Chapter 3: Training for Leadership
A major goal of the MCH Training Program is leadership
training. This focus is consistent with recommendations of the influential
Institute of Medicine (IOM) report The Future of Public Health, which
has helped to shape the nation's approach to public health over the last
However, despite the IOM report and other documents that
attempt to define leadership, the term remains ambiguous. MCHB sponsored
two meetings of training directors in the late 1980s to discuss and help
define leadership Conference participants struggled with the concept,
ultimately concluding that Leadership is an ongoing, dynamic process,
not a goal or a definable position one can achieve.” In particular,
conference participants resisted the notion that leadership can be defined
by an individual’s position within an hierarchical organization.
Conference participants then attempted to define how
to measure leadership, and in particular how to assess whether or not
MCH graduates actually exhibited leadership. Several indicators were posited
as signs of leadership, most of which reflected academic success (e.g.,
having been published, receipt of funded grants, teaching, participation
on grant review panels). However, an important consensus reached by conference
participants was that No easy method exists to directly relate a person's
contributions to her or his participation in the MCH Training Program.
Such a conclusion appears extremely difficult to reach and would require
complex experimental designs and extensive resources.
This evaluation did not attempt to assess whether or
not particular projects are successful in creating leaders; rather it
examined the ways in which the concept of training for leadership is operationalized
by grantees. In particular, it explored how projects define leadership,
how they train for it, and how they evaluate their success.
DIFFERENCES IN LEADERSHIP TRAINING AMONG PROJECTS
Projects differ in four
key ways with respect to leadership training:
(1) the degree to which they explicitly stress training for leadership;
(2) the extent to they emphaswhich ize policy work and academic accomplishment
as key to leadership versus more clinical ways of developing leadership;
(3) the methods they use in training for leadership; and
(4) the groups selected to receive leadership training.
The Emphasis on Leadership Training
The administrators of many graduate programs conceive their mission
to be that of training self-promotion and pressing national leaders.
They expect that their graduates will become university professors,
conduct meaningful research, attain high-level positions, and contribute
to their professions in myriad ways. The MCH stipend in universities
with such a mission becomes primarily an inducement to recruit good
students into what is, in reality, an existing leadership training program;
with the MCH support, that program becomes more focused on women and
children. MCH trainees may receive very little, if anything, that is
special with respect to leadership training at such institutions, and
there may be little or no explicit emphasis on leadership, even though
a strong argument could be made that these trainees are, in fact, being
groomed for leadership along with all the other students in the program.
On the other hand, project administrators in some programs that attempt
to train all students for leadership believe that the MCH program requires
them to provide supplemental activities that go beyond what their students
already receive. In these projects, a special seminar may be added,
policy work more strongly emphasized, or field opportunities developed
to allow trainees to practice leadership skills. MCH training project
directors in academic departments that do not strive for universal leadership
training may develop a special leadership program as a result of the
training grant. For example, they may enhance the department’s
focus on research for MCH trainees or engage trainees in policy work.
A few projects, however, simply redefine leadership to correspond to
their existing academic or clinical programs: A leader is someone who
does excellent work, whether that is chairing a meeting or treating
a patient. In such projects, leadership training consists of the same
qualities that define high-caliber graduate training in general.
“Students are trained to be well-educated, to think
critically, and build on previous work; they are being trained more
to be effective than to be leaders.” —Faculty member, School of Public
Policy, Academic, and Clinical Leadership Project directors define
leadership as encompassing everything from changing the national system
of health delivery for children to providing first-rate clinical care
to achieving academic success through teaching and research. Projects
that emphasize high-quality clinical care as the most important aspect
of leadership often provide little or no content on policy.Other projects
stress advocacy and policy work as key components of leadership, and
this is reflected in their curricula. Highly academic centers typically
equate leadership with success in research endeavors.
“A leader is a capable practitioner who knows how to
seek out the services that children need and an agent of change who
can affect policy and implement system change.” —Faculty member,LEND
Faculty in one project point out that academic and community leadership
require different skill sets which sometimes conflict. Faculty attempt
to make the differences explicit in order to promote and help ensure
success in both venues.One faculty member commented,“Academic leadership
requires self-promotion and pressing your own agenda, while community
leadership means letting the community define the agenda.”
"I feel that part of being a leader is conveying
the excitement I feel about MCH nutrition."
—Current student, Nutrition
Essentially, all the projects strive to motivate trainees
by imparting a vision that can sustain them for years to come. A goal
of such motivation is to create agents of change who, throughout their
lives, will strive to secure a better future for children and their
Methods of Leadership Training
Because each project defines the concept
of leadership differently, and because the academic settings of the projects
are so varied, it is not surprising that the educational programs related
to leadership are diverse. For example, some projects provide a weekly
or monthly leadership seminar that includes segments on such topics as
grant writing, presentation skills, coalition building, and management.
Others have no formal course work but may attempt to integrate leadership
concepts throughout the curriculum: One project fosters excellence in
teaching skills by having trainees orally evaluate faculty lectures immediately
after the presentation. Projects that have defined leadership as encompassing
research typically assign each trainee a research mentor and require trainees
to participate in one or more research methods courses. Some projects
are quite innovative: One has developed a formal mentoring program through
which faculty work with trainees to develop goals for achieving academic
tenure and require trainees to visit other universities to observe a variety
of academic administrative systems and styles.
"The leadership concentration focuses on oral
and written skills, including presenting at professional
meetings, grant writing, and evaluation."
—Faculty member, Nursing
Many projects provide trainees with opportunities to
practice leadership by making presentations to community groups or developing
policy position papers, and others require trainees to complete a leadership
portfolio that describes the variety of leadership activities they have
experienced in the program. Internships and field experiences also provide
Groups Selected for Leadership
Recipients of training include high
school students, master's-level students, doctoral candidates, residents
and fellows in medicine, residents in pediatric dentistry, certificate
students (including bachelor's or master's level individuals currently
working in the field), and "mini-fellows" (physicians receiving special
training, but not as intensive or as lengthy as that found in traditional
fellowships). Moreover, most of the interdisciplinary projects (e.g.,
LEND, PPC, LEAH) train individuals who spend varying amounts of time in
the program, including medical students and residents doing clinical rotations,
other short-term trainees (less than 40 hours), intermedi-ate-term trainees
(40-300 hours), and long-term trainees (more than 300 hours). In many
programs, students from outside the department take MCH courses. Most
project directors do not expect that all of these groups of trainees will
become leaders; thus, training clearly has other goals besides leadership.
Projects that provide training for high school students
hope to influence young people to select a health care-related career.
Certificate programs are designed either to encourage practicing professionals
to return to school for additional education and/or to provide important
information useful in these individuals' current employment. The programs
also provide a mechanism to foster ongoing working relationships with
local public health agencies. Both high school and certificate programs
are used to increase ethnic diversity. One project with a minifellowship
program views the program as a way to infuse MCH-related issues and
values into the work of midcareer physicians, to enhance the hospital's
and university's cultural competency, and to foster institution-wide
improvements to children's services through the work of the fellows.
Clinical training programs with different levels of
trainees (e.g., short-, intermediate-, and long-term) obviously have
a greater impact on those trainees who are in the program the longest,
and it is typically these trainees who are expected to become leaders.
Other, different advantages accrue from the shorter-term training, such
as exposure to the interdisciplinary approach, education about policy
issues related to women and children, and improved clinical skills for
treating children. One project director, however, questions the value
of investing in short-term training; this director commented that although
it is possible to teach knowledge in a short time, instilling MCH values
Overall, even though leadership is defined in multiple
ways, it is clear from the site visits that the goal of preparing long-term
trainees for leadership is one that the majority of grantees take quite
seriously. Some struggle with defining leadership but most have developed
a concept of leadership that is meaningful to them and that they have
used in redefining their educational programs in ways that are sometimes
innovative and highly creative and that most trainees appear to value.
OF TRAINING FOR LEADERSHIP
Leadership training begins with recruitment.
Grantees emphasize that they have the ability to attract excellent trainees,
both because of the stipends and the quality of their training programs.
One could argue that the individuals who are recruited would likely become
leaders in any event, and that a leadership training program is thus somewhat
superfluous. It may be true that the trainees selected for many of the
projects-often the top graduates in their special-ties-would likely become
leaders in their general field, but without the MCH Training Program,
the field that they choose might not be MCH-related. Almost all grantees
contend that recruitment "captures" young people who are bright and who
have already demonstrated great potential, and ensures that their talents
are used to benefit children and the broader MCH community. A few projects
emphasize their ability to recruit a diverse group of trainees and thus
to promote cultural diversity and ethnic visibility in particular fields
where these may be lacking.
"I discovered that the MCH program was the best
program at the school. I like the structure and the curriculum. Initially,
I was thinking of going into hospital administra-tion/management. But
when I took a few courses in MCH and met the professors, I realized
that I was interested in MCH."
-Former student, School of Public Health
Policy and Community Action
Great variation exists among training
projects in the extent to which they foster and encourage policy and community
work, and in the manner in which they do so. Some projects instruct trainees
on how to be effective in working in collaboration with professional associations,
legislative bodies, and local organizations. As a result, grantees have
successfully improved health care services for children, both locally
and nationally. For example, trainees have advocated for new community
services, many of which have become institutionalized. Many projects consciously
emphasize a dual mission: to teach young people while engaging them in
activities that effect important system and/or policy changes to benefit
women and children.
Without the grant, fellows would not have the time to engage in
community advocacy. All their time would have to be devoted to clinical
Project director, Behavioral Pediatrics
We are helping people to recognize that it is possible to provide
services in the community, that it doesn't have to be
done in a hospital. We are trying to see how to link the medical center
with the medical home; that is in practice here.
Faculty member, LEND
Clinical projects teach trainees the
skills needed to practice effectively. But MCH training projects also
seek to teach other skills. Certain skills are required for effective
advocacy (e.g., how to communicate effectively or how to work with the
media). Other skills are for leadership (e.g., how to lead a group, manage
a budget, or raise money). Some skills are competencies, such as those
developed by the Association of Teachers of Maternal and Child Health
and by individual projects, or the ones for nutrition training developed
by the Association of Graduate Programs in Public Health Nutrition and
which are now used nationally. And finally, some skills are designed to
facilitate success in a career (e.g., how to work within an academic setting
or make a PowerPoint presentation).
"The program takes a 'see-do-teach' mode of
learning. You aren't just studying from a textbook. You
are physically doing things. Then, when you can explain it to others,
you really understand the material."
-Current student, Historically Black Colleges and Universities
Providing a Mentor
Essentially all projects claim that
faculty act as mentors to trainees. However, the term mentor is
as elastic as that of leadership. In some projects, a faculty mentor becomes
so close to a trainee that he or she knows the trainee very well and is
able to tailor the educational program to the special needs of the trainee.
In other cases, the term mentor is used to define a role that is closer
to that of guidance counselor-that is, the mentor is someone who ensures
that a student takes appropriate courses. In most MCH projects, the role
of a mentor lies somewhere in between. Due to the variability across projects
in the way in which mentoring is defined and provided, it is difficult
to generalize about its impact on the program as a whole. However, trainees
almost always appreciate any mentoring that they receive, and they believe
that mentoring relationships greatly enhance their learning. Moreover,
the extent to which trainees are satisfied with their educational program
appears to be related to the depth of the mentoring they receive.
"My mentor appreciates the experience that I had
before I came [to the program]. We work as partners in planning my experience
here, including what I can bring [to the program]."
-Current student, LEND
PROJECT SUCCESS IN TRAINING LEADERS
Several project directors
stated that an evaluation of the MCH Training Program would require an
assessment of the success of the various projects in actually creating
leaders. That is, because leadership training is the primary goal of the
program, leaders are the outcome of interest. However, given the varied
definitions of leadership and the subjective nature of most of those definitions,
measuring attainment of leadership by former trainees presents great difficulties.
A further challenge is that trainees do not emerge
as leaders immediately upon completion of the training; rather, according
to faculty, it takes most trainees about 10 years to actually accomplish
those activities that define someone as a leader in a field. However,
tracking former students for 10 years is extremely difficult for projects.
Moreover, projects are constantly changing and evolving, and assessing
leadership in a cohort of persons who completed a training program 10
years earlier may say nothing about a current program. And finally,
there are undoubtedly many intervening variables over a 10-year period,
and crediting (or blaming) the training projects for success (or failure)
would seem a dubious proposition at best.
For these and other reasons, not all projects attempt
to assess the accomplishments of their graduates. Some do, however,
typically through administration of a survey of their graduates, either
annually or every 5 years. Many of the projects report low response
rates, some as low as 8 percent, citing the difficulty in maintaining
current contact information for trainees who may have moved several
times over the course of the years. Some projects have been slightly
more successful in tracking their alumni.
"We use an annual survey. The response rate
varies, but it is about 65 percent for first-year graduates." -Project
director, School of Public Health
In their continuation applications, grantees are asked
to provide short descriptions of several former trainees. These vignettes
provide anecdotal evidence for the success of the projects, but they
obviously are insufficient to document the overall success of a project
in creating leaders.
The MCHB-sponsored PPCs developed and conducted a Pediatric
Pulmonary Leadership Training Outcomes Survey during 1996-98. Surveys
were sent to 418 graduates from all seven programs, including physicians,
nurses, nutritionists, social workers, respiratory care practitioners,
and physical therapists; 274 (66 percent) of those surveyed responded.
Survey results indicated that most PPC graduates have served MCH populations
(82 percent) and are members of an interdisciplinary health care team
(82 percent). Almost all (92 percent) have provided training to professional
and lay audiences about the special needs of the MCH population. Leadership
activities included developing guidelines (68 percent), conducting strategic
planning (46 percent), and participating in program evaluation (48 percent).
Graduates have been officers or committee chairpersons in 7 national,
18 state, and 27 local professional associa-tions.These
findings suggest that the PPCs have been quite successful in training
national leaders in MCH.
Findings from Interviews with Current
As a part of this study, each training
project that was site visited invited its current trainees to meet as
a group with the evaluation team to discuss the academic program. The
vast majority of those interviewed were extremely positive about their
training experiences. A few provided candid critiques, with suggestions
"The stipend provides external
validation that you have the potential to be a leader."
-Current student, Social Work
An interesting finding was the impact of these projects
on self-efficacy. For some students, being selected to participate in
a leadership training program in and of itself was enough to initiate
changes in self-perception. Moreover, for some, the honor of being selected
brings with it an expectation of high-level accomplishment. Explicit
statements by faculty that trainees are expected to be leaders, perhaps
paired with specific course work focused on leadership (however it is
defined), reinforce the message of the selection process and appear
to lead to a stronger sense of self-confidence and to higher aspirations
among a large number of trainees.
"As part of the LEAH program, we had several
training opportunities specifically designed to encourage our leadership
potential. More importantly than these individual instructions, I felt
that the program and specifically the faculty worked hard
to instill confidence in our abilities as professionals, which often
translates into more productive leadership skills."
-Current student, LEAH
The impact of the projects on self-efficacy is apparent
when comparing the responses of students who are new to a training project
with those of students who have been in the training project for 2 or
3 years; the students with more time in the project are much more likely
to say that they can envision themselves as future leaders than are
the new students. Many continuing students also say that they did not
have a perception of themselves as potential leaders in their field
upon entry into the program. In other words, many bright trainees enter
these traineeships with no personal goals of leadership but, as a result
of their training, come to view themselves as having both the responsibility
and the capability to lead. They appear to transform their ideas of
themselves, to develop a belief that they can make a difference in the
lives of women and children. The strong sense of self-efficacy that
many trainees develop through the MCH Training Program may well be one
of the major factors that permit some program graduates to become national
leaders in their fields.Trainees clearly value the training they have
received in the interdisciplinary approach to care provision. The opportunity
to work with professionals from a wide variety of disciplines has helped
trainees to understand the role of other professionals and to see a
perspective other than their own.
"My career goals have changed
due to the program. I want a community leadership role when I leave
-Current student, Pediatric Pulmonary
One LEAH trainee described the impact of interdisciplinary
training on his career in this way: "The advantage I have over
my colleagues is a knowledge and comfort level with medicine, social
work, and other disciplines that I will have to work with in my professional
career. Specific treatments have been defined for me that many of my
colleagues do not utilize, such as the necessity of involving physicians
and dieticians in psychological treatment of eating disorder cases."
"I have had the opportunity to give a lecture,
which I had not done before. I appreciated the confidence
that others had in my skills."
-Current student, Occupational Therapy
MCH trainees also expand their visions of leadership.
For example, many who enter a program with the goal of university-level
teaching-and who may view that as a form of leadership-come to incorporate
research and advocacy into their definitions of leadership and into
their personal ambitions. Others state that their training has helped
them to view leadership as incorporating aspects of their daily work,
such as successfully leading a treatment team.
"Pediatric dentistry is relatively new to the
LEND training program at the University of Washington. I've learned
about the role of developmental pediatrics. I've added
assessment skills since participating in the program."
-Current student, LEND
Not surprisingly, students highly value the financial
support that they receive. Some would be unable to participate in a
training program at all without such support. Others believe that the
impact of the training would be diminished if they did not have funding,
because of the time they would need to devote to paid work as opposed
to learning. Some projects support students with assistantships rather
than grants, and these assistantships enable trainees to work closely
with professors on real-world projects, providing valuable experience.
"The stipend increased my ability to take risks
and challenges and be involved in things that I otherwise couldn't because
I don't have to work."
-Current student, School of Public Health
Many projects include field work as a part of the curriculum,
and trainees find these for the most part to be an extremely valuable
aspect of their training. Many trainees state that these experiences
reinforce their views of themselves as future leaders.
"Seminars and field experiences
complement one another nicely and expand our knowledge
in different ways."
-Current student, Nutrition
Findings from Interviews with Former
Of the 110 former trainees who completed
the interview, 65 percent (n=72) graduated in 1995 and 35 percent (n=38)
in 1990. Information detailing additional characteristics of the respondents
is provided in Appendix C.
"Faculty in the program believed in what they were
doing; they weren't just providing a service. They involved
students in every aspect. I never felt like a student I always felt
like a member of the team."
-Former student, Pediatric Pulmonary Center
As shown in Figure 6, 78 percent (n=86) of the former
trainees who were interviewed are still practicing in the MCH field.
Most respondents reported significant changes in their careers as a
result of the training, including new jobs or new responsibilities;
only 6 percent (n=7) reported no significant change in their jobs following
the training (see Figure 7). The great majority (80 percent) of former
trainees attributed job changes to the training they obtained (see Figure
Former trainees stated that the faculty in their respective
programs were highly knowledgeable, and respondents considered this
a major strength of the training projects. Faculty expertise in the
field of public health in general, and maternal
and child health specifically, was cited as particularly valuable. A large
majority of respondents (83 percent; n=91) reported that they had had
a faculty mentor (see Figure 9), and they perceived the mentoring to be
quite important to their careers and education (see Figure 10). Trainees
appreciated the easy access to faculty and the personal encouragement
they received from faculty. Sixty-eight percent of former trainees who
received mentoring stated that the mentoring continued after they left
the training program (see Figure 11).
"Without the mentoring, my most significant
achievement to date—an article published in a peer-reviewed
journal would not have been possible."
-Former student, School of Public Health
Survey respondents were provided with a list of possible strengths
and asked to indicate which of these strengths applied to their respective
training projects. A majority of former trainees indicated that the
curriculum was quite strong (60 percent; n=66). In addition, those
in programs with a clinical training component rated that aspect as
a strength (60 percent; n=46). Those who trained in an interdisciplinary
model particularly appreciated their training, and many spoke eloquently
about the benefits of learning how to treat a child holistically and
how to incorporate a multiplicity of per-spectives—those of
various health professionals as well as the family—into treatment,
leading to a higher quality of services provided. These trainees not
only gained skills, but experienced attitudinal changes as well, learning
to understand the complex and multifaceted needs of children and the
roles of the various other disciplines also providing care to children.
"In traditional classroom settings, you don't
have the whole team communicating with you. You read about it but
don't really experience it. It was one of the greatest things to have
this experience. I don't think I could have gotten it any place else."
-Former student, Nutrition
In addition to identifying the strengths of their
projects, former trainees also identified areas in which the projects
could have met their needs better. Nearly one quarter of the respondents
(n=26) said they would have benefited from more administrative training,
such as managing staff, developing budgets, and dealing with workplace
issues. Although many touted the research component as a program strength,
others (18 percent; n=20) felt that research training could have been
stronger. Similarly, although the majority of the former trainees
interviewed were pleased with the mentoring they received, a small
percent (15 percent; n=16) stated they would have benefited from additional
one-on-one time with faculty. A few former trainees (16 percent; n=18)
would have preferred more attention to policy; suggestions for strengthening
this aspect of the project included having guest lecturers and developing
joint courses with a school of public policy.
Former trainees were provided with a list of topics
and asked if the Training Program had enhanced their knowledge in
any of the topic areas. Some of the topics in which trainees most
consistently reported increased knowledge are those that MCHB is especially
interested in promoting: knowledge of MCH programs and policies (82
percent; n=90); interdisciplinary services (78 percent; n=90); com-munity-based
programs (70 percent; n=77); advocacy (66 percent; n=73); population-based
public health practice (65 percent; n=72); and family-cen-tered health
practice (56 percent; n=62). Although cultural competence was not
included as one of the potential checkbox responses, two former trainees
stated that the program had enhanced their knowledge in the area of
Former trainees were also asked about new skills
that they had learned as a result of the Training Program. The most
frequently mentioned skill was critical thinking (78 percent; n=84),
whereas 71 percent (n=78) stated that the program had improved their
research skills, and 63 percent (n=69) stated that the program had
enhanced their policy and advocacy skills. Without prompting from
the interviewer, four trainees stated that the program had in general
improved their leadership skills.
"This training program accurately reflected
the complexity that exists in the field. And I had resources to draw
on when I left the program. I especially appreciate this now that
I am working with new therapists who haven’t had this background.
I realize how much I learned in a very short period of time."
-Former student, Occupational Therapy
A strong majority of former trainees (64 percent;
n=71) considered themselves leaders in their field (see Figure 12).
Many of the respondents who did not consider themselves leaders cited
current familial obligations as the reason. As shown in Figure 13,
a higher percentage of trainees who graduated in 1990 (76 percent;
n=29) viewed themselves as leaders than those who graduated in 1995
(58 percent; n=42). This is consistent with the common-sense notion
that achieving leadership takes time. In fact, several trainees noted
that they had not been in the field long enough and did not yet have
the experience to be considered a leader, but several commented that
they see themselves as being on a “leadership trajectory.”
"The way the whole thing comes together creates
a context where trainees and fellows really get to become
leaders in MCH with a lot of mentorship and guidance— everything
from developmental screening skills to researching policies and guidelines
to working on an interdisciplinary team."
Those trainees who saw themselves as leaders cited
as evidence activities such as teaching, program development and administration,
and policy work and advocacy through service on state advisory committees,
on task forces, and with professional associations. These activities
mirror the goals of the Training Program. Figure 14 provides examples
of leadership activities mentioned by former trainees.
Consistent with the findings of interviews with current
trainees, former trainees stated that the Training Program altered
their thinking about leadership and what they, as individuals, could
and should accomplish. One former LEND trainee noted,“I consider
myself a leader primarily because my notion of what a leader is has
changed, from that of ‘positional’ leadership to understanding
that leadership is an experience that comes from within oneself. The
Training Program fostered this kind of thinking.”
Figure 14: Examples
of Leadership Activities of Former Trainees
• Authoring book chapters
- Developing a training program for dietitians
- Teaching continuing education courses in neonatal
- Conducting training workshops for health education
- Teaching continuing medical education courses
- Designing and establishing a curriculum for
- Establishing a fellowship in developmental and
- Supervising psychiatry trainees
- Serving on the local medical school curriculum
Involvement with Professional Associations
- Participating on an American Physical Therapy
Association task force
- Serving as a delegate to the Alabama Nurses
- Serving 8 years on the state perinatal board
- Holding a leadership position in the Massachusetts
- Developing the specialty board exam for the
American Dietetic Association
- Serving on numerous community action groups
- Developing an interdisciplinary child abuse
and neglect team
- Serving on an advisory group to the state Medicaid
program to initiate funding for aug-mentative/alternative communication
- Participating in a group reviewing proposed
regulations on the Individuals with Disabilities Education Act
- Working as part of a state team to design and
implement training for special education professionals
- Serving as chair of the Surgeon General’s
Conference on Children and Oral Health
- Developing a new program and related office
in oral health at the University of Washington
In sum, these interviews suggest that the training
projects are quite successful in creating leaders (as defined by
the former trainees themselves and exemplified in the activities
they are pursuing); that most individuals trained through the program
remain in the field; and that former trainees believe their mentoring
experiences were quite helpful in directing their careers.
One Training Program
project director commented somewhat plaintively that “it would
help to have a definition of leadership.” An elusive concept,
training for leadership nevertheless has real benefits: It provides
helpful skills to many trainees, enhancing their ability to become
effective more quickly; it provides some trainees with a positive
sense of self-efficacy that may well contribute to success; and it
includes fairly intensive guidance to many trainees through mentoring
relationships that foster success. Most projects have intelligently
operationalized the term leadership in ways that have tended to enhance
trainees’ learning and to foster qualities that define leadership.