For years, I’ve been preaching a proposition I consider self-evident: physicians exercise leadership competencies every day, and those competencies should be on a par with their cognitive and technical abilities. Physicians can have all the knowledge and technical skill in the world, but if they lack the ability to influence patients, families, and healthcare teams, they won’t be as effective as they otherwise could be in their practice.
We have always recognized that doctors need cognitive and technical competencies. And we invest a tremendous amount of effort and expense in ensuring they acquire them.
The cognitive work begins on day one of medical school. You’re learning, you’re reading, you’re attending lectures, you’re participating in group discussions. You’re looking at X-rays and labs, studying anatomy and physiology. Identified resources are provided to you—libraries and published works, and online sites like Google Scholar, AMBOSS, and Geeky Medics. You’re tested and evaluated, and you can’t progress unless you pass those tests.
In the technical realm, the hands-on work starts very early. Anatomy is one of your first courses, and you spend countless hours dissecting tissue and looking at anatomic structures. You have labs on practical skills, where you learn how to tie knots, handle endoscopes, and maneuver surgical equipment. You’re introduced to the OR and start learning how to prep and drape patients, make incisions, and stop bleeding. Even if you don’t end up in a specialty where a lot of procedures are performed, you’re still exposed to technique.
So we know how to do this. We know how to teach and build competencies. We know how to combine classroom work, practical work, and experiential feedback. We know how to help students learn core concepts and apply them in case-based scenarios, and then take them out into real hospitals to acquire experiential learning. We have structures in place to provide them with feedback on their progress throughout both cognitive and practical learning.
All those steps apply equally well to teaching leadership. The military offers a great example of this. From the minute you step off the bus in basic training, you’re learning how to follow orders, then you’re learning why that’s important, then you’re learning how to lead small groups, and so on, with constant feedback on how you’re doing from both your instructors and your peers.
We already possess the ability to do something similar in medicine, without adding time or structure. Here’s a good example: You’re a surgeon standing at the scrub sink with a resident, preparing to go into the next case. You use that time to talk about how things went in the first case—how the suture line looked at the end and how the resident did a nice job of getting the bleeding under control.
But let’s say there was a fumbled handoff of an instrument, which fell on the floor, and the resident just calmly said to the scrub tech, “Oh, that’s okay, I’ll use that one, and let’s see if we can get another one up to replace it.” As the surgeon teaching leadership, you can and should provide feedback on that exchange as well. “You did a nice job with the tech there. You dropped an instrument, and you could have let it rattle you or yelled at the tech, but you maintained composure in a stressful moment. Everybody moved on, and nobody experienced negative emotions, which can impact the performance of the team.” You’ve now reinforced some important leadership competencies in a natural way.
So, again, we can teach leadership just as we teach cognitive and technical skills—by introducing concepts in the classroom, identifying their applications in clinical settings, and offering feedback and instruction in real-time. All that’s required is that we recognize leadership as a necessary competency rather than just a “nice to have”, and commit ourselves to teaching it in the same ways we teach those other competencies.