Evaluating Leadership in Clinical Emergency Medicine

Angela Lumba-Brown MD, FAAP

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True or false: a good physician must be a good leader?  What if I modified that question…True or false: a good EMERGENCY MEDICINE physician must be a good leader? Does it strike a different cord?

I work in St. Louis where the trauma bay often feels like our bread and butter. Recently out of fellowship, the charge nurse rushed over to me and said “4y/o, GSW to the head, GCS 14…ETA 2min.” Being a PEM physician means learning to be an effective leader of a team where the unexpected is inevitable and where the outcome may be a child’s life.  I summoned my “leader voice” and went to the bay where the GSW to the head was a graze wound.   Our team was prepared for worse because we had already talked about it in those 2 minutes.  I’ve learned that verbalizing anticipation and response has helped me to be a better team leader.

PEM leadership responsibilities do not stop there; we lead the ED and must also be cognizant of flow, resource utilization, trainee education, the list goes on. Outside of the emergency department, there are pressures to be a successful leader in research or education, not to mention the requirements of leading a household. Can I get a little leadership training here?!

Harvard Business School has multiple courses and programs dedicated to teaching the skills of being a good business leader.  (For only $11,500 you too can take a 5 day course on Best Leadership Practices) Where were the courses in medical school on being a good physician leader? I personally have not had formal training in leadership…or have I? Residency was based on establishing 6 core competencies supported by the Accreditation Council for Graduate Medical Education (ACGME):

•Patient Care

•Medical Knowledge

•Practice Based Learning and Improvement

•Systems Based Practice

•Professionalism

•Interpersonal Skills and Communication

These things all sound like the traits of good leader! As the Next Accreditation System comes into play, detailed and measurable definitions of specialty specific competencies will be used to assess trainees. But still, despite the building blocks of my certification, I can’t help but feel that a good PEM leader has more, a je ne sais quoi. So, I did some digging on what it takes to be a good physician leader.

The Happy MD wrote, Physician Leadership Skills – Why Doctors Make Poor Leaders and What YOU Can Do About It” describing that doctors are trained to be poor leaders by employing top-down leadership styles based on giving orders.  While this article gives good advice, I wasn’t convinced. I wondered if there were other physician’s out there challenging their leadership skills – it turns or there are and they’ve written about it in books: Effective Medical LeadershipThe Six P’s of Physician Leadership: A Primer for Emerging and Developing Leaders, and The Interprofessional Health Care Team: Leadership and Development to name a few.

Fact: The goal of excellent patient care comes with and effective team and an effective team needs a good leader.

What I have discovered during this quest in identifying the traits of a good PEM leader is that it must begin by identifying our personal leadership styles through introspection, feedback from those we work with, and with reading or even (if you are the type) an online quiz. From there, we can work on enhancing the skills we have.

We can utilize simulations to work on leadership goals and ask for feedback. A mock code is not only a great way to assess clinical acumen, but also to evaluate team leadership. Hunziker published “Importance of leadership in cardiac arrest situations: from simulation to real life and back” in Swiss Medical Weekly listed in PubMed describing the employment of leadership skills in simulation and its effects in real time.  Have you heard of debriefing after critical situations to engage the team in real time? Go to Inspire’s website to learn more about DART- debriefing assessment in real time.

Finally, we can build or supplement our leadership skills by taking on leadership opportunities. The American Academy of Pediatrics Section on Emergency Medicine has a Committee for the Future exclusively formed to present leadership opportunities to fellows and junior faculty.  Email the section for more information.

As PEM physicians, our clinical goals are the same.  Please share with me the ways you have built leadership skills in the ED and your recommendations to the group!

Angela Lumba-Brown MD, FAAP

Angela Lumba-Brown MD, FAAP

Clinical Assistant Professor Pediatric Emergency Medicine at Stanford University School of Medicine
Angela's research focus is in pediatric traumatic brain injury and recent research has been in therapeutic intervention for concussion. She the director of PEMNetwork.
Angela Lumba-Brown MD, FAAP
Angela Lumba-Brown MD, FAAP

Angela Lumba-Brown MD, FAAP

Angela's research focus is in pediatric traumatic brain injury and recent research has been in therapeutic intervention for concussion. She the director of PEMNetwork.