for a good physician leader—our firstnovel finding—has thus far received little or no attention.
Our second novel finding was that good leadership entails tailoring workloads to the individual strengths and skills of physicians, which requires considering physicians’ diversity and work
competence. Therefore, the medical students who participatedin this study were not traditional followers—receivers of leadership—who act only in accordance with their leaders’ visions
and goals (Gordon et al., 2015); instead, they wanted physicians’ voices to be heard. Finally, the third novel finding of ourresearch was a greater interest in leadership work among medical students compared to that in earlier studies (see e.g., Abbas
et al., 2011; Ministry of Social Affairs and Health., 2020; Styhre
et al., 2016).
Ethics approval and consent to participate
The research was carried out in accordance with the instructionsof the Finnish Advisory Board on Research Integrity, in compliance with EU data protection regulations and the research practices of the University of Oulu and the Faculty of Medicine. The
permission for the study was granted by the Faculty of Medicine
in accordance with current policies.
Availability of data and materials
The data that support the findings of this study are available
from the corresponding author upon reasonable request.
Competing interests
The authors declare that they have no competing interests.
Funding
Funding/Support: None.
Acknowledgements
The authors wish to thank the medical students at the Universityof Oulu for their participation in the study.

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Authors
Sari Huikko-Tarvainen MD, PhD, is a Specialist in General Practice and Dermatology and D.Sc. (Economics and Business Administration).
Her current research includes physician leadership in medical education.
Address: Faculty of Medicine, University of Oulu, Oulu, Finland, P.O. Box 5000, FI-90014 University of Oulu, Finland.
E-mail: sari.huikko-tarvainen@fimnet.fi
Tel: +358408221250
Orcid ID: https://orcid.org/0000-0001-6561-2911
Timo Tuovinen MD, is a Specialist in Gynaecology and Obstetrics and a former Clinical Teacher (eHealth and medical leadership).
Address: Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland, Medical Research Center, Oulu University
Hospital, Oulu, Finland, and Faculty of Medicine, University of Oulu, Finland., P.O. Box 5000, FI-90014 University of Oulu, Finland.
E-mail: timo.tuovinen@oulu.fi
Tel: +358 41 5027864
Orcid ID: https://orcid.org/0000-0001-7079-3673
RG: https://www.researchgate.net/profile/Timo_Tuovinen
Petri Kulmala MD, PhD, is a Professor of Medical Education and the Dean of Education at the University of Oulu, Faculty of Medicine,and a Specialist in Paediatrics and Paediatric Allergology at the Oulu University Hospital, the Clinic for Children and Adolescents, Oulu,
Finland. His current research includes a variety of areas in the field of medical education.
Address: Faculty of Medicine, University of Oulu, Oulu, Finland, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland,
P.O. Box 5000, FI-90014 University of Oulu, FinlandE-mail: petri.kulmala@oulu.fi
Tel: +358 50 5647533
Orcid ID: https://orcid.org/0000-0003-2895-8563
RG: https://www.researchgate.net/profile/Petri-Kulmala30

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