“I don’t believe in taking responsibility for other people’s emotions,” an intern once told me.
The statement wasn’t directed at me. We had a patient whose complex care was starting to wear down the team’s emotional morale, and as the weeks dragged on it was clear that we were all starting to feel it. But his bold statement still surprised me.
Somewhere else in the hospital, deep in the ORs, was a second-year resident who disagreed with that mentality. Once, during his usual PACU rounds, the resident had stopped me in the hallways just to ask, “How are you doing? Are you feeling like you’re being included as part of the team?” It was the one and only time a resident asked how I felt, and I felt like I was being included. He gave me the impression that, if I had said no, that he would find a way to fix it. It was only a few words, but the difference was striking. One resident was being a good leader, and the other was not.
As I get closer to residency, I have been thinking about the kind of resident I want to become. Of course, I want to be a good resident, but I also want to be more than just that. When I reflect on the personal qualities of the residents that I have respected the most during my clerkship years, predictable characteristics come to mind: approachable, patient, intelligent. But another unexpected quality appears on my list as well: good leadership.
I liked my intern. We got along. He laughed at my jokes. He was intelligent and incredibly hardworking. But compared with the PGY2 resident, the difference between their leadership skills was striking. It seems like such a small thing, to care about someone else’s emotional world. But throughout my clerkship years, I realized that caring about your team’s emotions has been a hallmark of strong leadership, and therefore, of a strong resident. But I also realized that our current medical education and training programs don’t teach medical students or residents how to be good leaders, leaving bright, capable residents and students like my intern to work it out alone.
Between research, teaching, administrative positions, and public policy, I have a difficult time conceptualizing a physician who practices without filling some form of leadership role. But there is a dearth of intentional, guided leadership training for students and residents. Instead, it seems like medical schools preferentially admit students who they believe have a propensity for leadership, with the hope that they grow into their skills. This mindset is propagated in residency programs as well. I can’t help but feel that this does a disservice to our students and residents, who are given vague missives to develop their leadership skills without any formal guidance or training, who are functionally told to “grow” without effective directions.
For example, as a fourth-year student helping in the first-year anatomy lab, I have found myself being disgruntled, frustrated, or bewildered with freshly minted medical students. Instead of wallowing in negative emotions, I could have used the experience as an opportunity to refine my own skills — problem solving, exercising emotional intelligence, practicing active listening — but wasn’t able to recognize the moment for what it was. I can’t help but wonder if my intern felt the same way when he made his brash statement about caring for others' emotions. Without practice and direction, talent remains just that — talent.
I have found that it’s easy as a student to see an attending in a leadership position and say, “Of course they’re in charge,” without critically thinking about the qualities that make them excel in that role. A common shorthand in our field is to define someone’s leadership by their academic accomplishments or years of experience, but when I reflect on my attendings who were also good leaders, the qualities that make them a good leader often aren’t visible on a CV. I think about one of my vascular surgery attendings years ago who was the program director of the fellowship. He had an impressive CV, but what people remember him for was his ability to remain calm under duress, and his seemingly endless patience. Or I think of my allergy attending, who was chair of her department. It was a position that was surely bolstered by years of research experience, but what I admired most were her people skills and unmatched ability to listen.
Identifying and critically reflecting on the qualities of a good leader are only a tiny part of the broader conversation around leadership in medicine. The next step of intentionally refining these traits in our students and residents represents the more challenging work that still needs to be done. Many graduate business schools have leadership seminars and courses integrated into the curriculum, but such programs are not seen in medical school curricula. For the past year, I have been looking for a way to improve my own leadership skills, largely through self-guided efforts. But self-guided improvement is hard. I’ve been reading books and listening to leadership podcasts, but there’s only so much a disembodied voice can teach me over my headphones. I also find that, while most advice I come across is admirable, it is rarely tailored to the nuanced needs of the medical field, where both teamwork and adhering to the command hierarchy is valued. Despite my independent study, I find myself right where I started — with good ideas but little practical know-how.
I acknowledge that the conversation around leadership training is nuanced, especially for women and people of color. There are obstacles external to students and residents that will affect their perceived capability as a leader that no training or mentorship can overcome.
Leadership is a learned skill and can be taught, refined, and directed. The wide variability of leadership abilities among students and residents further proves the need for medical education and training to include intentional leadership training, so that students and residents feel supported as they grow into their careers, and in turn, can support the people on their team. My intern admitted to me that he felt like he wasn’t a good leader, but he retained the desire to be a good leader regardless. It was unfair to compare him to the PGY2 resident, who had the benefit of age and a whole career outside of medicine in which he was able to refine his leadership skills before entering the field. I have a lot to learn and a lot to practice when it comes to leadership, but for now, I plan to start by asking my future students, “Do you feel like you’re being included on the team?”
What type of leadership education or training would you benefit from as a clinician? Share your thoughts in the comment section.
A Texas native and Massachusetts transplant, Dallas Walter is an incoming general surgery intern at the University of Massachusetts. Her personal interests include social disparities of health, diversity in medicine, and stand-up comedy. Dallas is a 2021–2022 Doximity Op-Med Fellow.
Illustration by Diana Connolly