By James S. Lin, MD

Leadership can be thrust upon you. In 2016 at Bagram Air Base in Afghanistan, a suicide bomber detonated near the starting line of a Veteran’s Day 5K fun run. At the time, a now-faculty member in my orthopaedic surgery department was part of Joint Special Operations Command (JSOC) deployed in Afghanistan. He served as an orthopaedic surgeon assigned to special forces teams downrange and had already been up for an entire day. Upon hearing of the bombing, he ran to the hospital where he would proceed to operate for 18 hours straight, performing surgery for not only musculoskeletal injuries but also emergency procedures such as bowel resections. I am confident that he already had many experiences being a leader as a US Army officer and as a surgeon, but this unique position of leadership was thrust upon him by the Taliban bomber who killed 5 Americans and wounded 16 others that day.

Years later, he shared this story with my co-residents and me and informed us that “You all are leaders, whether you like it or not”. The more I reflect upon this assertion, the truer it seems to be. Many of us likely chose our profession due to a passion for performing upper extremity surgery and compassion to heal those afflicted by injury or illness; our principal goal for pursuing this career may not necessarily have been to become “captain” or “quarterback” of the operating room. Nevertheless, the expectation of leadership is often thrust upon those in a certain position. In the National Football League (NFL), the starting quarterback is often a de facto team leader and almost always named as a captain. Likewise, the surgical team looks to the surgeon for leadership in the operating room setting. However, we should be aware of the distinction between authority and leadership. A leader is more than just someone who has seniority or holds authority from a certain position. For instance, an intern may be thrust into leadership by a deteriorating patient that he or she identifies on the floor. By employing clear and calm communication, the intern can coordinate the escalation of care that the patient requires. Similarly, the surgeon who consistently employs clear and calm communication in the operating room will go a long way in gaining the trust and confidence of the team tackling a challenging case.

In the nascent days of the COVID-19 pandemic, the senior residents in my orthopaedics department were thrust into new and unique leadership roles. Almost overnight, the chiefs were tasked with creating new schedules that divided the residency program into two teams in order to minimize exposure and prevent a scenario where a critical mass of the orthopaedic workforce would be quarantined and no longer able to effectively care for patients. At the time, I found the actions of one chief resident especially memorable. He volunteered to take overnight call – shifts traditionally covered by second year residents – from anyone too anxious or unable to see consults in the emergency department during that period of uncertainty in the pandemic. The lesson is not that leaders put themselves in harm’s way, but that leaders put in more than they take out. Saying thank you to those who help clean the OR go a much longer way in terms of improving turnover time than simply telling the staff to hurry up. Better yet, the surgeon helping take out the trash and wiping down the tables himself or herself is a more convincing testament to the team that the surgeon is not just an authority figure, but a leader committed to having their backs and working towards a common goal. Likewise, the chief resident who willingly stays late with his or her team, performing work traditionally relegated to an intern, more effectively encourages the team getting through a challenging day than words alone.

Like it or not, we have all been thrust into leadership having entered this profession. Although our day-to-day circumstances and objectives may vary, it is up to us to put in, build our team up, and lead.