Chapter 1: Fundamental Principles of Leadership Training in Surgery

KEY POINTS

1. Effective surgical leadership improves patient care.

2. A fundamental principle of leadership is to provide a vision that people can live up to, thereby providing direction and purpose to the constituency.

3. Surgical leaders have the willingness to lead through an active and passionate commitment to the vision.

4. Surgical leaders have the willingness to commit to lifelong learning.

5. Surgical leaders have the willingness to communicate effectively and resolve conflict.

6. Surgical leaders must practice effective time management.

7. Different leadership styles are tools to use based on the team dynamic.

8. Surgical trainees can be taught leadership principles in formal leadership training programs to enhance their ability to lead.

9. Mentorship provides wisdom, guidance, and insight essential for the successful development of a surgical leader.

INTRODUCTION

The field of surgery has evolved greatly from its roots, and surgical practice now requires the mastery of modern leadership principles and skills as much as the acquisition of medical knowledge and surgical technique. Historically, surgeons took sole responsibility for their patients and directed proceedings in the operating room with absolute authority, using a command-and-control style of leadership. Modern surgical practice has now evolved from single provider–based care toward a team-based approach, which requires collaborative leadership skills. Surgical care benefits from the collaboration of surgeons, anesthesiologists, internists, radiologists, pathologists, radiation oncologists, nurses, pharmacists, social workers, therapists, hospital staff, and administrators. Occupying a central role on the healthcare team, surgeons¹ have the potential to improve patient outcomes, reduce medical errors, and improve patient satisfaction through their leadership of the multidisciplinary team. Thus, in the landscape of modern healthcare systems, it is imperative that surgical training programs include formal instruction on leadership principles and skills to cultivate their trainees’ leadership capabilities.

Many medical and surgical communities, including residency training programs, acknowledge the need for improved physician leadership.² Surgical trainees identify leadership skills as important, but report themselves as “not competent” or “minimally competent” in this regard.^2,3 While a small number of surgical training programs have implemented formal curriculum focused on teaching leadership principles, it is now imperative that all surgical training programs teach these important skills to their trainees.^4,5 Interviews of academic chairpersons identified several critical leadership success factors,⁶ including mastery of visioning, communication, change management, emotional intelligence, team building, business skills, personnel management, and systems thinking. These chairpersons stated that the ability of emotional intelligence was “fundamental to their success and its absence the cause of their failures,” regardless of medical knowledge.⁶ Thus, training programs need to include leadership training to prepare trainees for success in modern healthcare delivery.

In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has established six core competencies—patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice (Table 1-1)⁴—that each contain principles of leadership. The ACGME has mandated the ...