Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_857_Библиотеки_им_академика_М_И_Перельмана
.pdf
17 How to Teach Technical and Judgment Skills Eectively from Outside the Operating Room (Including…
https://t.me/medicina_free
183
Advances in video technology, increasing use of
videoconferencing, and improving Internet
access make all these approaches feasible even
from a vast distance. Additionally, trainees may
be directed to reliable and ever-expanding sources
of information for independent study, many of
which are free and available to anyone with
Internet access. Today’s global surgeon should
consider education and local capacity building as
an essential part of their mission. Thankfully,
resources and training methods are available to
adapt training to a wide range of contexts, allowing global surgeons to train the next generation of
safe, independent surgeons.
References
1. Peluso M, et al. Building health system capacity
through medical education: a targeted needs assessment to guide development of a structured internal
medicine curriculum for interns in Botswana. Ann
Glob Health. 2018;84(1):151–9.
2. Cook M, et al. A consortium approach to surgical
education in a developing country: educational needs
assessment. JAMA Surg. 2015;150(100):1074–8.
3. Mocumbi AO, et al. Innovative strategies for transforming internal medicine residency training in
resource-limited settings: the Mozambique experience. Acad Med. 2014;89(8 Suppl):S78–82.
4. Sawyer T, etal. Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for
procedural skill training in medicine. Acad Med.
2015;90(8):1025–33.
5. St-Martin L, et al. Teaching the slowing-down
moments of operative judgment. Surg Clin N Am.
2012;92:125–35.
6. DaRosa DA, etal. A theory-based model for teaching
and assessing residents in the operating room. J Surg
Educ. 2013;70(1):24–30.
7. Roberts NK, etal. The brieng, intraoperative teaching, debrieng model for teaching in the operating
room. J Am Coll Surg. 2009;208(2):299–303.
8. Huang E, etal. From novice to master surgeon: improving feedback with a descriptive approach to intraoperative assessment. Am J Surg. 2016;212(1):180–7.
9. Brasel K, etal. Surgical milestones work group; 2019.
Surgery milestones, version 2. ©2019 accreditation
Council for Graduate Medical Education (ACGME).
Available online: https://www.acgme.org/globalas-
sets/pdfs/milestones/surgerymilestones.pdf. Accessed
12 June 2022.
10. A User’s Manual for the Operative Performance
Rating System (OPRS). May 2012. Available online:
https://www.absurgery.org/xfer/assessment/oprs_
user_manual.pdf. Accessed 12 June 2022.
11. ACGME Program Requirements for Graduate
Medical Education in General Surgery, effective July
1, 2020. Available online: https://www.acgme.org/
globalassets/pfassets/programrequirements/440_generalsurgery_2021.pdf
12. Sanfey H, etal. Morning report: combining education
with patient handover. Surgeon. 2008;6(2):94–100.
13. Abdelsattar JM, et al. Enhancing the educational
value and faculty attendance of a morbidity and mortality conference. J Surg Educ. 2020;77(4):905–10.
14. Endicott KM, et al. Use of structured presentation
formatting and NSQIP guidelines improves quality of
surgical morbidity and mortality conference. J Surg
Res. 2019;233:118–23.
15. De Vos MS, etal. Toward best practices for surgical
morbidity and mortality conferences: a mixed methods study. J Surg Educ. 2018;75(1):33–42.
16. Aboulian A, etal. The public mock oral: a useful tool
for examinees and the audience in preparation for the
American Board of Surgery Certifying Examination.
J Surg Educ. 2010;67(1):33–6.
17. Ericsson KA. Acquisition and maintenance of
medical expertise: a perspective from the expertperformance approach with deliberate practice. Acad
Med. 2015;90(11):1471–86.
18. Autry AM, etal. Teaching surgical skills using video
internet communication in a resource-limited setting.
Obst Gyn. 2013;122(1):127–31.
19. Mikrogianakis A, et al. Telesimulation: an innovative and effective tool for teaching novel intraosseous
insertion techniques in developing countries. Acad
Emerg Med. 2011;18(4):420–7.
20. Okrainec A, Henao O, Azzie G. Telesimulation: an
effective method for teaching the fundamentals of
laparoscopic surgery in resource-restricted countries.
Surg Endosc. 2010;24:417–22.
21. Li MM, George J.A systematic review of low-cost laparoscopic simulators. Surg Endosc. 2017;31:38–48.
22. Ahmet A, etal. Is video-based education an effective
method in surgical education? A systematic review. J
Surg Edu. 2018;75(5):1150–8.
23. Antoniou SA, etal. A comprehensive review of telementoring applications in laparoscopic general surgery. Surg Endosc. 2012;26:2111–6.
24. Andersen D, et al. An augmented reality-based
approach for surgical telementoring in austere environments. Mil Med. 2017;182(S1):310–5.
25. Rojas-Munoz E, etal. Surgical telementoring without
encumbrance: a comparative study of see-through
augmented reality-based approaches. Ann Surg.
2019;270(2):384–9.
26. Mota P, etal. Video-based surgical learning: improving trainee education and preparation for surgery. J
Surg Educ. 2017;75(3):828–35.
27. Keller DS, etal. Video-based coaching: current status
and role in surgical practice (part 1) from the Society
for Surgery of the Alimentary Tract, Health Care
184
https://t.me/medicina_free
E. W. Riddle and C. E. Haisch
Quality and Outcomes Committee. J Gastroint Surg.
2021;25:2439.
28. El-Gabri D, etal. Surgical coaching for advancement
of global surgical skills and capacity: a systematic
review. J Surg Res. 2020;246:499–505.
29. Hu YY, et al. Complementing operating room
teaching with video-based coaching. JAMA Surg.
2017;152(4):318–25.
30. Greenberg CC, et al. A statewide surgical coaching
program provides opportunity for continuous professional development. Ann Surg. 2018;267(5):868–73.
31. Parker AS, et al. An online, modular curriculum
enhances surgical education and improves learning outcomes in East, Central, and Southern
Africa: a mixed-methods study. Ann Surg Open.
2022;3(1):e140.
32. Carpenter EL, etal. Surgical society podcasts: a novel
way to engage and educate the community. J Surg
Educ. 2022;79(3):565–7.
How toTeach Teamwork
https://t.me/medicina_free
andLeadership Skills Eectively
fromOutside theOperating Room
(Including Virtually)
EmadH.Asham, KorinE.Leer, andCarlE.Haisch
When restraint and courtesy are added to strength, the latter becomes irresistible.
– Mahatma Gandhi
18
Abbreviations
LMICs Low- and middle-income countries
M&M Morbidity and mortality
PAACS Pan-African Academy of Christian
Surgeons
Introduction
First, we must dene what a leader is. A leader is
a person who has specic well-dened goals and
E. H. Asham (*)
Department of Surgery, Methodist Hospital at Texas
Medical Center, Houston, TX, USA
e-mail: ehasham@houstonmethodist.org
K. E. Lefer
Department of Pharmacology and Toxicology, Brody
School of Medicine, Department of Advanced
Nursing Practice and Education, College of Nursing,
Pharmacology Liaison, School of Dental Medicine,
East Carolina University, Greenville, NC, USA
e-mail: Leferk19@ecu.edu
C. E. Haisch
Division of Surgical Immunology and
Transplantation, Faculty Development, Brody School
of Medicine, East Carolina University,
Greenville, NC, USA
e-mail: haischc@ecu.edu
a plan to lead others toward such goals. The
leader is simultaneously committed to identifying, managing, and allocating resources to
achieve the objective.
According to Bass’s theory of leadership,
there are three basic mechanisms that turn a person into a leader:
1. The great event or great man theory, when
leaders are born under the pressure of a critical situation and rise to the occasion to lead.
2. Trait theory, for people who have natural abil-
ities that qualify them to lead.
3. Transformational or process leadership the-
ory, when an individual chooses to become a
leader through learning skills.
The latter theory is the most accepted theory
today [1]. In the past, many leaders used a transactional management style, which rewarded and
punished certain behaviors. In contrast, transformational leadership theory emphasizes vision,
empowerment, and support to inspire followers
toward action and growth.
Real leaders have a clear vision of objectives
and the ability to inspire and enable others to
attain them. Leadership is essential in life—
whenever two or three persons get together, one
person will become the leader, within a family,
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
M. A. Hardy, B. R. Hochman (eds.), Global Surgery, https://doi.org/10.1007/978-3-031-28127-3_18
185
186
https://t.me/medicina_free
E. H. Asham et al.
small community, department of surgery, or an
organization.
Surgeons assume leadership in three principle
domains: rst, as clinicians taking care of patients
in the clinical arena; second, leading a surgical
team in the operating room; and third, as managers in the administrative duties of day-to-day surgical practice. These administrative
responsibilities can be as varied as heading a
research laboratory, a residency program director, or a chief of a division within the department.
With more interest in global surgery, leaders
must be able to successfully intersect with surgeons from other areas of the globe and within
varying environments and cultures. This interaction may occur at a national meeting with international guests, a visiting professorship, or an
invited lecturer. The leader may also be asked to
help develop new programs and infrastructure, to
operate, and to train and send trainees to an international site for collaborative growth and experience in low- and middle-income countries
(LMICs).
knowledge and wisdom. As Isaac Asimov wrote:
“The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom” [3]. Knowledge is gathered by
reading books and journals, listening to lectures,
and attending conferences and symposia.
Wisdom, on the other hand, is gleaned from years
of experience; lifetime learning, not only about
science but also about people; and most importantly, common sense. Wisdom entails a deep
understanding of the zeitgeist and emotional
intelligence. For example, the use of articial
intelligence in medicine needs to be understood;
however, the leader must learn not only to know
how to use this technology but to learn its
strength, hazards, and weaknesses. The technology itself cannot provide the wisdom and intuition to make the critical decisions for its use in
taking care of patients.
Leader Surgeons Are Humble
A good leader discerns the difference between
Surgical Leaders Are Visionaries
A surgical leader must have a clear vision of the
goals of his department, must prioritize these
goals, and have a plan to achieve them. Without a
clear vision, the team will go astray. Good leaders know where they stand and where they are
heading. They have the ability to inspire their
staff to a common goal.
The young German surgeon Kurt Semm at the
University of Kiel was an enthusiast about laparoscopy. When he performed the rst laparoscopic appendectomy in September 1980in the
department of gynecology, he faced erce opposition. This did not deter him from his vision for
laparoscopic surgery, and he took the rst steps
toward his goal and changed the course of traditional surgery. Now laparoscopy is a wellestablished approach in any surgical practice [2].
If surgical leaders are to develop a vision and
goals for their department, they must be scholars
who keep abreast of new disease interventions
and rapidly developing new technologies.
To aspire to leadership is an honorable ambition.
The root of ambition is from the Latin word
ambitio, which means to go around, to campaign
for promotion. Leadership offers social visibility,
peer recognition, popularity, and exercise of
authority over others. Nevertheless, ambition
must be tempered by humility; otherwise, it can
lead to arrogance on the part of the leader and
destruction of the team for which the leader is
responsible. As Lord Acton said, “power tends to
corrupt and absolute power corrupts absolutely.”
Humility and leadership may appear to be an
oxymoron. The traditional surgical hierarchical
autocratic leadership model has been slowly
phasing out recently. Humility of the chief executive ofcers (CEO) has been shown to contribute
to the success of the enterprise and to improve
outcomes. In an article in Forbes, Nicole Heimann
highlighted how future CEOs are shifting from
the heroic model to being humble [4]. Leadership
should be viewed as an opportunity to serve
rather than to seize power. This is clearly
manifested in the traditional calling of surgical
subdivisions a “service.”
18 How to Teach Teamwork and Leadership Skills Eectively from Outside the Operating Room…
https://t.me/medicina_free
187
Surgeons should be humbled on regular basis
by diseases that they cannot conquer, cancers that
spread beyond the scalpel’s reach, and terminal
illnesses that cannot be cured. Indeed, human
mortality is before the eyes of every surgeon’s
day and thus needs to keep their views of themselves in perspective. True leaders set their egos
and emotions aside to be as objective as possible
in all the important decisions they are obliged to
make daily. The late British scholar and author
C.S.Lewis wrote: “Humility is not thinking less
of yourself but thinking of yourself less” [5]. To
translate this to the daily life of a surgical leader,
he/she must be approachable, courteous, and
respectful to his staff. On a practical note, while
on a short-term trip to an LMIC, one of the
authors found that the local surgeons had scrubs
that were of much lesser quality and ill-tting
compared to the pressed, clean, breathable cotton
ones he takes and uses on every trip. He chose to
wear the local ill-tting scrubs to identify with
the local staff. On the last day, he donated the
scrubs he brought to allow the staff to explore if
the scrubs could be produced locally.
Surgeon Leaders Are Good
Managers
Not all managers are leaders, but all leaders are
managers. Leader surgeons must manage their
human resources including students, residents,
new faculty, as well as existing faculty. They
must also manage material resources such as
ofce space, strategic planning, budgets, expansion, and adoption of new technologies. Surgical
leaders have pecuniary responsibilities that need
to intersect well with hospital administration
concerning operations, nance, reimbursement,
quality assessment, and assurance and conict
resolution. A good manager is a responsible
steward with the resources entrusted in his/her
hands. He/she should allocate these resources,
whether human or materialistic, to achieve set
goals. Efcient time management is an essential
quality of good leadership. Good leaders are
focused, have mechanisms to lter distractions,
and know how to delegate responsibilities. They
also remain happy in their life as well as in their
work.
Micromanagement is the adversary of efcient leadership. It can cripple command, demoralize junior staff, and block progress. In the
military realm, delegation to competent and condent staff down the chain of command has been
shown to be very effective [6]. Autonomy must
be entrusted and delegated to team members who
are well trained and have a full grasp of the mission and goals of the team.
Leaders should use metrics to measure their
progress and success. In the surgical world, there
are several metrics to monitor the progress of the
mission or of the department. For example, in the
domain of surgical education, residency program
directors can measure their success by how frequently they recruit high-quality residents and
how reliably and well they perform and if they
have good in-service examination scores and
show good pass rates on the nal board examinations. A surgeon leader uses the appropriate metrics to measure and evaluate the team
performance, including the individual staff members’ peer and mentees’ evaluations, their surgical outcomes, and their patients’ satisfaction.
This must also include their overall behavior,
empathy, and contributions to the team’s effort.
In LMIC settings, the inuence of culture and
environment plays a major role in development
of such patterns of behavior. The structure of surgical services still mostly remains traditionally
autocratic. In order to make rapid progress, it will
need to evolve to more modern approaches appreciated by the new generation of surgeons.
Surgeon Leaders Walk theTalk
During the Second World War, in a French battleeld, an American battalion was given the order
to advance inland through a large mineeld. The
commander decided to cross at the crack of dawn
and so ordered his troops to camp for the night.
Overnight, there was a heavy snowfall, and the
mineeld turned white. The captain of the
battalion developed a plan. A soldier would step
out and walk carefully through the eld; if a mine
188
https://t.me/medicina_free
E. H. Asham et al.
exploded, the next soldier would walk to that
point and take another path toward the goal of
crossing the mine eld. This would continue until
the battalion crossed the eld. There was dead
silence among his men. While the soldiers were
looking at each other, the leader of the battalion
took the rst step into the mineeld, leading the
wa y.
True leaders spend ample time with their
troops. They do not reside in their ivory towers or
behind gloried rhetoric and big desks. A leader
surgeon does not shy away from taking night call.
He/she is often seen in scrubs in the operating
room, transferring his/her acumen of skill and
knowledge to his/her residents and colleagues.
He/she may even help transfer the patient to and
from the operating table. A surgeon leader in
white coat makes rounds with his team. It is
essential for the leader of a surgical service to get
to know his staff both on a professional and on a
personal level, to recognize their strengths and
their weaknesses, and to spot areas that need
improvement or reward.
An additional quality of a good leader who
leads by example is to care for those he/she leads,
to listen to their professional and personal problems, to be trusted by them, and to take their concerns seriously. Recently, online evaluations have
made the evaluation process mechanistic and far
less human than when done face to face. The
human interaction during evaluations or at a day
retreat, at team sport event, or at a cookout outing
can break barriers and strengthen both professional and personal relationships between the
leader and his team members.
Care and attention for team members’ welfare
also needs to be part of hospital and organizational structure and commitment. An example of
this quality is the Pan-African Academy of
Christian Surgeons (PAACS). PAACS is a charitable organization that trains national surgeons in
Africa according to the highest American standards. Part of the requirement to start a surgical
residency program is to ensure the hosting hospital provides adequate living accommodations for
the residents and their families. Moreover, the
residents are compensated with a stipend that
matches the cost of living in that country. PAACS
also sponsors an annual retreat to support the
residents’ and their spouses spiritual and emotional well-being [7]. This type of bidirectional
interaction between the hospital/institution and
the individual team member is necessary not only
to create a cadre of highly qualied surgeonleaders but to retain them in the region or the
country to prevent the existing “brain drain” in
LMICs, mostly because of inadequate funding.
Surgeon Leaders Are Eective
Communicators
Surgeons in leadership roles must master the art
of communication on an individual and group
level. On an individual level, a good leader surgeon sits down with his residents before a surgical procedure, discusses the patient’s history and
physical, and reviews the imaging studies. Just
like in the war room studying battle elds maps,
the surgeon leader clearly communicates the goal
of the operation, the steps to achieve the goal, and
the plan to avoid potential complications and
denes the role of each team member.
Leaders are knowledgeable and articulate and
know how to convey ideas, goals, and orders in a
very clear and respectful manner. Morning
rounds is a great opportunity to sharpen the skill
of communication. A surgeon leader should serve
as a model for the art of listening empathetically
and patiently to the patient complaints. He/she
needs to assess his/her team’s ability to analyze
the data, formulate differential diagnosis, and initiate a care plan.
Morbidity and mortality (M&M) conferences
are a good occasion to practice the art of communication skills for the entire surgical department. Students and residents present the case,
and surgeons pose questions and share their perspective. M&M conferences should never be a
place for indictment of individual surgeons based
on the case being presented. On the contrary, the
conference should be a place for sharpening critical thinking, honest intellectual curiosity, and
candid discussion to learn from mistakes. A good
leader surgeon turns the M&M conference to be
the soul of a surgical department.
18 How to Teach Teamwork and Leadership Skills Eectively from Outside the Operating Room…
https://t.me/medicina_free
189
Good leaders are not compulsive talkers. “He
would not listen, he gives an answer before I had
a chance to state the problem,” once complained
a junior faculty about the chair of his department.
Sympathetic listening requires not only hearing
the words but also understanding the meaning,
the ethos, and the context of what the other person is saying.
Surgeon Leaders Handle Criticism
A surgeon leader makes numerous decisions on
daily basis. Some will meet the approval of his/
her team and the administration, and some will
be criticized. Good leaders do not dismiss or
ignore criticism. They listen and analyze carefully, seek counsel on the issue, and, if necessary,
reconsider their decision.
In the business world, Fred Smith, founder of
FedEx, was given a C grade by a Yale University
management professor when he wrote a paper
proposing a reliable overnight delivery service
because the idea was deemed not feasible. Fred
Smith followed his dream, and now FedEx is a
gigantic global corporation.
In the surgical world, Thomas Starzl, the pioneer of liver transplantation, had to leave the
University of Colorado. At that time, the
University deemed that liver transplantation
could not be performed safely in humans. Despite
severe criticism, he never gave up his vision or
goal and pursued liver transplants successfully at
the University of Pittsburgh. Thomas Starzl
worked tirelessly to transform liver transplantation from a dream to reality. Surgeons around the
globe ocked to Pittsburgh to train under his tutelage and have made liver transplantation a therapy that has saved thousands of lives [8].
Surgeon leaders learn from their mistakes. In
their book Extreme Ownership, two retired navy
seals Jocko Willink and Leif Babin dedicated the
rst chapter to an important trait in good leaders—namely, total ownership of the operation or
project they lead, including mistakes [9]. They
were quoted as saying, “The best leaders checked
their egos, accepted blame, sought out constructive criticism and took detailed notes for improve-
ment. They exhibited extreme ownership.”
Admitting mistakes rather than shifting the blame
down the chain of command and an honest analysis of why and how an error happened helps the
whole team avoid future errors. Total ownership
and taking the responsibility does not undermine
the authority of the leader. On the contrary, it
reinforces trust in leaders.
Leader Surgeons Are Good Mentors
Subordinates look up to leaders not only to learn
the skill of the trade but also for inspiration,
encouragement, and conict resolution. True
leaders create the space and allocate the time for
mentorship of those on their team who exhibit
leadership qualities. Even in the age of Zoom
calls, a healthy mentor–mentee relationship can
be developed and be rewarding to both. Good
leaders recognize talents and know how to nurture and develop mentees. They do not miss the
opportunity to learn from their mentees, appreciating that learning can be bidirectional. Residents,
younger faculty, and colleagues may bring new
ideas from unique backgrounds and education
that can help achieve the goals of the leader and
of the team.
Global Leaders Have Cross-Cultural
Sensitivity
The Internet has connected people like never
before and turned the world into a global village.
Cross-culture communication is the new norm.
Cultural sensitivity is important, and leadership
across different cultures requires a particular skill
set. Cultural differences should be regarded with
respect, not on a superior-inferior scale. A good
leader listens attentively, observes carefully, and
gathers information to learn about the culture
with which he/she wants to interact. The best way
to learn about another culture is via immersion
experiences. Visiting hospitals in LMICs, sharing
the daily life of surgical colleagues, and realizing
the differences in resources across the globe are
an eye-opener and of high educational value.
190
https://t.me/medicina_free
E. H. Asham et al.
Genuine leaders do not apply their methodologies, no matter how successful they may be,
across different cultures without thoughtful adaptation to the local culture and resources. For
example, not all that can be done laparoscopically in the USA can be done laparoscopically in
Africa. Open surgery is still the cornerstone of
African surgery. Laparoscopic equipment and
instruments are not widely available. On the
other hand, African surgeons are procient in
open surgery more than many newly trained
western surgeons who trained in the minimally
invasive era and rarely do open surgery. Listening,
planning, and cooperating with the local leaders
are of paramount importance. Learning can
always be reciprocal.
Courtesy is the most important pillar of crossculture leadership. Paying attention to differences
such as time zones, holidays, or even working
days (some countries expect a 6-day work week)
is particularly important when organizing online
meetings and events or visiting in person. Despite
various cultural differences, e.g., ways to greet,
address, or express thanks to others, there are also
similarities that leaders can capitalize on. Mutual
respect and integrity are highly prized within
most cultures across the globe.
Leader Surgeon AndtheDigital
(Virtual) World
There are currently many platforms that allow
leaders to exercise their duties from a distance in
the digital world including desktop or laptop
computers and mobile phones. The COVID-19
pandemic and the lockdown brought these digital
platforms to the forefront of daily life for the
public, physicians, and the hospitals. Grand
rounds, tumor boards, and M&M conferences
can be conducted and attended online using digital platforms such as Zoom and Microsoft Teams.
The use of virtual platforms was explored during
the pandemic for use in simulation labs. Internet
connection and digital media have increased possible learning platforms for learners worldwide
and now provide additional learning opportunities. Surgical videos are great tools not only for
surgical learning but also for evaluation of competency of surgical trainees by their leaders
before certication [10].
Virtual surgical forums are increasing at a
quick pace and are being utilized at an increasing
rate. The American College of Surgeons sponsors
many forums, as does the Academy of Master
Surgeon Educators. One which has been very
useful is the International Hernia Collaboration
page on Facebook. This allows the exchange of
expertise and sharing of innovations without traveling [11]. This type of sharing applies to many
other specialties whose societies have initiated
many webinars on sharing of information and
innovation.
Intraoperative surgical consultation can be
obtained live on FaceTime from any operating
room in the world, provided there is a reliable
Internet connection. One of the authors has been
providing such pro bono consultation on regular
basis to a network of surgical colleagues with
whom he became acquainted during a series of
short-term mission trips to an LMIC.
A word of caution: medicine cannot be 100%
digitalized. Surgeon-patient relationship is the core
of practicing surgery. The core of training and
exhibiting leadership has traditionally required
person-to-person contact and cannot be totally
replaced using the digital medium. Eye contact and
a gentle touch or tap on the shoulder can be soothing to the patient and learner. Hospitals remained
open for emergencies and treating COVID-19
patient during the pandemic lockdown. Leader surgeons innovated how to do safe tracheostomies
with extra protection from infection transmission
via aerosolization [12]. Physicians, surgeons,
nurses, physiotherapist, respiratory therapist, and
all supportive staff took care of patients “in person.” However, digital platforms are very useful
and can be employed to reinforce the human surgeon-patient relationship and inter-collegiality
among leader surgeons and their staff.
Conclusion
This section of the chapter has briey outlined
characteristics of leaders, which are critical as
18 How to Teach Teamwork and Leadership Skills Eectively from Outside the Operating Room…
https://t.me/medicina_free
191
people develop leadership skills. Being a follower is also part of being a leader at a different
level and sometimes to a different population—
each physician is a leader for a patient who seeks
his/her care and advice. As has been previously
mentioned, leadership is critical in the crosscultural context. Special abilities are required,
which demand adaptation to new cultural norms
and humility as new challenges are met. As leadership and teamwork are taught, both the teachers
and learners must be willing to learn from each
other to make the relationship and the work
successful.
Virtual Teaching inLeadership
andTeamwork
The following section focuses on “how to” give
the reader tools that can be used in person or virtually. The format is designed as a framework to
teach virtually but can be adapted for in-person
use. The reader is encouraged to change this as
needed but to keep in mind the principles which
are outlined (CEH).
Teaching soft skills like leadership and teamwork continues to be important. Doing this virtually requires careful rethinking on how these
skills are to be transferred successfully to the
mentees. The earlier part of this chapter enumerated the essential skills needed by surgeon leaders. Often, these important skills in surgery are
not formally taught but rather are “caught” while
on rounds and in the operating room. Since soft
skills like leadership are “taught” in the same
physical space with the teacher, there are many
subtle cues which are not available in a virtual
setting. These skills can be taught on a virtual
platform, but this requires conscious changes in
the approach by the teacher.
Developing online training in the essential
skills of being a leader is more difcult and often
must deliberately focus specically on the goal
of teaching leadership. Instead of relying on the
learner observing these skills in the context of
physical space, the teacher must model this on a
virtual platform while emphasizing and demonstrating the same leadership skills during per-
sonal contacts, in the operating rooms, and in
other clinical settings. The teacher must also
remember this may need to be done in a crosscultural context with authority and honesty, while
interpersonal relationships and the community
play an important a role in the learning environment [13]. Developing leadership skills in isolation and alone is very different than developing
them while interacting during in-person group
training. Instructors must intentionally consider
the participant’s isolation and technological disadvantage by purposely targeting a feeling of
community and engagement within the virtual
learning. It is still essential to maintain a small
number of learners within the group to adequately
promote leadership in the participants.
Community interaction over a Webex link with
more than six learners is very difcult, so it is
recommended to try to keep groups at six learners or fewer. As one begins virtual training, it is
imperative that the trainer knows the names of
the individuals with whom he/she will interact
and be familiar with each learner’s basic key
information.
Learning leadership skills virtually requires
the lessons to be broken down into small segments. Multiple shorter segments ensure that
each point is well understood and assimilated
before proceeding to the next one. Group discussions are necessary to help understand the concepts, and this should be later combined with
“homework” to reinforce the taught principles.
The homework may consist of either direct information or be a case analysis, which will allow the
learner to better understand the concept and to
retain and retrieve the learned skills. Interaction
among the mentees within the virtual environment helps one another to teach leadership and
teamwork skills while at the same time solving
clinical and/or surgical problems. The information used for teaching in case studies and complications must relate to real-world issues for them
to be valuable for learning purposes. This offers
an opportunity to have real-world interactions
foster teamwork and leadership among the members of the small group of virtual learners.
Discussion of solutions and problems should
include and dene the roles of the individual
192
https://t.me/medicina_free
E. H. Asham et al.
interprofessional healthcare team, composed of
nurses, family members, and other medical specialists, to assure that the case example applies to
real-life situations. Analysis of such real-life situations allow surgical learners to understand and
embrace leadership roles and to reinforce their
leadership skills. Interprofessional communication and collaboration skills are critical for the
development of optimal healthcare outcomes and
the establishment of innovative programs.
A solid review of leadership learning outcomes can also be done virtually. Clear and concise outlines of the key teaching points need to be
emphasized when the learners interact with the
trainer. At times, one-on-one coaching will be
helpful to ascertain that the learner understands
and is applying the leadership lessons appropriately. This is particularly true in a virtual situation where the learner is unable to individually
ask content questions because of the virtual platform. Individual sessions, even if infrequent,
encourage an authentic relationship between the
trainer and the learner and allow for questions
and deeper interaction. A mentor can then individually recommend areas for leadership growth
and emphasize the positive leadership skills that
the trainee already possesses. As is true in all
learning, review and repetition at different time
points are important for the lessons taught virtually to be retained and mastered. For this purpose, the teacher should build in regularly
scheduled time for summary and review with the
learners. This should be easily managed since the
relationship between teacher and learners in a
long-term surgical training situation allows time
for skill building and advancement.
Example ofanApproach toTeach
Leadership Virtually
(The framework below illustrates how to teach
leadership skills across a virtual platform.)
First Session: Assignment—Learners are asked
to think about who they dene as a good leader
from their professional acquaintances and
who they would consider as not a good leader
and why. Have them write the key characteristics of each person and whether they are positive or negative. They then should create their
own denition of a leader’s characteristics and
determine themselves if they t into that denition. They should also dene what character
traits they want to see in a leader.
Second Session: Assignment—Learners should
conduct a personality survey to learn about
themselves and then initiate a survey to learn
their perceived leadership style. The learner is
then asked to incorporate the discussed skills
dened in the rst session prior to evaluating
their own leadership strengths and where their
weaknesses need to be addressed.
Third Session: Assignment—This session’s
selected assignment is to evaluate different
types of leadership. It is to reect on the question which one of the leadership types applies
to which individuals in the group. A discussion among the learners should clarify if they
individually view the information in similar or
different ways. At this point, the mentor can
also recommend additional (optional) outside
reading material (notable books on leadership) if mentees would like to take their development a step further.
Fourth Session: Assignment—Follow-up on third
session. Give a problem regarding activities
on a surgical ward (possible examples: vital
signs not being taken appropriately, medications given at the wrong time, wounds not
being evaluated and reported on incorrectly,
etc.). Have individuals solve the outlined
problem with his/her leadership style and discuss the results. What are the strengths and
weaknesses of each approach? Ensure a positive and non-judgmental learning space for the
learners, and emphasize that this is an informal discussion and not subject to evaluation or
criticism.
Fifth Session: Assignment—Distribute a reading
assignment on teamwork, and discuss it virtually within the small group setting. Discussion
should focus on how leadership styles impact
teamwork and collect your learners’ thoughts
and conclusions on this topic. Ask learners to
write a short reection after the session on
Соседние файлы в папке Библиотека им академика М.И. Перельмана