FROM THE RESIDENTS & FELLOWS COMMITTEE
How Do We Train the Future Leaders of Urology?

What comes to mind when you think of a good leader? We can all recall a chief resident or attending that had a significant impact on our development, well-being, and overall experience. And yet, the majority of North American urology residency programs do not offer formal mandatory training in leadership.¹

The development of strong and effective leaders is a key goal of residency training. For many other specialties, becoming a chief resident is a voluntary and separate choice, one which typically involves a formalized nomination and selection process to identify suitable leaders. In urology and most surgical subspecialties, however, this position and responsibility are automatically assumed by residents as they advance, without the same level of rigor and preparation. The lack of formal leadership training in many residency programs across the US and Canada is a significant issue that warrants attention and consideration.

Other comparable industries take a different approach. The military, with a similar high-stakes environment and hierarchical structure, has officer training schools. In the business world, formal leadership training is a standard part of professional development, often required after promotion to manager-level roles. However, this is rarely taught in medical schools. The assumption that future physicians will simply pick up the necessary leadership skills as they progress through their training is a flawed one. “Intellect and good technical skills do not always ensure the leadership success of these senior residents,”² and they overlook the importance of intentional, dedicated focus on a critical and teachable skillset.

The question of what makes a good leader is complex, nuanced, and situation dependent. There is no one-size-fits-all answer, as the thousands of publications on the subject demonstrate. It can be especially challenging for residents transitioning from a junior to senior role, balancing the rigors of residency with intricate interpersonal relationships, both social and professional. Do you trust your team to problem-solve in their own unique way and learn from their mistakes, or do you run the service strictly to avoid any patient harm? How do you give constructive feedback without damaging the team’s dynamic? Do you shield your junior residents, or do you give them the opportunity to challenge themselves?

The problem extends to attendings as well. Even if you do not aspire to be a chairperson, program director, or serve in hospital administration, at the local level you have to manage a clinic and operating room staff, including advanced practice providers, nurses, and anesthesiology staff. The academic research setting similarly involves collaboration, coordination, and execution. Building trust, increasing efficiency, and maintaining morale are critical to patient outcomes, financial success, and physician well-being. “Non-technical skills (NTS) such as teamwork, effective communication, organizational talent, and trust have increasingly emerged as critical factors improving team performance in the perioperative setting by preventing medical errors and enhancing patient safety.”³ A study by Shanafelt et al in 2013 demonstrated each 1-point increase in composite leadership score was associated with a 3.3% decrease in the likelihood of burnout (P < .001) and a 9.0% increase in the likelihood of satisfaction (P < .001) of the physicians supervised, controlling for age, sex, specialty, and duration of employment.⁴

Where do we go from here? There are programs and opportunities available, but few are urology specific, and almost none are tailored towards residents. The AUA Leadership Program is a great opportunity for young attendings, the Accreditation Council for Graduate Medical Education’s Leadership Skills Training Program for Chief Residents is available to all residents, and the Residents as Teachers and Leaders course offered by the American College of Surgeons is designed to teach relevant nonclinical skills to surgical residents. But given the constraints of residency, the most accessible solution is to prioritize the nurturing of these soft skills at the program level. Data from general surgery residencies point to benefits of targeted needs assessments and longitudinal leadership training programs including residents of all years, prior to the beginning of chief years.² Transitioning from an informal to a standardized process allows for measurable, consistent, and superior outcomes for patients and residents alike.

In conclusion, as the field of urology continues to evolve and grow, it is essential that we prioritize and invest in the development of strong leaders within the specialty. By recognizing the importance of formal leadership training and taking steps to integrate it into residency programs, we can ensure that the future of urology is led by individuals who are not only skilled clinicians but also effective and compassionate leaders.