344
Merely promoting well-behaved physicians into “accidental” leadership posi-
tions is like allowing a laparoscopic surgeon to do a prostatectomy with a da Vinci
robotic device without any advanced training and practice. We need physicians with
advanced leadership training, so that they can not only define shared clinical visions,
but also build commitment, and implement medical reforms that challenge assump-
tions, traditional roles, behaviors, and systems of authority (see [ 55 ]).
This chapter examines the importance of teaching leadership to surgeons and
adding leadership training and development as part of contemporary surgical educa-
tion. Teaching leadership to medical students, surgical residents, fellows, and other
surgeons is a challenge for medical professionalism [ 38 ].
There is no end to the many ways we can waste time and distract students with
abstract theoretical approaches to leadership or other popular notions. Leaders need
to be taught practiced and effective concepts and tools. They also need feedback on
their behavior and a safe space in which to reflect with a coach. Leaders who can
reflect on their behavior will always be on a steep and asymptotic learning curve:
feeling challenged,^10 assessing their own behavior and the outcomes, and learning
from small mistakes [ 1 , 7 , 20 , 30 , 50 ].
Leadership training and development requires activity in the presence of knowl-
edge. It requires an application of knowledge as well as experience and skills and a
willingness to commit to the responsibilities of leadership, to understand the impor-
tance of a leader as a role model, and to believe in the capability of the team.
It also requires a relentless willingness to:
- Learn from mistakes.
- Take full responsibility for outcomes (never finger-point or excuse yourself from
poor results) - Communicate why the mission and goals are important and meaningful to
everyone
Not everyone will agree that every surgeon should be the ascribed or emergent
leader. Some surgeons may have notable abilities (knowledge, skills, and experi-
ence) to be leaders; they may also have appreciable disabilities. What is certain is
that not all leaders are effective in every situation unless they are able to diagnose
and analyze the situation and adapt their styles. So, while there may be few “born”
leaders, we can train many surgeons to become better leaders. That may be the most
important and hopeful lesson for surgical education and the future of health care.
The remainder of this chapter is broken down into six main sections: (1)
Leadership Versus Management: Some Definitions; (2) The Surgeon as Leader; (3)
Teaching What They Need to Know: Leadership Models Not Leadership Theory;
(4) Teaching Leadership to Surgeons Using Cases; (5) Physician-Centered Learning
(^10) To deprive leaders of feedback is to cheat them, and yet evolutionary psychologists tell that for
most human beings, negative feedback leads to hurt feelings (see [ 43 ]).
J.A. Chilingerian