Principles of leadership for the young surgeon

The Resident and Associate Society of the American College of Surgeons (RAS-ACS) recently presented a webinar on leadership development for surgical trainees and young surgeons. With the annual Leadership & Advocacy Summit scheduled to take place in Washington, DC, this month, it is worth taking this opportunity to summarize key points of information from the training session.

Understanding your power

It is impossible to discuss leadership without discussing power. Leaders are inherently in positions of power and use their status to stimulate changes. The word “power” sometimes has negative connotations, perhaps because as a society we typically define it as the ability to control others. But the true definition of power is the capacity to influence the behavior of those around us and together reach a common goal.

Influential surgeons have the ability to help a health care institution to grow, to improve resident education, and to bring about the changes necessary to produce better patient outcomes.

Empowered individuals have the confidence to exert their authority when it is needed, to develop partnerships with likeminded individuals, and to ensure fairness and transparency in our professional environment. When we understand our power and its impact, we can better see that leadership in surgery is not a privilege but a duty in which we serve our institutions, our patients, and our profession.

Leadership is a choice, not a rank

Productive leadership is every surgeon’s responsibility. Leading a team and advocating for our patients are examples of how we use our leadership skills in daily clinical activities and interactions. Effective leadership is a skill that can be learned and enhanced by understanding the following five key concepts.

Find your purpose

As a leader you must know what you want to accomplish, and strong leaders typically feel passion for a particular goal or project. Passion is a strong emotion that can sometimes overtake logical thinking, but if these intense feelings can be focused, they can help support a project. A leader’s mission can be an extension of his or her passion and refers to what we are meant to accomplish in the long term.

Understanding the difference between a surgeon’s profession and their vocation is important when defining your purpose and mission. A profession can refer to an individual’s paid occupation, while a vocation refers to a strong suitability for a particular profession such as surgery, along with a moral obligation based on personal principles to provide optimal care for the patient. Taking the time to conduct a self-assessment to determine where our passion, mission, vocation, and profession intersect efining a clear purpose for a surgeon leader.

Once your purpose is defined, it is important to communicate your vision with pathos (an appeal to emotion), logos (understanding the logic), and ethos (always taking into account ethics and integrity) to your team in order to convey credibility in your role as a leader. Your team’s commitment to helping you fulfill your goals depends on your ability to show them that change is necessary and that they have an important role in the process.


Leaders know the value of paying it forward. They know that they build goodwill by extending opportunities to the rest of the team, allowing them to move ahead. These opportunities must be offered in a way that is ethical and authentic.


Leading with authority is not about exerting force, but rather about being a trusted expert on a specific area. Excellent clinical performance is of the highest importance on the path to leadership in surgery.


Human nature seems to suggest that individuals sometimes desire things that are available in limited quantities. One of the best examples of using scarcity to demonstrate value can be found in sales, where advertisements indicate a product is available in limited supply or for a limited time only. As a health care provider, scarcity— or rather, your availability—can be a marker of your value as a team leader. Successful surgeon leaders excel at time management. Maintain control over your time commitments and devote yourself to a limited but meaningful number of activities.


Leaders are consensus builders. They understand that having the support of stakeholders, or at least having them understand the leader’s point of view, can support the message and, hopefully, lead to better results. Aligning your goals with the goals of your institution and your team will allow for a successful outcome for all parties involved.

Presenting your best self

Leaders exude and inspire confidence in those around them. Although confidence comes from within, there is some evidence that small interventions can affect how we feel about ourselves and our ability to lead with assurance.

In humans and other mammals, testosterone levels rise in individuals who hold situational power. These levels also increase in anticipation of a competition and as a result of a win; conversely, they drop following a defeat. Cortisol levels tend to increase in people who feel less powerful and capable. Carney and colleagues have shown cortisol levels drop and testosterone levels rise in healthy volunteers who hold power poses for 90 seconds or more. The same study showed increased cortisol in those individuals holding low-power poses. Power poses may be a quick fix to empower yourself and perform better under stress. However, building courage to take on difficult situations is a lifelong challenge. Being confident and appearing confident to others might be connected, but they are not the same. Being able to see a situation from a broad perspective and without feeling defensive is part of an ever-evolving mindset.

The role of the ACS

The ACS is committed to providing surgeons with the skills they need to be successful leaders.

The RAS-ACS provides all members in training and the early stages of their careers with opportunities to get involved in the activities of the College; to serve on various standing committees of the organization; and to participate in educational programs, including free admission to the ACS Clinical Congress to those who register in advance. Membership in the RAS-ACS provides trainees and Associate Fellows with access to career planning resources, networking situations, advocacy training and resources, and fellowship and scholarship programs. In addition, the College offers the Residents as Teachers and Leaders course to help young surgeons and trainees develop leadership skills.

The ACS Young Fellows Association (YFA) represents the interests of surgeons ages 45 and younger and provides a forum for them to shape the future of the organization and their specialty. The YFA provides opportunities to serve on committees and to lead courses and sessions at the Clinical Congress and locally through the ACS chapters. YFA members may serve on one of four workgroups (Advocacy, Communications, Education, and Member Services) and have opportunities to serve as a leading voice on advocacy and health policy issues. These groups work during the entire year to help all members getting involved in the national Clinical Congress program and all other ACS activities.

For surgeons interested in additional leadership development, the ACS offers the Surgeons as Leaders: From Operating Room to Boardroom course, which includes a week of intense training and networking.

The College also organizes the annual Leadership & Advocacy Summit mentioned at the beginning of this month’s column. This meeting provides a forum for surgeons to advocate to improve health care, meet with influential policymakers, network with ACS leaders, become more engaged in the organization, learn innovative ways to meet leadership and surgical challenges, and enhance leadership skills.


Leadership is a learned skill that allows surgeons to exert positive influence in their work environment. As surgeons, we are responsible for leading our teams. We serve as trusted authorities and advocates for our patients. It is important that we develop and maintain leadership skills throughout our careers. The ACS has programs in place to aid in the development of surgeon leaders starting early on in our careers.


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