We need medical leadership built on trust

Trust is central to the practice of medicine, but recent events have shown it to be fragile, even within our professional communities.

In 2022, the Ipsos Global Trustworthiness Monitor asked people from 29 countries what attributes were most important when deciding whether to trust an organisation or institution.1 The top three responses were: “If it is reliable/keeps its promises,” “If it is open and transparent about what it does,” and “If it behaves responsibly.” Recent events have shown that our medical community has lessons to learn.

The announcement by the UK Foundation Programme Office (UK FPO) that the appointment process for the Specialised Foundation Programme will change in 2025 to preference-informed allocation, a system that does not take account of previous academic attainment, has left many medical students feeling distressed.2 The change in the recruitment process impacts many students who made decisions based on the current system, only now to find the rules have changed without them being consulted. Consequently, they are asking if other components of integrated academic training programmes may also be subject to unheralded change, and it is difficult to reassure them convincingly.

The extraordinary general meeting (EGM) of the Royal College of Physicians (RCP), held on 13 March, has similarly engendered mistrust and anger among the medical community.3 Before the meeting, a survey of college members was undertaken to seek the views of doctors at all stages of their careers on the impact of the introduction of physician associates.4 A limited and misleading summary of the survey findings was shared at the EGM, resulting in widespread calls for the entire dataset to be immediately made available to allow fellows of the college to take the survey findings into account when voting on a series of motions over the coming days.5 The RCP has now published the full dataset, and it appears that the messages emerging from the data and those presented at the EGM are not well aligned.6

The 2023 NHS England staff survey showed that 45% of the 707 460 staff (48% response rate) who completed the survey were satisfied with the extent to which their organisation values their work.7 Only 71% of respondents felt that their immediate manager cares about their concerns, and 68% said that their immediate manager takes effective action to help them when they face challenges. It is inconceivable that we can have a thriving and vibrant medical community when we do not trust that our voices will be heard or that action will be taken when we raise what we perceive to be important issues. The Edelman Trust Barometer 2024, which aims to understand the acceptance of innovation across the world, highlights that hearing people’s concerns and allowing them to ask questions are among the top three trust-building actions sought by people when they are being asked to accept change.8

At a time of change, when trust in our medical organisations and institutions is fragile, we require leadership that understands that building trust requires reliability, transparency, and responsibility—actions must align with words and professional values. We need to ensure that all members of our community feel assured their voices will be heard and the issues they raise will be listened to and tackled rather than ignored or dismissed.

Trust is hard won and easily lost—or, as the Dutch proverb says, it arrives on foot and departs on horseback.