Leadership or Control? A Barrier to Student-Centred Learning in Pakistan’s Health Professions Education

Abstract

Health Professions Education has evolved substantially over the past three to four decades, particularly following the introduction of the SPICES Model (1984) by Ronald Harden (see figure 1).¹ This marked a major shift from teacher-centered approaches to student-centered learning, with an increased emphasis on the student’s abilities, needs, learning styles, and interests rather than those of the teacher.² On the other hand, the teachers’ role is not limited to just an “information provider”, but also a facilitator, a role model, a planner, an assessor, and a resource developer.² The successful implementation of student-centered educational frameworks depends not only on curriculum design, but also on leadership practices that shape educational culture.

Figure 1: SPICES Model by Harden (1984)¹

Health professions education is undergoing another significant transformation with the integration of global Artificial Intelligence (AI). Emerging AI applications in health professions education across learning and teaching, clinical practice, research, and educational leadership are reshaping institutional expectations and educational roles.³ The integration of AI further challenges traditional leadership styles, as effective use of AI in education requires adaptability, trust, experimentation, and learner autonomy. The culture of health professions education in Pakistan is predominantly characterized by authoritarian practices.⁴ However, the country appears to be in a transitory phase, with health professions leaders, educationists, and educators demonstrating a spectrum of leadership styles ranging from authoritarian to transformational, often exhibiting hybrid characteristics.^4,5 The problem with the predominant authoritarian leadership style is its fundamental incompatibility with student-centered learning, which relies on psychological safety, collaboration, and learner autonomy.^2,6 What exactly is at stake if authoritarian leadership persists? Learner autonomy, psychological safety, faculty engagement, and the sustainability of student-centered educational reform. Authoritarian leadership relies on compliance and hierarchy to manage educational environments, emphasizing centralized authority and control and often limiting autonomy and participation.⁵ In educational settings, authoritarian practices tend to produce passive learners and foster a fear of making mistakes. Persistent authoritarian leadership can limit educational reform, learner development, innovation, and faculty engagement. In contrast, transformational leadership emphasizes facilitation, collaboration, critical thinking, and partnership. Transformational leadership supports the development of active and reflective learners by empowering, inspiring, and intellectually stimulating them, encouraging them to work towards shared educational goals. Transformational leadership can help promote student-centered learning environments and foster collaboration.^5,6

Steps can be taken on multiple levels to reshape educational environments within health professions education in Pakistan. At a macro level, regulatory authorities need to align national policies with student-centered educational values. At the institutional level, health professions education institutes should offer periodic leadership development programs focused on reflective practice, communication, effective feedback, facilitation, and change management.^5,7 Leadership appointments and promotions should be guided by educational leadership competencies rather than years of service alone. Institutions should also strengthen mentorship processes, promote shared decision-making, foster role modeling, support leadership research, and amplify faculty voices.^2,6 At an individual level, this paper calls on educational leaders, educationists, educators, and learners to critically reflect on their own leadership styles and actively develop characteristics conducive to student-centered approaches. Promoting transformational leadership and student-centered approaches is not solely the responsibility of those in key leadership roles. Every leader, educationist, educator, and learner has a role in creating an environment that fosters collaboration, shared decision-making, student-centered approaches, psychological safety, trust, and learner autonomy. Re-examining current leadership practices is key to achieving student-centered educational reform in Pakistan.