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The transient and multifaceted nature of leadership in Health Professions Education has changed over time. Programme directors associated with medicine, pharmacy, nursing, allied health and those involved in a clinical setting typically serve as managers and leaders concurrently. Furthermore, managers in modern organisations are expected to fulfil leadership roles. Leader and leadership development are inter-reliant phenomena. Moreover, the growth of leaders, the mutual development within a group and the consequent development of an organisation in the context of health professions education HPE require framing. This is especially true when leaders are faced with an array of constraints in low- and middle-income countries. In order to appreciate leader development, we need to ask “what qualities do we need to develop in our leaders?” and for leadership development “what qualities do we need to develop in our organisation?”. Thus, within the context of the current study we essentially ask: “What qualities have developed in our leaders, organisation and the consortium?” The current study sought to understand leadership development of appointed and emergent leaders in new medical schools in Africa. A mixed-methods approach was employed and the data collection instruments included: a Likert scale survey, a multiple case study approach and a qualitative document analysis (QDA). A total of 29 surveys (64.5% response rate) were returned and 10 successful interviews were conducted after ethical approval and obtaining consent. Many of the participants fulfilled multiple roles as lecturer (linked to the basic medical sciences), departmental head and/or a clinical teaching position in the hospital. Their academic positions and seniority as leaders included deans, a deputy dean, a programme director, heads of departments (HODs), medical educationalists and lecturers. Any additional biographical information was excluded in the study in order to ensure anonymity of the participants. Finally, the QDA relied on a four-step Scott method and considered a total of 58 documents that ranged from meeting agendas and reports, scholarly works, book chapters, newsletters, external reports, conference proceedings, and the CONSAMS (Consortium of New Sub-Sahara African Medical Schools) constitution. Findings from the current study led to the development of a framework to navigate the complex nature of leadership development in new medical schools in Africa. The three-tier framework views leadership development of the individual, the institution and within the context of collaboration such as a consortium. Leadership development at an individual level is dependent on the interplay between an institutional climate, contextual forces and resultant responses of leaders. Five archetypes of leadership development were identified at an individual level: the leader in front, the strategist, the silenced leader, becoming a leader and the leader as manager. The archetypes are the result of biographical, programmatic, institutional and contextual forces. The leader subsequently interprets these forces in order to negotiate their roles, position and course of action. Leadership development at an institutional level occurs within a hierarchical system and can sometimes occur in isolation. Development is often hampered by day-to-day activities that are reactive in nature in a bid to negotiate the various forces. The formation of teams and coalitions are hampered by climate factors such as ineffective engagement of colleagues, poor bilateral communication, perceived misalignment of the values and unsuccessful collaboration. The formation of networks and alliances, as in the case of CONSAMS, drives the leadership development at a collaborative level. Within this context, leadership development is largely dependent on effective communication and feedback. Within a consortium, each participant contributes from the position of their dominant archetype, but are also temporarily freed from institutional constraints to think more strategically. The consortium generates a unique climate where the heterogeneity of leaders through their archetypes can be challenged, tested and strengthened. Interaction within the consortium permits freedom, more so than within the domain of an institution.

Addiction continues to impact millions of people in the US and remains a public health priority. Public health views addiction as a disease that can be prevented and treated. However, traditionally the public health system has viewed individuals and entire communities from the perspective of needs and problems, as opposed to strengths and assets. As a result, the data indicate that Latinos and Latinas have been disproportionately impacted by addiction. However, despite the fact that Latinos and Latinas possess enormous funds of knowledge and cultural capital, they are under-represented among credentialed counselors. Moreover, the literature on drug and alcohol credentialing has produced knowledge about and for addictions counselors, with little attention awarded to Latino/a-specific issues. This dissertation seeks to contribute to the literature and discourse on Latinas and Latinos and the credentialing processes. By employing the story-telling and counter-storytelling methodologies described in Latino Critical Race Theory (LatCrit) and Culturally Responsible Pedagogies, this research creates knowledge with Latino and Latina counselors, beginning from their lived-experiences. This dissertation includes Latino and Latina individuals in the development of knowledge about their experiences with micro-aggressions and the credentialing processes. This qualitative study includes seventeen in-depth interviews and two focus groups with eight credentialed and seven non-credentialed individuals from across Massachusetts. The participants in this research study eloquently talked about the role of class and how their families impacted their views about education. They also recounted their painful experiences with racism, racialization, sexism, colonialism, internalize oppression and other forms of micro-aggressions. It should be noted that a significant number of the participants are in addiction recovery and they talked about their recovery processes, the impact on their families, and their decisions to give back to the community. All of the participants also talked about their experiences with formal education, the impact of participatory versus banking education, and the credentialing process. The counter-narrative produced by their stories includes important recommendations and opportunities for praxis. Throughout the counter-stories one can note the impressive amounts of cultural and social capital, as well as funds of knowledge possessed by the participants. They also exhibit agency, self-determination, and resiliency.

Assessment as part of the enacted curriculum is underscored by the professional judgement of the lecturer, who decides on the body of knowledge that should be learned. A vacuum exists in understanding how the practice of assessment is shaped by the lecturer and between the social groups within departments and the academic institution at large, as well as the transformational policies within the higher education space. Assessment is a key driver to advance a socially just medical curriculum, especially in the context of the legacy of colonialism and apartheid in South Africa (SA). Using the existing body of knowledge about assessment from the global North, without re-contextualising it for a South African context, has led to decontextualised practices that treat assessment as a one-size- fits-all phenomenon. In this study, the influences on lecturers' assessment practices within an undergraduate medical programme were explored. Enabled by the critical realist paradigm, this study sought to illuminate the structural and cultural mechanisms that enabled or constrained medical lecturers' assessment practice. Margaret Archer's social realist theory was used to theorise assessment by using analytical dualism and giving powers and properties to structure, culture, and agency independently, as a way to explore and critically analyse the mechanisms that condition lecturers' assessment practice. Using collective case study design, individual interviews were conducted, and the assessment documentation was gathered from six lecturers in the medical programme at one institution. Narratives from two pre-clinical and four clinical lecturers and the assessment documentation were analysed to provide a way to better understand the influences guiding lecturers' assessment practices. More importantly, how lecturers exercise their personal emergent powers and properties to enact assessment was examined. The analysis shows that the interplay of the systemic mechanisms that emerged in the assessment practice of lecturers set up complex choices for the transformation of assessment. In the context of historic transformation imperatives and the student protests, the study's findings show that lecturers exercised their agential powers and properties to elaborate the ideas and theories towards conventional evidence-based assessment practices that were predominantly teacher-led. Lecturers relied on their own experience of assessment, learning about assessment formally in education programmes and informally through colleagues and courses. However, the systemic constraints such as timetabling, limited integration, disciplinary power, insufficient human, and financial resources to innovate and transform assessment, encouraged choices that were ill aligned to inclusive assessment practices. The support of lecturers' assessment endeavours is desperately needed at all levels, national, institutional, departmental and programmatic, to transform assessment practice. The findings highlight the need for re-evaluation of current interventions to elevate the ontological and epistemological issues. The results have implications for the design of staff development activities and the way assessment is designed, created, and administered.

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Thesis (M.P.H.)--University of Michigan, 1944.