POSNA Leadership Program (PLP): Developing surgeon leaders for patients, organizations, and our society

Abstract

The Pediatric Orthopaedic Society of North America (POSNA) initiated a Leadership Program in 2022. The POSNA Leadership Program (PLP) is designed to enhance emotional intelligence (social skills, empathy, communication, self-regulation, and self-awareness) and in-depth leadership skill development for selected participants in a year-long seminar. Disruptive behaviors detrimental to health care professionals, patients, and care delivery organizations can be identified and lessened through education. Most surgeons rightfully focus their learning intently on specific surgical knowledge and technical expertise, especially in the early and middle career stages. Despite this, surgical errors still occur secondary to limitations of nontechnical surgical skills: decision-making, communication, leadership, and teamwork. More senior surgeons are also prone to leadership and communication errors. By gaining education and expertise in nontechnical surgical skills, improved team building with more professional staff engagement, empowerment, and trust can result in lower risk.

Keywords: Emotional intelligence; Followership; Leadership; Nontechnical surgical skills.

Figure 1

Goleman emotional intelligence categories of Self-awareness, Self-Regulation, Social Skills (Communication), Empathy (for others), and Motivation (for others) as key traits leaders need to mature in themselves and grow in others.

Figure 2

Nontechnical skills for surgeons: A validated tool to measure operating room behaviors and performance assessing in detail: situational awareness, decision-making, communication and teamwork, and leadership as noted by categories and elements of each category used in scoring surgical team performance. NOTSS is used both in simulations and live operating room and audiovisual recordings from “wheels in to wheels out” to assess and by debriefings, aim to improve performance and lessen the risk of error.

Figure 3

Leadership Program for Surgical Fellows at Boston Children's instituted in 2017 and is ongoing there as well as now in modified curricula for Harvard Combined Orthopaedic Surgery Residents, Atrium Health Carolinas Medical Center Orthopaedic Surgery residents, OrthoCarolina Orthopaedic Surgery Subspecialty Fellows, and Stanford University Orthopaedic Surgery subspeciality fellows.

Figure 4

Throughout our careers from UGME through PGME to CME, all surgical education programs and subspecialists emphasize specific knowledge content and surgical technical expertise. Leadership, emotional intelligence, and nontechnical skill development are random and arbitrary, even more so in the 21st Century. Formalized skill leadership and followership development should be the “third rail” of surgical education throughout careers.

Figure 5

Leadership Development Curricula for Orthopaedic Surgical Residents, Surgical Fellows, and Faculty expand beyond education for knowledge content and surgical expertise to learnings and training in emotional intelligence and nontechnical surgical skills as outlined. The "third rail” in electrical trains is where both the power and risk lie.

Figure 6

POSNA Leadership Program (PLP) inaugural class (2023-24) from left to right: Robert Cho, MD, Shrine'rs Children’s Southern California; Benjamin Shore, MD, MPH, FRCSC, Boston Children’s Hospital; Maryse Bouchard, MD, MSc, FRCSC, The Hospital for Sick Children Toronto; Corinna Franklin, MD, AB, FAOA, Yale University; Amy McIntosh, MD, Texas Scottish Rite for Children; Derek Kelly, MD, Campbell Clinic Orthopaedics; Wudbhav (Woody) Sankar, MD, Children's Hospital of Philadelphia; and Burt Yaszay, MD, Seattle Children’s Hospital.

Figure 7

A, B: PRISM Profile testing by SurePeople is performed by PLP participants and with a detailed assessment of their tendencies when at they are at their best as well as under stress. The PRISM along with 360 evaluations were quite helpful for each leader to learn more about themselves and areas for improvement.

Figure 8

Leaders need to be trusted (and trustworthy) and work with their teams in psychological safe work environments in order to develop highly functioning professional teams. Leaders also need to follow at appropriate times for the well-being of their teams and organization.