Dr Loughlin opened his presentation by reminding the attendees that when you consider medical school, residency, and, in many cases, fellowship, that most urologists have a decade or more of postbaccalaureate education, yet it is unusual for a urologist to receive even an hour of leadership training. He utilized the actions of 4 nonphysicians—former Wyoming Senator Alan Simpson, Apple cofounder Steve Jobs, George Washington, and Dwight Eisenhower—to illustrate what he considers the 4 core principles of leadership. Alan Simpson said, “With integrity, nothing else matters; without integrity, nothing else matters,” which outlined the crucial role integrity plays in leadership. Steve Jobs coined the phrase, “Think Different” as the Apple slogan, which illustrated the critical aspect that vision contributes to leadership. George Washington demurred when offered the opportunity to serve a third presidential term as an unselfish gesture to place the good of the country over self-interest. Finally, Dwight Eisenhower prepared 2 letters to the American public on the eve of the D-Day invasion, one in the event of victory, the other in the event of defeat. In the event of defeat, he accepted full responsibility for the outcome and placed blame on nobody else. Dr Loughlin stressed that the 4 principles of integrity, vision, unselfishness, and accountability serve as the underpinning of all leadership, including medical leadership.

He pointed out that these 4 leaders were all White men and that such a demographic is obsolete. Race, culture, religion, gender, or sexual preference are all irrelevant when it comes to leadership. Dr Loughlin went on to emphasize that ambition should not be confused with leadership. He advised that if a urologist seeks a leadership position, he/she should not be concerned with titles, but instead should have 3 specific goals defined if successful in obtaining the position. Genuine leaders effect change, not self-aggrandizement.

He elaborated on some other components of leadership. He emphasized that a leader should be a good listener and cautioned against he/she who interrupts others. He reminded the audience that leadership is not power but persuasion, and that successful leaders surround themselves with a coterie of close advisors who are willing to tell them when they disagree. Good leaders should avoid isolation. Part of leadership should be to seek to be both a mentor and a mentee.

He expanded his leadership discussion by emphasizing the value of humility in leaders and quoted the Stanford management guru, Tom Peters, who said, “You can learn a lot by walking around” as a lesson of the value of both interaction and visibility within your organization. He stressed the damage that occurs when a leader arrogates the achievements of others on his her/team. He noted that there are 2 types of medical leaders: those who are amplified by the success of their colleagues and those who are threatened by it.

In the next portion of his presentation, he outlined the value of a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis as an instrument to evaluate yourself and your organization. He reminded the audience that their opportunity for leadership extends beyond their medical practice. Physicians should remember that they are among the best educated and most respected individuals in their community, and as such, they have a role in community leadership. Urologists should embrace their roles as “surgeon-citizens” and utilize letters to the editor, OpEd columns, participation on school boards and places of worship, and philanthropic endeavors as opportunities to become local leaders.

Dr Loughlin closed his presentation by urging the course attendees not to forget to “take care of the caregiver” and to acknowledge that urological practice can be stressful. Urologists need to carve out some time for themselves to be away from their practice and to develop hobbies and interests outside of medicine, and to practice good health habits. Leaders are not born, they are developed. Like surgery, leadership is an acquired skill (see Figure).