Wednesday, November 20, 2013

Early Lessons in Leadership

by Sophia K. McKinley

Do you consider yourself a leader?

For most of medical school, I did not consider myself a leader. To me, leaders were people with big personalities and big visions, the kind of individuals who could inspire passion in large crowds or start political movements. I was a quiet-voiced student at the bottom of medicine’s hierarchy – surely not a leader, and in no position to lead.

My perspective on leadership changed dramatically while spending a year as a Zuckerman Fellow at the Center for Public Leadership at the Harvard Kennedy School. Every week I participated in three hours of leadership training in the form of small-group seminars with prominent individuals, workshops on practical skills such as public speaking and negotiating, and personal development sessions. Whenever anyone asks me what I learned over the course of the year-long leadership curriculum, I always identify the same three take-aways:

1. Leaders are made, not born

I used to think some people were leaders and others weren’t. Now, I see leadership as a skill that can be cultivated, practiced, and improved. This shift in attitude has meant that even when I don’t feel as if I am a leader, I still see myself as someone who can learn to become a leader. And, I am now on the lookout for opportunities to practice leading and to gain skills as part of a lifelong process of becoming an increasingly skilled leader.

I expect surgery residency will be full of opportunities to practice leadership skills. Oral presentations will be public speaking practice, and overnight call will serve as an exercise in prioritization and time management. Leaders need excellent interpersonal and teamwork skills even in tense situations—where better to deliberately develop these abilities than the operating room? No one expects newly graduated medical students to show up to intern year as fully formed surgeons. I now know it is just as unrealistic to expect myself to be a fully formed leader.

2. Self-understanding matters

Leadership is about influencing other people. In order to do this better, I realized I first needed to understand myself and my own behaviors. Through a variety of assessments including emotional intelligence evaluation and a 360 feedback process, I gained a greater understanding of how my actions were influencing those around me.

For example, I learned that I often concede what I want in order to avoid negotiation. But in surgery, being a leader often means effectively advocating for patients in difficult situations. Awareness of my tendency not to press my agenda means that in future conflicts, I can reflect on whether I am being assertive enough, or whether I am failing to identify collaborative, “win-win” solutions that satisfy all parties including myself. I now know that a key to my future success as a leader will be improving my negotiation skills. Yet gaining self-understanding isn’t just about identifying weakness—it’s also about understanding strengths. Nearly all of the individuals who provided me with feedback during my 360 evaluation commented on my written communication skills. I know that for me to be the most effective leader possible, I should capitalize on my ability to influence others through writing.

3. Leadership happens at all levels

Finally, I no longer believe that leadership is solely the purview of those at the top. While leadership manifests itself differently at different levels within an organization, individuals at every position in a hierarchy can exhibit leadership. One of the most common definitions of leadership is acting in a way that enlists the support of others towards the accomplishment of a common goal. A title that indicates authority or power is not necessary to engage in leadership of this kind.

Think of a situation during medical school, residency, or beyond in which a group of individuals at the same level were given a task or assignment. Even without adopting formal roles or titles, some individuals functioned as group leaders because their behaviors influenced others towards superior performance in task completion. And probably everyone has been on a medical team in which the individual who did the most to improve group performance was not the team’s most senior member. As I enter intern year and beyond, I hope to be the kind of resident who exhibits leadership by influencing others to better achieve common goals. What I do to exhibit leadership may change as I rise through surgery’s ranks, but no matter what level I am, there will be opportunities to function as a leader, even if that means leading by example to peers and more junior trainees.

Not everyone has the experience of participating in a formal leadership curriculum across a year, but everyone can reflect and seek feedback to gain better self-understanding of leadership strengths and weaknesses. We can all seek opportunities that will develop particular leadership skills, and we can consciously practice leadership in the setting and position we currently work and learn. Hopefully, when asked “Do you consider yourself a leader,” more women surgeons will affirm, as I do now:

“I am a leader.” 


Sophia is a dual-degree M.D./Ed.M. student at Harvard Medical School and the Harvard Graduate School of Education. She received the 2012 Association of Women Surgeons Patricia Numann Medical Student Award and spent a year as a Zuckerman fellow at the Center for Public Leadership at Harvard Kennedy School. Sophia is passionate about medical education, and she hopes to be an academic surgeon who brings educationally-sound innovations to surgical training. Her clinical interests are gastrointestinal and minimally invasive surgery. Sophia is currently interviewing for general surgery residency during the 2014 Match cycle.


  1. Sophia, yes, leadership is a skill that can be developed and needs to be continually nurtured. As you learn other leadership styles, having self-awareness and situational awareness will help elect the appropriate style.
    Personally I think all women surgeons are leaders whether they do so in official capacity or not - being underrepresented in our field naturally places us in a position of leadership. That too will change.

  2. Minerva, that's a great point. I remember when medical school started, I went out of my way to seek mentors who were similar to me. As someone who had never encountered any women surgeons prior to medical school, I was both reassured and inspired to discover women at all levels of surgical training--from interns all the way to full professors. Intentional or not, these women became my role models!