An Opinion Piece About Leadership That Learns
- Jun 1
- 7 min read
Dr. Omosefe Christina is a Medical Doctor, Entrepreneur, and Founder of Elite Exams. She blends frontline clinical practice with medical education and community programmes to help International Medical Graduates (IMG) and African families flourish in their careers and communities in the UK.
When I arrived in the UK, everyone talked about familiarising doctors with the system, workshops, inductions, conferences, and some structured support. Yet I noticed that expectations were subjective, left to each doctor to navigate. I began to understand that real change was not driven by better induction. It was driven by learning, by building habits and systems that actually allow people to adapt.
Understanding the system for what it is
The NHS is built on strong values. We talk about breaking barriers and driving innovation in patient care, but we actually reward predictability over curiosity. This is because mistakes in healthcare have consequences. To maintain clinical safety, healthcare systems rely on routines and protocols, sometimes seen as “the way we do things here.” When you reward predictability without considering flexibility, you create consequences for the person who does things differently, even when different works better. The IMG who approaches a case differently, the supervisor who questions a protocol, the team that tries an alternative pathway; they experience that as risk. Risk to their evaluation, their progression, their standing.
The system does not need to explicitly punish deviation. It just does not reward it. In a system that moves fast, where trainees are constantly being assessed, withholding rewards has its own cost. People learn quickly: fit in, follow protocol, do not ask why. The person trained elsewhere learns it fastest, because for them, everything is already unfamiliar, and now conformity feels like the only safe choice.
Yet the system is never just a set of programmes or policies. The NHS is made of relationships between people and colleagues, organisations and people who shape and influence decisions, and formal and informal rules that influence behaviour.
To make lasting change, we have to understand the system’s true workings. We also need to recognise that what seems to be functioning as intended may actually be broken. There is an urgent need to address root causes for real improvement.
The power hidden in measurement
Every system reveals itself through what it chooses to measure.
In healthcare, we count patient numbers and waiting times, while we recognise that measuring experiences, such as whether a patient felt heard, is difficult. Numbers help us feel like we understand a system. But they also let systems ignore what does not fit the metric. Job satisfaction, whether an IMG felt respected, whether the system actually learned from failure; these disappear from the data. This means institutions can claim they are making progress while people are actually leaving. Research from BMJ Open and the British Journal of General Practice (2024) found that even after accounting for knowledge and experience, internationally qualified doctors faced lower pass rates in postgraduate exams.[1][2]
What the statistics hide is the accumulated weight of navigating a system that was not built with you in mind, and of performing at full capacity while learning an entirely new professional culture.
The scale problem
In many developing countries, professional relationships are strong. Learning is communal through departmental meetings, grand rounds, and bedside teaching sessions. Learning and adaptation were constant. We rarely worked in isolation. This is different in the UK. Structure, research, and governance are strong, but scaling up medical education can sometimes reduce the human closeness that supports learning.
I have seen educational and health innovations work in one learning community but fail to take off in another. The ideas were not weak; they may even be similar. It is easier to replicate models, but changing a learner’s mindset is more challenging. In medical education, real scale is not about size. It is about how well leaders and learning platforms learn across boundaries, how well they adapt to challenges, and how they generate momentum through constant reflection and improvements.
Establishing the leadership standard
If we want different outcomes, we need different approaches.
Create space for structured reflection and feedback, not just service delivery. IMGs need space for structured reflection, peer learning, and time to adapt. These are not niceties; we are building a sustainable workforce infrastructure. If you will not fund the right learning and support a doctor needs, you are saying: keep working at speed without understanding what you are doing.
Share decision-making power with the people being assessed. There is no doubt that IMGs bring insight to the development of policies. IMGs should help design the standards they are judged by. If you are not doing that, you are measuring them against criteria you will not let them shape, or criteria they do not understand. Isolated policies on exams and workplace assessments can create systemic discrimination.
Design systems for the people you actually have, not the people you wish you had hired. A huge percentage of the NHS workforce is internationally trained. There is a need for targeted induction programmes, workshops, assessments, and career and leadership pathways that align with that reality. We can no longer afford to design systems that cater to a few and expect everyone else to fit.
Shift evaluation from proof to progress. Ask: What did we learn? Not just: What did we deliver? When we start understanding the differences in expectations and learning, we create real impact. Asking the right questions enhances our understanding of what is needed, since we cannot learn from data that does not ask the right questions.
We all appreciate the value of simplified, actionable feedback, the kind that comes from a simple question, for example: “What surprised you about this?” This creates real-life learning through insight. Conversations remain honest. Learning becomes mutual. We then shift from box-checking to understanding.
A practitioner’s toolkit for real change
For those in the workplace, change starts with practice, not just strategy. Here are three everyday habits that sustain a learning culture in the workplace:
Listen past comfort. In clinical teams, this means actively asking IMG colleagues how they would approach a case, and genuinely considering alternatives to how “we do it here.” The organisational or diagnostic approach they learned elsewhere might solve something your team has been stuck on.
Make a reflection routine. If clinical debriefs are structured and regular, people start seeing patterns, not just checklists. Educators can have structured debriefs after significant decisions, or even encourage regular peer conversations about “what surprised you,” or take a bit more time to ask, “Why did this happen?” The exercise is about collective learning for all involved, not about performance management.
Reward adaptation. Why do we not celebrate adjustment and integration? Celebrating teams that adjust when things do not work is a way to acknowledge what we learn from failure and improvement. The same goes for IMGs who learn and adapt. That is worth celebrating. Failure is a waste only when hidden. If a clinical pathway fails, most teams revert and move on. Better teams say: “This did not work. Here is what we are trying instead.”
They are rewarded for that honesty, not punished. The same applies to supervision. If an IMG is not responding to one style of feedback, a supervisor who shifts approach, making it more direct, more written, or more collaborative, should be recognised as good practice, not seen as lowering standards. Hidden failures teach nothing. Visible adaptation teaches the system how to evolve.
These practical changes, repeated often, are what really shift the cultures most IMGs face. Sustained, these small everyday actions provide a source of lasting transformation for everyone.
Learning as survival
In medicine, we learn that learning and early feedback save lives. Organisations and their workforce systems are no different. The NHS depends on internationally trained professionals, especially in tough times. The GMC Workforce Report 2025 states that IMGs account for 42% of the workforce, yet their success rate in specialisation applications is 23%, compared to 69% for UK-trained doctors. Success, or failure, is not simply about individual clinical skills; it depends on a myriad of factors, ones that good leaders would enable their workforce systems to learn from.
The same applies to social innovation to support professionals who have migrated to the UK. Real change does not happen when key stakeholders sit on opposite sides of accountability. It happens when they learn together.
The leadership we actually need
As a physician and educator, I do not possess all the answers; who does? Real leadership is not about possessing all the answers, but about encouraging the right mindset to ask the right questions and creating the right environment, where insight and learning drive realistic change. It means asking better questions, creating space for uncomfortable truths about the real challenges IMGs face, and choosing humanity as a deliberate strategy. Systems do not transform through pressure. They evolve and survive through persistent learning.
Consistent learning is necessary for system survival and renewal. Leaders must prioritise and model this approach for real progress. That statistic, 42% of the workforce and 23% application success, is a system failing at learning. This is not slow change; it is active failure. Systems that do not learn from 42% of their workforce will lose them. The choice is not between an optional learning culture and business as usual. It is between learning now or collapsing later, when the people you depend on have already left.
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Read more from Dr. Omosefe Christina
Dr. Omosefe Christina, Medical Doctor, CEO and Founder
Dr. Omosefe Christina creates digital learning platforms that turn frontline experience into practical support for international doctors in the UK. She is the CEO of Elite Exams, which supports the medical education of international trained doctors aspiring to become independent GPs. She builds digital systems, courses, platforms, and automated learning pathways to support doctors who migrate to the UK.
References:
[1] Woolf K et al. Perceived causes of differential attainment in UK postgraduate medical training. BMJ Open. 2016.
[2] Brown et al. Language of primary medical qualification and differential MRCGP exam attainment. BJGP. 2024.
[4] GMC Workforce Report 2025, BMA summary.
[5] Schwab Foundation & World Economic Forum. Why Collective Social Innovation is Future Philanthropy. 2025.
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