Growing into a Leader in the ICU

Amanda Decimo, RN, MSN, MPH

Essential leadership skillsets training is needed during intensive care fellow training. Marginalized groups need support from leadership and each other to thrive in academic medicine. The six key elements of successful leadership include competence, intelligence, realization, purpose, self-management, and taking back control. During Education Session I: Leadership beyond the Bedside in the ICU: The Leadership Shadow You Cast on May 14 at the SOCCA 2021 Annual Meeting, the speakers discussed the elements that led to successful leadership.

Your Leadership Shadow in the Institution: Do You Understand Your Sphere of Influence?

ICU fellows must develop essential leadership skillsets in order to establish authority quickly while rotating through chaotic ICU settings. Liza Weavind, MBBCh, FCCM, MMHC, Associate Chief of Anesthesiology Critical Care Medicine at Vanderbilt University Medical Center, describes an extraordinary leader, not as an individual with all the answers, but a versatile agent of change with the vision and ability to motivate others to positively impact outcomes.  

Surgical fellows gain experience leading teams during their residency, while anesthesia fellows lack leadership training, essentially only managing themselves and one patient. ICU fellows at Vanderbilt University Medical Center are provided with a leadership curriculum that includes self-awareness and emotional intelligence, leadership style, conflict resolution, team management and coaching.

Being self-aware and authentically branding yourself and your leadership style are crucial to becoming a successful leader. Dr. Weavind describes the Johari Window exercise, used to help fellows understand how colleagues view them. Determining your leadership style while under pressure and understanding how to effectively “lead-up” to attending physicians with different personalities are also important considerations.

Navigating Leadership While Under-Represented in Medicine: Battling Imposter Syndrome and Staying True to Yourself

Our diverse backgrounds and experiences shape and enrich our field, creating collective wisdom that is greater than the sum of its parts. -Mehta S et al., Gender Parity in Critical Care Medicine 

Meghan Lane-Fall, MD, MSHP, David E. Longnecker Associate Professor of Anesthesiology and Critical Care at Perelman School of Medicine at the University of Pennsylvania, discussed barriers for marginalized groups including harassment and the imposter phenomenon. Women and other underrepresented groups face formidable challenges in academic anesthesia. NIH defines underrepresented groups relative to the population and includes Black, Latinx, American Indian, Alaskan Native, Native Hawaiian, and Pacific Islanders. Whereas marginalized groups relate to lack of access to power and include LGBTQA+, women, Asian race, and many other groups. Intersectionality occurs when an individual holds several of these identities and thus experiences marginalization from multiple vantage points, for example, being a Black woman or gay and Asian.

Recent studies indicate that 25% of women in anesthesia report disrespect of gender in the past year. Imposter phenomenon is a feeling of intellectual phoniness or self-doubt. Marginalized individuals may feel a sense that they don’t belong in academic medicine.

Dr. Lane-Fall suggested that faculty and leadership should work together to create conditions for marginalized groups to thrive. Marginalized individuals are at a critical mass in academic medicine and should use the opportunity to support each other and move forward.

Leading in Our Societies and Advocating for the Next Generation of Intensivists

Sheela Pai Cole, MD, FASE, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine, discussed six key elements of successful leadership including competence, intelligence, realization, purpose, self-management and taking back control.

• Competence: Competence is not about knowledge in this case but about personal and social competence. Personal competence includes self-awareness and self-management. Social competence involves reading other people and then making a decision to say or do something. The key part of competence is to accept what we cannot do.
• Intelligence: All anesthesia providers have proven their intellectual intelligence, but effective leaders require emotional intelligence.
• Realization: Realization involves considering that colleagues are also competent and hard-working. Dr. Pai Cole recommended the book, I’m OK-You’re OK, by Thomas Harris, which discusses respecting and considering others’ viewpoints.
• Purpose: Dr. Pai Cole described purpose as a study of paradoxes and referenced five pillars that are extrapolated in the book, The Serving Leader. The five pillars include run to great purpose, upend the pyramid, raise the bar, blaze the trail and build on strengths. One paradox she gave as an example was “to do the most good, strive for the impossible.”
• Self-management: Self-management involves considering your own attitude and behaviors. Using the camera approach to see only the situation in front of us prevents bias from previous experiences.
• Taking back control: To take back control, we bring in three different factors to a scenario: 1) See/Think – our biases; 2) Feel – our emotions; and 3) Speak/Do – the visible actions based on the first two factors. Proactive interactions mean checking biases and approaching situations positively, which leads to collaborative actions. Reactive interactions lead to negative energy, disruption and ultimately, burnout and jeopardizing patient outcomes. Taking back control requires excellent communication skills.

Communication is a key part of any interaction. While we have hundreds of interactions daily, few of us train to improve our communication skills. Nonverbal cues and listening are more important elements of communication than speaking. Open-ended questions and reflective statements help us listen to our colleagues and try to understand their points of view.

To truly lead, Dr. Pai Cole stresses, you need mentorship and sponsorship and to meet people where they are, accepting and providing actionable feedback.