Guest post from Matthew A. Hunt, MD, Associate Professor and Resident Program Director, University of Minnesota Department of Neurosurgery
Coridon J. Quinn, MD, Neurosurgery Resident, University of Minnesota
Kristi Olafson, Stone River Consulting, LLC, St. Paul, Minnesota
Teach a neurosurgeon to be a leader? If you think about it, it makes a lot of sense. Leadership skills are inherent to successfully navigating our role. As physicians, we need to be the best advocates for our patients by leading our teams. For most physicians, this includes both the office and in the hospitals. For neurosurgeons, we also must lead in the operating room.
Health care systems are looking for physician leaders with collaborative leadership skills. That requires preparing newly minted neurosurgeons to navigate systems and organizations both inside and outside their worlds. While leadership may be inherent to the role, it’s uncommon for this skill to be taught to residents as they become neurosurgeons. But through an innovative program, that is what we’ve started doing at the University of Minnesota. Our goal is to create these leaders.
The raw materials are there; most neurosurgery residents are energetic, eager to help others, and committed to bettering patient care. Whatever leadership role chosen — department chair, hospital or community directorship or organized medicine responsibility — we want them to be able to lead where they live.
While many critical leadership skills are universal, neurosurgery requirements differ in important ways from those in other professions. For example, in the operating room, the teams may change from case to case and day to day. We have to pick up quickly on different processes, on the different ways people interact, and still be able to lead them to a successful outcome for the patient. And we have to do all that under time pressure, with a patient’s outcome and well-being on the line. This makes the leadership stakes much higher in our profession.
Under such stressful circumstances, unconscious behavior patterns known as “de-railers” can rear their ugly heads. They are the things that make us less successful. One important lesson we teach our residents is to leverage their strengths instead of falling into these weaker areas or old habits. The residents completed an assessment process designed to help identify their values, personalities, and “dark sides” (de-railers). The Hogan Leadership Forecast Series, as well as other exercises and tools, were used to for this component of the program.
Program success also required that this work fit within a predefined competency framework, which integrates the personality-related traits with specific needs and goals in neurosurgery. The model contains three primary areas:
- Thought leadership — Where am I headed? What do I as a neurosurgeon want to create for my field, my patients, my students?
- Team leadership — Am I building a team or dividing it? How am I helping others cope with stress? Am I compassionate and collaborative? Are we going further together than alone?
- Personal leadership — Am I leading with integrity and accountability? Am I taking care of myself so I can show up for work and take care of my patients in a high-quality manner?
We’re helping our residents understand that they have choices in every moment. What they choose defines them and defines how people remember them. While not all components of patient care are controllable, intentions, attitudes and responses can and should be. The residents are learning to be mindful about the kind of leader they intend to be and the kind they’re showing up as every day.
The competency model provides a framework for how our residents are taught about leadership, and as supported by the Accreditation Council for Graduate Medical Education (ACGME), there are milestones to help individuals set and achieve goals. This process produces tangible and measurable individual improvement. A loop-back process was built in to help embed ownership for leadership development with the residents. This required timely reassessments, to revisit their growth and challenges on a regular basis. Through this, they would reconsider the goals they have achieved and look ahead for new challenges.
Another aspect of the work was making sure that the department’s mentoring and coaching processes aligned with the leadership development curriculum. We created a mentoring agenda that touches on all major areas of the competency model, as well as the milestones, giving it more structure and guidance. As a result, the residents have people who, for the period of their residency, are dedicated to helping them grow, learn, and be successful in their practice to help them become who they want to be.
This innovative program hopes to provide essential new skills that allow neurosurgeons to assure the highest quality of care for their patients while sustaining job satisfaction. Whether these lofty goals are fully realized will take years. Training a neurosurgeon through residency does take seven years, so it is still too early to see the final product of this program; however, we believe that the short-term goals of improving resident performance, satisfaction, and ultimately patient care, are already evident.