AAP – Section on Medical Students, Residents and Fellowship Trainees

presents …

LEADERSHIPCHALLENGE

Drawn from the Research Efforts of James Kouzes and Barry Posner

LEADERSHIP BEGINS WITH YOU.Everything you will ever do as a leader is based on one audacious assumption. It is the assumption that you matter.

You Make A Difference.

Truth #1  

Why You Matter?

Pediatricians have unique role in society to impact health of children and families.

Leadership is accessible to anyone who has passion and purpose to change the way things are.

Your personal experiences are unique and valuable, and they can be harnessed to achieve positive change.

As an intern in continuity clinic, you see your third patient in the past month with elevated lead levels. As you look back in their charts, you notice that they all live on the same street a few blocks away from your clinic.

You start to wonder whether this is just a coincidence or whether there is a problem with the soil, paint, or water supply in that area. You want to help your patients, but you are not sure if your efforts will matter, or if you are the right person to lead on this issue. What should you do?

Case 1  

Is this a problem that requires action? Are you the right person to get involved? What happens if you don’t act on your concerns? What initial actions can you take to help your patients? If not you…who? Who are potential partners in your clinic

or community that can help you make a difference? Is your gut telling you action is needed and you can do

something about it?

Consider …

HONESTY IS THE BEST POLICY.If people don’t believe you, they won’t willingly join or follow you. You must do what you say you are going to do. This means being clear about your beliefs and demonstrating with your actions that you live them every day. 

Credibility Is the Foundation of Leadership.

Truth #2 

http://www.cartoonmovement.com/cartoon/4821

Trustworthy

Value-driven

Honest

Principle-centered

Synonyms 

Impact of LOW credibility?

Employee burnout (Gabris, 1996)

Low sense of team spirit (Kouzes and Posner 1993)

Distrust in information (Roberts and O’Reilly 1974)

Better teamwork (Lewis, 1959)

Improved group problem solving (Zand, 1972)

Satisfaction with leaders (Falcione 1974, 1976)

Organizational satisfaction (Kouzes and Posner, 1993)

Impact of HIGH credibility?

Your attending continually reminds you about how to “appropriately” prescribe antibiotics for patients with URI symptoms. He has given several lectures on the topic to your class and at national meetings. He has also written several editorials to medical journals on the issue.

Despite this, you also note that when you are rotating with him in the ED, he often is much more liberal in his prescribing practices than he suggests to you from his lectures. Today, he is clearly prescribing a patient an antibiotic who does not need one, but the family insisted. When you query him about it, he notes that “several factors play a role in this decision” and it may “affect patient satisfaction ratings” if you do not comply with the families wishes.

Case 2  

What does this behavior make you think of him? Does it devalue any educational information or advice

he gives you in the future? How do you reconcile his teachings with his practice? How can you best bring this issue to the attention of

someone who is higher up the chain than you? What can you do in this specific situation if you firmly

believe that the prescription is not best for the patient?

Consider … 

BE PROUD OF THE VALUES YOU HOLD DEARYou need to know what you believe in because you can only fully commit to the organization or cause when there is a good fit between what you value and the organization values. This is true, too, for the people you lead.

Values Drive Commitment.

Truth #3

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What Drives You? People want to know

what you stand for

People want to feel they belong to a community with shared vision and values

People want to feel a part of something great

Your community has recently been tragically affected by gun violence. In addition to providing support to your patients affected by the incident, you strongly believe that proactive violence prevention programs would improve the community.

Case 3  

How could you best use these values to lead a violence prevention advocacy campaign?

What strategies will you use to engage other trainees and the community in your prevention program?

How will use your community’s values to inspire a shared vision and make an impact?

Consider … 

Focusing on the Future Sets Leaders Apart.YOU HAVE TO BE FORWARD LOOKING.It’s the quality that most differentiates leaders from individual contributors. You need to spend time reflecting on the future. Big dreams that resonate with others inspire and energize.

The quality of being forward-looking is second only to honesty as the most admired leader characteristic.

Truth #4  

How Do Leaders Become Forward-Looking? Spend more “mind” time in the

future Read materials articulating

visions of the future Create a “future research”

committee or a team focused on tracking innovation and new trends

Practice articulating visions of the future that open possibilities and lift people’s sights and spirits

Residents in your program are unhappy about current work hour restrictions. Many feel that regulations are preventing them from getting enough rest and that their exhaustion is affecting their ability to care for patients.

As a Chief Resident, you know that your program is beginning to interview potential candidates for the upcoming residency class. You don’t want the frustration of current residents to continue or to affect the perceptions of the interviewees. You need a future-focused strategy to improve work-life balance and resident well-being.

Case 4 

Do you have a vision for a better way? A better culture? Does anyone know about it?

What strategies would you use to engage the current residents in a discussion about new vision and culture change?

How can focusing on the future help leaders make educated and informed decisions?

Consider . . . 

BE A TEAM PLAYER, NOT JUST A LEADER!Leadership is a team sport, and you need to engage others in the cause. You need to enable others to be even better than they already are.

You Can’t Do It Alone.

Truth #5  

ENGAGE

http://2.bp.blogspot.com/-YPEn3BQ0Ruw/T8T-doYTAsI/AAAAAAAAATM/WHeCGTPmHpk/s1600/Dilbert_Unmentioned+Goals.jpg

It’s 7 am and you are starting as a ward senior on a new rotation. When you arrive in the work room, the medical students are online checking their Facebook. One of the interns arrived late and the other greets you by stating that “she is tired of being an intern”

How will you conduct successful rounds that first day and how will you begin to develop a team atmosphere?

Case 5  

Interns might not automatically know the expectations, since they encounter different seniors and working styles

Seniors should have opportunity to discover their own leadership and personality styles and how it influences engagement of others

Many conflicts might be avoided if senior sits down individually with each team member to review expectations and goals

1 minute manager rules can be applied1. Emphasize goal-setting with individual and team

goals2. “Catch people doing something right”3. Provide immediate feedback (routinely offer

alternative suggestions and give positive feedback)

Consider . . . 

Pay Attention to your TEAM! Your attitude affects everyone

Always find positive things to say about your team members

Never talk badly about other leaders

It should never be about ME! Focus on your team and how to help them and, in turn, they will help you

TO ENLIST OTHERS, YOU NEED TRUST. Build mutual trust; you must trust others too. 

 Trust Rules!

Truth #6 

Trust is defined by Character (your integrity and intent); and Competence (your capabilities and results)

As physicians, we work in teams everyday It is important to build trust within the team Allow team members to do what they do best and

have autonomy

Teams that feel unimportant underperform

Foster accountability

COMPETENT TEAMS ARE BUILT ON TRUST

December is your first rotation as a senior resident on service. Your day never ends. You are calling every consultant personally. You double and triple check all of your interns’ work before going home.

During rounds, you are quick to correct any mistakes when the interns are presenting to make sure your attending knows you are on top of things.

You do not understand how the other resident team seems happier and more efficient.

Case 6  

Trusting your interns to preform their responsibilities then follow up

Prepping the interns prior to rounds will make the entire team look good rather than undermining in front of the attending

Make sure your interns know they can depend on you if they are struggling

Consider . . .  

LEADERSHIP IS ABOUT LEADING THROUGH CHANGE.The key to leading through challenge is grit, the ability to keep pushing and be resilient through the stress of change.

Challenge is Crucible for Greatness.

Truth #7  

The Importance of Challenges

Leadership is most needed in challenging times.

Challenges require great resilience to keep pushing forward through the stress.

When the challenge wins, it is important to learn from failure.

New AAP guidelines on the treatment of infants with bronchiolitis recommend against a trial of a short acting beta agonist (albuterol).

However, most physicians at your institution have not yet widely adopted these guidelines.

You decide to implement a quality improvement project on the topic at your institution.

Case 7  

Curve of Innovation AdoptionN

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TimeIdea developed

Leaders Laggards

Leaders are in the minority when a new change is beginning to be implemented.

There are few leaders, and you have to be one of the first in line.

Who will you reach out to in order to help begin implementation?

How will you generate buy-in from your fellow trainees? Attendings? Nursing staff?

What will you do with complaints about the process from your colleagues?

Not everyone will uptake the process immediately. Will you identify these individuals? If so, how?

How will you coach them?

Consider . . .  

YOU HAVE TO GO FIRST AS A LEADER. That’s what it takes to get others to follow your lead.

You Either Lead by Example or You Don’t Lead at All. 

Truth #8  

You are planning to begin your Chief Resident year when you learn that the residency Program Director and the Department Chair are leaving the institution in the next two months. A brand new intern class is set to start residency in three months.

You are shocked and a little upset, but you believe 1-2 key changes could really help improve the program. Uncertain about who the new Chair or Program Director will be, you are determined to see them through.

Case 8  

How will your role and leadership be affected by this change?

How are the other people on your team reacting to the change?

What can you do to prepare the current and future members for the change?

How will you prepare and fight through the challenge? Can you still achieve your priorities for this year?

Consider . . .  

LEARNING IS THE MASTER SKILL OF LEADERSHIP. Leaders are constant improvement fanatics. 

The Best Leaders Are the Best Learners.

Truth #9 

10,000 HOURS RULE-Malcolm Gladwell, OUTLIERS

https://en.wikipedia.org

Malcolm Gladwell proposed in OUTLIERS that it takes 10,000 hours of practice to become great!

He used Bill Gates and the Beatles as examples.

Case 9  

You have graduated from residency last year. As a new attending, your first year was not what you expected.

You always loved cardiology and had debated fellowship in the past.

You also miss the teaching and learning associated with an academic environment.

You have become aware and interested in building your leadership skills with an eye toward future leadership roles.

Should you change to a field that aligns more closely with your passion?

Are there other ways to incorporate continual learning and education into your current practice?

Are there other ways to improve and practice your leadership skills?

What ways can you become involved in the community or other professional organizations?

Consider . . .  

LEADERS LOVE WHAT THEY’RE DOING AND THOSE THEY LEAD.Leaders make others feel great about themselves and are gracious in showing their appreciation.

Leadership Is an Affair of the Heart.

Truth #10  

Show them that you care

Fall in love with what you do

Promote the positive

Love is the soul of leadershiphttp://www.skipprichard.com/becoming-a-heart-centered-leader/

This rotation you have a “very nice” attending who enjoys being on the wards and brings team treats and coffee. However the rounds are not that pleasant, she runs on tangents and does not teach much.

How will you as the team senior improve teaching during the month?

Case 10 

Planning a meeting in advance with the attending

Open dialogue by asking to talk about personal experiences as a resident on the wards

Create a list topics of interests from all team members and give attending

Find things that attending love to teach and match with the list

Consider . . .  

Have fun on your journey to become great leaders!

Thank you to the Leadership and Growth Workgroup …

Ken Slaw, PhD Julie Raymond, CAE

Sameer Vohra, JD MD Jennifer Gerardin, MD

Joshua J Davis Irina Prelipcean, MD

Shannon Brockman, MD Britta Roach

Danna Qunibi, MD