349Broadly speaking, teaching surgeons about leadership theory may not be relevant
to most surgeons’ work. These theories have been developed to align with basic
social science theories often using standardized measurement and convenient math-
ematics for purposes of research, publication, or edification. Most of these theories
have not been developed to teach people how to lead. However, it will be helpful to
begin with a very brief review of the literature, which I will do in the next section.
A Brief Review of Some Leadership Theories
Leadership theory courses often start with ideologues and heroic leaders, such as
Moses, Joan of Arc, Genghis Khan, Napoleon, Gandhi, and Mao Tse Tung.^18 All of
these are entertaining and interesting as historical leadership studies. From there,
the history of leadership follows with a search for “idealized” personality traits of
these great leaders. Drawing on psychology, social psychology, sociology, and other
social sciences, the literature continues to evolve.
Today, the literature includes descriptive studies of skill sets (technical,
interpersonal, and conceptual), contingency approaches, theories of transactional
versus transformational or charismatic leadership, path-goal theory, leader-
member exchange, and the like.^19 There are no stable theories of leadership.
Perhaps studies of clinical and managerial situations reveal far too many variables
and insufficient observations to develop a strong theory. Significant variables pop
in and out.^20 Every one of these so-called theories of leadership has some strengths,
but also some serious criticisms and critiques of their scientific quality.^21 Leaders
are left with broad generalizations and platitudes: model the way, challenge the
process, enable others, inspire a vision, and encourage the heart, rather than the
conditions under which some behaviors will be more effective and more likely to
achieve a goal than others.
While leadership theories may be useful for academic research or to explain or
describe events and behaviors, teaching surgeons a leadership model that can be
applied may be more useful.
(^18) All of the leaders mentioned above mobilized people and accomplished some aspiration. They
became heroes or villains. It can be said that without Moses, his followers would have remained in
Egypt as slaves.
(^19) For a more complete description of the rich literature on leadership concepts and theories, see
[ 44 ], Leadership: Theory and Practice.
(^20) A recent example is the review of one of the trendier theories of leadership—charismatic-
transformational leadership theory. The review essential closed down this body of work as having,
lacking in conceptual clarity, confounding leadership with its effects, suffering from valid
measures, and resulting in unstable findings (see [ 33 ]).
(^21) Some scholars see the leadership as a weak science. There are no “barriers to entry” and no spe-
cialty boards examining the knowledge and skills of leadership coaches and leadership gurus. The
danger is that some sell what Stanford Business School Professor Jeffry Pfeiffer calls a pseudosci-
ence or “Leadership BS” (see [ 45 ]).
20 Teaching Surgeons How to Lead