359- What is your diagnosis of the situation?
- What is your hypothesis or theory about what happened?
- As a surgeon leader, what would you do?
- How would you communicate that idea?
During the case discussion, there is simultaneously too much general information
and never enough specific information. There is time pressure and uncertainty in the
situation, but the basic question remains: What would you recommend? As a leader
you must guide and motivate the group. What is your decision? What would you do?
A student is called upon to answer. When a student gives an answer, the profes-
sor then asks, What do the rest of you think? Would that work? Why or why not?
The discussion begins. There are rational and emotional reactions from students.
From time to time, there is a covert activation of biases that support the student or
argue with the student’s thinking. The instructor must weave together the discussion,
building on the ideas, summarizing the conditions under which some ideas work and
other will not. By enabling a case discussion to become a collaborative experience, it
becomes an opportunity for everyone to reevaluate their own ideas and the quality of
their thinking and to confront and reflect on their own attitudes, biases, and prior
experiences—i.e., an occasion to learn. The responsibility of the instructor is simply
to lead the case discussion and, as such, to enact the learning process.
Professionals learn from good stories. Following are several cases I have used
when teaching surgeons.
Case 1: Surgical Leadership in the Removal of an Unexploded
Ordnance
On March 16, 2006, American soldiers were on a mounted patrol in Afghanistan. As
the Americans were coming around a bend in their vehicles, they were ambushed from
the left. The Americans were under attack from small arms fire and then heavy arms
fire with rocket-propelled grenades (RPGs). One RPG went over the head of the US
truck and struck an American soldier, Chaney Moss, in his abdomen piercing his pelvic
bone and lodging in his right thigh. As the wounded soldier, Chaney Moss, recalled:
I felt the cool breeze of the chopper coming and I could see the yellow smoke. I thought
about my wife and my girls growing up without me. I had those quiet moments on the heli-
copter. I thought I was going to die. I didn’t think anyone could save me. But if I did survive,
I would not be able to function. I felt at peace at one moment. That’s if I did die, I died for
the right cause and I did the right thing. But you want to fight and you want to live. Your
inner feeling is to fight and go on. You can do this. We touched down at OE, and everyone
was rushing.Chaney Moss was brought inside the forward surgical unit. The general surgeon,
Captain Oh, took away the dressings and realized that the soldier had live ordnance
in him and he told everyone to get out.
The general surgeon recalled the situation and how he reacted as a leader:
I never saw an RPG before. It looked like some kind of munitions--it had fins on it. The
guideline is, you do not bring the soldier in. You leave them outside. I was scared. I was
scared “shitless.” I have never been so scared in my entire life. You look at the guy and then
you think, there is no way I am going to let this guy die.20 Teaching Surgeons How to Lead