• Emerging Leaders: Residents Practice Their Skills

    Authors: Kunal Gupta
    Todd Hollon
    Rafael Vega

    As neurosurgery residents at academic and tertiary medical centers, we regularly serve as first-responders for some of the most severe and debilitating diseases in medicine. Many times we have seen trauma patients in conjunction with a team of specialists, including trauma, general surgery, orthopedics and anesthesia. However, the final decision about whether the patient goes to surgery or requires further supportive care regularly lies on the neurosurgical resident and his/her attending. The significance of caring for extremely sick and tenuous patients can weigh heavily on a resident, especially when his or her neurological assessment can alter the course of patient's life and their families' lives. During family meetings, the patient's prognosis is often deferred to the neurosurgical team's assessment of the severity of the injuries and to the prospect of neurologic improvement. As a result, neurosurgery is often seen as a leader in the hospital amongst surgical specialties; a status that applies both to the department and its individual physicians. Moreover, resident leadership need not be limited to clinical service and can extend from hospital policy to global health. We believe becoming a successful neurosurgery resident consists in accepting one's role as a leader and conducting oneself accordingly.

    Being a Resident Leader

    We believe characteristics of good leadership include having compassion, integrity, respect, accountability, and responsiveness. As residents, we are expected to master these qualities in order to work effectively as a leader within our healthcare team. As neurosurgery residents, we are often involved in many situations where having these qualities is key in successfully working as a team member. One leads as a resident by demonstrating to other members of the team how to take on challenging tasks and situations in a professional and considerate way. Leading by example is an effective way to model a high standard and work ethic.

    An impressive example of this came in 1997 at the University of Michigan. Dr. Nicholas Boulis, then a second-year neurosurgery resident, responded to a dire need for pediatric neurosurgery in the developing world. He recognized the opportunity to provide relief for pediatric patients with untreated hydrocephalus and neural tube defects. In the midst of a stressful junior residency, Dr. Boulis founded a relief project aptly named Project Shunt. The project was met with support from Dr. Karin Muraszko, anesthesiology department chairperson, and operating room staff for its ambitious goal and noble cause. Working with Healing the Children and Pediatric Foundation of Guatemala, the group provides much-needed neurosurgical care to children in Guatemala. Dr. Boulis continues to accompany the team from Emory University, and serves as one of Project Shunt's neurosurgeons. To date, more than 300 Guatemalan children received free operations as a result of this inspiring example of resident leadership.

    Neurosurgeons also play a critical role in local hospital organization. Staff at our institution are included in surgical committees encompassing those involved in systems, quality, and purchasing. The ability to guide purchasing in the O.R. and influence quality control can allow neurosurgeons to guide the acquisition of new technologies, such as stereotactic platforms, robots, etc., to dramatically alter the levels of care provided to patients. Most recently in our institution, the department of neurosurgery took the lead on the consultant response to Emergency Room consultation, stratifying the urgency of consultation and defining response times. The goal is to improve communication between providers, and improve access to specialist care teams. This has improved compliance with benchmark response times to urgent consults, and allowed the sickest patients to be triaged appropriately.

    Neurosurgery leadership can evidently play a strong role in defining care standards at a national and international level. Resident leadership allows residents to directly influence the management of patient care, develop experience in the leadership roles that they will take on in transition to independent practice, and is an important part of complete resident training.

    How does one develop their leadership skills?

    While undoubtedly a challenging task for junior residents, being an effective leader often defines your success as a chief resident. With an entire cohort of residents and their training needs behind you and the demands of patient care and attending scrutiny ahead of you, gifted hands alone are unlikely to absolve you of poor leadership skills. As a result, a considerable amount of time and effort goes into training and developing a neurosurgery resident. In addition to clinical and operative skills, neurosurgery departments are also required by the Accreditation Council for Graduate Medical Education (ACGME) to demonstrate residents' competency in several areas of leadership; including professionalism, interpersonal, and communications skills. Interestingly, despite the importance of leadership in our training, most neurosurgery residents never receive formal instruction in leadership or management during residency. What training we do receive is generally from observation, mentorship and life experiences.

    Many programs use an apprentice model for training that generally relies heavily on leadership from senior and chief level residents. As such, many of these higher-level residents tend to teach by example and from their own personal experiences. Some of these teaching moments occur during morning rounds and in the operating room, but also on many different occasions in between. Sharing these experiences can provide a better understanding to the junior level residents to allow them to learn and ultimately grow.

    Our department has recognized the importance of instilling leadership in our chief residents by appointing a resident leadership mentor, Dr. John McGillicuddy. Dr. McGillicuddy had recognized a lack of strong leadership among residents and, more importantly, a lack of leadership training. Inspired by military leadership training, he devised a leadership curriculum, wherein all sixth year residents meet bimonthly with Dr. McGillicuddy to discuss the traits of a good leader and how to apply them to residency. The curriculum covers a range of topics that include the role of the leader, leadership styles, motivating team members, and camaraderie. The resident leadership training has been received with unanimous praise from both the residents and faculty.

    Future Directions

    Neurosurgeons increasingly need advanced skills in business, finance, organizational management, strategic and tactical planning, conflict resolution, team-building, negotiation, and leadership. Residents in neurosurgery see these nontraditional topics as an important part of professional education, but they do not necessarily feel confident or competent in these areas. Therefore, leadership and learning are inextricably interconnected. Further, more deliberate efforts should be made to include the aforementioned skills in neurosurgical training in order to prepare the next generation of neurosurgeons for the challenges that lie ahead.


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