Editor’s Corner: Learning to Lead

Elizabeth Brém, MD
Assistant professor of medicine at University of California Irvine Medical Center in Orange, CA

We learn a lot in medical school. But as I move through my still-early career, I find myself occasionally reflecting on what we are not taught. As it turns out, continuing education does not just refer to continuing medical education.

Physicians, researchers, and advanced practice providers are not traditionally taught how to teach, even though we are frequently called upon to educate others. Luckily, this is beginning to change. Many larger residency programs have clinician educator tracts. The American Society of Hematology (ASH) established its Medical Educators Institute (MEI) in 2016. Some of our institutions hold teaching workshops of varying lengths for trainees and faculty. Of course, we also are now joining teachers across the globe in learning how to best use remote and electronic learning platforms. (Please take a look at Dr. Alexandra Wolanskyj-Spinner’s October 2020 Editor’s Corner for further advice and inspiration.)

Another important skill not traditionally taught in medical school is how to conduct and understand clinical research. We all want to deliver evidence-based care; we cannot do that without being able to thoughtfully dissect and analyze data. Journal clubs are typically the arena in which these skills are taught, but the opportunities for trainees to hone them are increasing. Some of you have done master’s or certificate programs in clinical research. I was able to take several courses through our local Institute for Clinical and Translational Science and participate in some national workshops. While these courses have taught me about trial design and how to write a protocol, there is much about managing a study that I still don’t know. Research is a team sport; how do I manage my team? How do I best use the skills of the individual members? As I prepare to open a multicenter study, how do I interact with the other investigators and the staff at their institutions?

I did not realize that these skills of team management and communication fall under the category of leadership until I signed up for a Leadership Skills workshop, run by our Department of Medicine. I had been operating under the assumption that some people are born leaders — those who go on to become program directors, division chiefs, or cancer center directors — while others are not. I realize now that every one of us is a leader in some way, whether as a leader of a practice, a leader of an inpatient team, a leader in the lab, or a leader or co-leader of a family. As we progress in our careers, from student to trainee, from trainee to attending physician or independent researcher, we not only assume more autonomy and responsibility, but also more opportunities to lead.

Many of us have identified people as “good” or “bad” leaders based on our observations of their effectiveness and interactions with others, but perhaps fewer of us have dissected the specific skills that these leaders may, or may not, be using.

A disclaimer before I go on: At the time of writing this, I am less than halfway through said workshop and have plenty to work on personally. I will not be writing a “How I Lead” article anytime soon.

A good leader is organized, reliable, and responsive. If we cannot manage ourselves, how can we effectively manage others? Our inpatient hematologic malignancy and bone marrow transplant service has recently picked up in volume. While I liked the change of pace, I found myself feeling exhausted and metaphorically crushed by the census, particularly after a shorter-staffed holiday weekend. As a result, I was no longer an effective leader at work or at home.

I have previously written about the concept from Stoicism of accepting what is in — and out of — our control. As leaders, it is helpful for us to keep in mind the three spheres of influence:

  1. Direct control: our own behaviors
  2. Indirect control, or where we can exert influence: the behaviors we try to model for others, or the structure and style we use to conduct rounds
  3. No control: things that are out of our control or have happened in the past

This last sphere requires us to recognize and accept where we lack control. Take a deep breath, focus our energy on the other spheres of influence, and move on.

My own action plan for maintaining my sanity and effectiveness, particularly for the inpatient service, includes the following techniques:

  • Get up and get started early. This is natural for some of you. I have never been a morning person, which is one of the many reasons I am not a surgeon. I try to meditate or do some deep breathing for a few minutes before I get out of bed.
  • Pause for a few seconds throughout the day to breathe, unclench your jaw, and drop your shoulders. You may be amazed by how tense you are.
  • Leave work by 5:30 p.m. unless there is an emergency. Otherwise, those notes or emails can wait until the kids are in bed, or until tomorrow morning.
  • Take a break from the phone. When I get home, I try to put it in a different room. I often only get an hour or so with my kids before bed, so I want to be as present as possible. Again, that email can wait.

Relax. We are reacquainting ourselves with some of life’s simple pleasures in the era of COVID-19. If you have not done so, I advocate for rediscovering the joy of a warm bath. I recommend bubbles or Epsom salts, a beverage of your choosing, and a good podcast or some music.

Thank you all for being leaders. Thank you for modeling safe behaviors and choices in our current reality. Thank you for taking care of your patients, your families, your communities, and yourselves.