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 Table of Contents  
Year : 2016  |  Volume : 2  |  Issue : 1  |  Page : 78-82

Leading with humility: Developing a culture of success!

1 Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
2 Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
3 Department of Surgery, University of Virginia, Charlottesville, Virginia, USA

Date of Submission13-Dec-2015
Date of Acceptance05-Feb-2016
Date of Web Publication2-Jun-2016

Correspondence Address:
Joseph V Sakran
Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2455-5568.183329

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Authentic leadership is critical to spearheading the advancement of young surgeons in their developmental stages as they acquire the skill sets necessary to lead successful careers in surgery. It is predicated on the understanding of the aptitudes, learned skills, dedication, patience, agreeableness, and nurturing of one's cognitive and emotional intelligence. Resilience and humility are a few of the attributes required to master for those who hope to become leaders and mentors within surgery. Perspectives on learning and leadership from the young trainee to the seasoned surgeon, both of which are considered students of surgery, are presented here. Traits of great leaders are discussed in the hope of creating a culture that fosters the development of surgical mentors in the next generations to come.
The following core competencies are addressed in this article: Interpersonal skills and communication, Professionalism, Systems based practice.

Keywords: Adaptive leadership, emotional intelligence, humility, teamwork

How to cite this article:
Sakran JV, Alshareef MA, Rustin RB. Leading with humility: Developing a culture of success!. Int J Acad Med 2016;2:78-82

How to cite this URL:
Sakran JV, Alshareef MA, Rustin RB. Leading with humility: Developing a culture of success!. Int J Acad Med [serial online] 2016 [cited 2023 Jan 31];2:78-82. Available from: https://www.ijam-web.org/text.asp?2016/2/1/78/183329

“I have been driven many times upon my knees by the overwhelming conviction that I had nowhere else to go. My own wisdom and that of all about me seemed insufficient for that day.”

-Abraham Lincoln

  Introduction Top

As surgeons, both young and old, we have a unique opportunity to be leaders – leaders in medicine, surgery, and in our communities. Greatness, as a leader, is the gift that is ultimately bestowed upon a select few after understanding and mastering the complexities of what it takes to lead a balanced, positive life, as well as accepting the disciplines of intellectual study, compassion, conviction, intellectual brilliance, openness, and most importantly, humility. Those who are able to effectively combine these traits are on the path to become tomorrow's leaders. Simple intelligence is but one piece of the puzzle that makes remarkable surgeons. Abraham Lincoln understood the enormity of life's challenges and was humble enough to admit it, learn, and move forward for the good of a young nation, divided.

This article explores the importance of leading with humility. We function in a time when fostering a culture of value and appreciation goes beyond just the mission of developing a professional and positive working atmosphere. It is critical to enhance the delivery of high-quality care to our patients. There are many lessons from the past from which we can derive guidance. In the recent book by General Stanley McChrystal, Team of Teams, the General skillfully illustrates the importance of moving away from a typical top-down approach that is often seen in so many organizations, then capitalizing on the characteristics of successful small groups such as agility and adaptability.[1] What is often overlooked is the significance of leading as a humble servant. We will take a unique approach by looking at this aspect from different vantage points ranging from the surgical trainee to the seasoned surgeon.

  A Trainee's Experience Top

As I sat one night around an inviting fire, conversing with friends, I spoke of someday becoming a surgeon and was faced by confused stares. These were all young medical students aspiring to become the next generation of physicians in today's world. Becoming a surgeon was considered by them to be associated with an air of arrogance, a notorious stereotype, which is at times casually attached to this field. Surgery has been thought of as a long and demanding career that spans numerous years of training under stressful mental and physical conditions. Upon entering the specialty, I felt a combination of optimism and intimidation of what lay ahead. Humility was initially instinctive, as I did not have the expertise to develop what I considered the sense of entitlement and superiority necessary to thrive professionally. However, as the months and years passed, it became more convenient to exhibit the opportunity to develop arrogance that had been unfortunately so intertwined within the practice of surgery.

The initial humility some of us experience as we begin our medical training tends to spur from a self-abasing humility. This is the perception that we lack the expertise and knowledge to be in such a complex role of responsibility. Therefore, many of us will be readily agreeable, learning from our superiors, and respecting all staff in all levels of the hierarchy in a conciliatory manner. The challenge is maintaining this social interaction as we grow within the ranks of leadership. Several factors contribute to this initial type of humility. The first is the transitioning into a new system and environment containing input from many independent variables, intimidating as it may be. Another variable is the immediate escalation of responsibility to care for critically ill patients, along with one's natural sense of unpreparedness in this transition and reticence to act on knowledge while translating it directly to patient care. Finally, we have seen an expectation from patients and staff for us to perform flawlessly, escalating our potential to make more medical errors. There is a continuous need to translate this conciliation and reticence into respectful discourse and dialog, challenging authority and surgical dogma so prevalent in caring for patients. Meeting this challenge can result in better delivery of health care as a team.

Familiarization with a new healthcare system brings along with it new challenges. Long hours spent working under constant pressure transition young surgeons to new phases of social interaction. Resisting criticism or becoming agreeable to suggestion from authority becomes a governor for earning respect among colleagues. An agreeable nature originates from two similar but distinct types of personalities, honesty–humility and agreeableness.[2] Honesty–humility is the tendency toward active cooperation whereas agreeableness is linked to reactive cooperation. Active cooperation deals more with individuals who have the predilection to be equitable when dealing with others even at their own expense. Reactive cooperation is when individuals have to tolerate the actions of others having the tendency to forgive and forget. As one then advances in training and develops levels of expertise, the signs of great leadership evolve from the honesty–humility personality factor rather than the reactive cooperation of the agreeableness trait.

In this early phase of my training, I have observed a number of important traits within my educators and their social responses to stress. Some select to practice medicine in an autocratic fashion.[3] This is a simple way of running a practice while simultaneously reducing the opportunity for discussion and debate. However, it is considered to potentially place an individual at an increased risk for error and reduces the ability to provide creative or meaningful discourse pertaining to patient care. Another common leadership style is a participative approach, whereby the physician allows the final decision to be made through the consensus of the healthcare team. This approach allows increased team morale and boosts productivity, but requires a significant display of humility on the part of the leading physician. These features can ultimately allow for quality improvement and establishment of redundancy, allowing more opportunities for the team to minimize healthcare-related errors. More importantly, it allows for approachability, a key feature of open communication and dialog.

Reactions from nursing staff and hospital staff toward actions taken by residents tend to differ dramatically. All individuals experience different rates of error in decision-making. It does not always correlate with the knowledge base imparted upon medical school graduates. It is rather the style with which each resident interacts with members of the team, and the amount of input they allow from each member. As we allow more input and feedback from other team members, more of the nuances of medicine can be appreciated. This enables the development of more courage and self-confidence in critical decision-making and efficiency.

There are valid comparisons from the business sector pertaining to humility, a core requirement for successful leadership. Humility tends to mature over time. As an intern, it is spurred by self-confidence and the willingness to learn from those with less expertise. It requires significant personal effort to develop this trait. As the author of a recent article in Forbes, Ryan Westwood, states, “successful entrepreneurs must be able to welcome new ideas, be able to effectively listen and suspend their own thoughts, support a strong team that performs tasks they lack experience in, and must be willing to make and admit mistakes.”[4] Honesty–humility, rather than agreeableness, is a necessary trait to achieve active cooperation among team workers working in unison.

Another aspect of humility is avoiding overbearing management of trainees, and allowing them to perform their tasks under supervision. It is of course essential to initially train a resident physician, especially a surgical resident, in the foundational science and art of surgery. Ultimately, the teacher must allow trainees to make their own decisions and to consider their input in order for them to achieve the training required to advance autonomously. In an interesting comparison of physicians to entrepreneurs, there are numerous approaches to the same problem, although each may have their own validated approach. My teachers challenge me regularly by requesting that I provide the plan prior to them giving their opinion. What makes this approach desirable to me as a trainee is the affirmation I receive once the plan is deemed valid, regardless of their differing approaches to the same problem. This expands self-confidence, allowing a variety of solutions for any given problem to be more thoroughly appreciated.

Breeding a generation of humble leaders requires the physical presence of those leaders at the point of learning. Many of the traits of great leaders are demonstrative in their own teams. This creates a sense of community built upon core leadership traits. Medicine has functioned historically as a hierarchical institution, “see one, do one, teach one.” As we ascend within this hierarchy, we attempt to mimic the personalities and traits of our leaders. The approach taken by our leading physicians, training students, and resident physicians will ultimately shape the next generation of healthcare leaders. As humility and respect continue to be implemented in a positive manner, we can develop a healthcare team with effective communication that is cohesive, innovative, and centered primarily on patient care.

  A Seasoned Surgeon's Experience Top

Intellectual brilliance is a special quality of the human mind that encompasses illuminating knowledge side by side with inventiveness, passion, and the ability to coordinate historical events with current challenges in a positive, progressive manner. Intellectual brilliance should be, as well, tempered by emotional intelligence to effectively govern the intensity of the innovative spirit, thus avoiding expected times of disappointment and failure.[5] As surgeons, we must exhibit the ability to pick ourselves up after defeat, realize the humility of life's challenges, and again begin forward motion. John Adams, Thomas Jefferson, and Abraham Lincoln were prime examples of individuals who exhibited high intellectual brilliance. Imagine the challenges they faced in the formative years of our nation!

Taking ideas and new thoughts to fruition requires conviction. We must embrace the concept that despite at times being surrounded by doubt or negativity, we should have the humility to accept challenges and remain positive, collaborate across disciplines, and be ready to environmentally adapt when necessary. Maintaining openness with others can sometimes be difficult for surgeons, who tend to frequently be placed in the position of the primary, sole decision-maker in challenging clinical scenarios that require rapid and sound judgment, often having to rely upon intuition. Micromanagement can often be seen as an innate trait in surgeons, but they should be cognizant of their environment and the degree to which it is implemented. We should be willing to accept the ambiguity of not always understanding what we are dealing with and at the same time willing to work to a goal accepting the fact we do not always know the best answer.

Humility is the synchronizing quality that distinguishes most great leaders from those who simply perform their tasks and have less of a lasting effect on others. Judaism, Christianity, Catholicism, Islam, Buddhism, Hinduism, and Taoism, all incorporate this treasured quality into their belief systems. “Leading from behind,”[6] a recent statement popularized by an adviser of President Barack Obama, is often misunderstood and exceptionally challenging, yet remains a paradoxically powerful statement acknowledging humility as a critical quality of leadership. Nelson Mandela also described it this way in his 1994 autobiography, “Long Walk to Freedom.”

“I always remember the regent's axiom: A leader, he said, is like a shepherd. He stays behind the flock, letting the most nimble go out ahead, whereupon the others follow, not realizing that all along they are being directed from behind.”[7]

We must learn to accept our mistakes and turn them around into “teachable moments” or, as the University of Virginia surgeon and mentor Dr. Robert Sawyer says, “opportunities for excellence.” Surgeons should continuously be aware of keeping the entire healthcare team in a proper, grounded context. Considering everyone's role, equally, as it pertains to caring and compassionate care for the suffering of the world nurtures a healthier environment for education as well. Humility trumps individualism when it pertains to true leadership.[8]

Having recently come face to face with the importance of humility as a humanitarian surgeon in equatorial Africa, I was able to see firsthand the manner whereby patients can suffer at the price of a surgeon's ego. As someone who generally approached life with a positive attitude, combined with excellent training and years of experience within the practice of surgery, I felt prepared to meet all the challenges of global surgery. I had grown up in a world of the individual exceptionalism of making a successful life as a surgeon in the USA. As my step-father had told me during my youth, success in life was related to ten simple words, “If it is to be, it is up to me.” Following this path, at times I neglected my family at the expense of dedication to my work. Upon arrival in equatorial Africa, I witnessed the global level of suffering of so many with so little. Despite their plight, there was a palpable sense of dignity amidst what seemed to be pointless optimism of defeating terrible diseases on a grand scale. Their uplifting energy was such a gift, more simple, and powerful than expected challenges to which I had prepared my capacity to cope. This was my humbling moment. It effectively became the spark that ignited my hope and conviction to work progressively with the operating room and emergency room national teams who were trying their best with low resources beyond comprehension of most Westerners. I frequently admitted I was not certain of what I was dealing with, and the input of the national health team was invaluable and positive. In the words of Lewis in Mere Christianity, “humility is not thinking less of yourself, but thinking of yourself less.”[9] This humility became the fuel for newly invigorated passion for my work and for the awareness of balance in my life between family, work, wealth, and true necessities of life. Realizing I had so much to learn from so many, in every station of life, with almost every affliction, was an enlightening moment that I will treasure for the rest of my life. I only wish I had realized this much earlier in life. Now my 10 simple words became, “If it is to me, it is up to we.”

  Adaptive Leadership Top

At the heart of adaptive leadership is understanding the need for change within an organization by disrupting the status quo. This concept introduced into the leadership world by Heifetz et al. in the mid-1990s is predicated on the fact that one does not need to have a specific title or position to be an agent of change. Authentic leadership as described by Heifetz et al. is “the practice of mobilizing people to tackle tough challenges and thrive.”[10] One of the critical pieces of being able to move groups or organizations forward is the ability to diagnose the current problem at hand. Often times, we might be premature in leaping to action, yet focusing on the observation and planning aspect of adaptive leadership is paramount to future success.

Once we diagnose the issues that are necessary to be improved, the next step requires the ability to design solutions tailored toward providing impactful change. This change will usually be met with both support and resistance. Potential conflict that arises from the implementation of interventions need to be managed. There can be a tendency to avoid conflict; however, challenging the status quo is necessary to move groups forward. This must be done in a thoughtful manner that ensures we actively listen to feedback being provided, while not being afraid to push against that circle of comfort allowing us to expand our ability to grow.

  Parting Thoughts Top

Being an effective leader who affects change on a grand scale is but for a few willing to make the effort. We are fortunate to be able to combine critical aptitudes and learned traits bathed in humility. It is a gift to those willing to accept and embrace it. Awareness of history, keeping up with advances in knowledge, balancing “me” with “we,” invoking intellectual brilliance, and trying to convert brief failure into lasting success, all while at the same time maintaining humility and respecting the human state, is life's task. I am proud to be a student of leadership every day and to have had the opportunity to become a surgeon. To be remembered as those who make a difference to others less fortunate, leaving a legacy of enthusiastic generations of surgeons is an ultimate goal as educators and mentors.

Leading a balanced life is important for many reasons. Our minds should best nurture the scientific and artistic nature of our profession while maintaining the work–life balance that is important for sustainability along one's career. Deciding how we can derive a content, positive life is of prime importance, and fitting our life's work within that positive lifestyle will make us better communicators, teachers, and mentors. That balance is also critical to avoid the burnout and compassion fatigue that is being seen in physicians across the country and throughout the world. Work-related despair has been seen across the spectrum of clinicians, from student to senior surgeon. This change does not happen overnight, and requires a change in the culture of the medicine we practice. As surgeons who are often viewed as “leader performers,” this is of utmost importance not only for ensuring the delivery of high-quality care to our patients, but also to help develop the next generations of future leaders in surgery.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

McChrystal S, Collins T, Silverman D, Fussell C. Team of Teams: New Rules of Engagement for a Complex World. New York: Portfolio, Penguin; 2015.  Back to cited text no. 1
Hilbig BE, Zettler I, Leist F, Heydasch T. It takes two: Honesty-humility and agreeableness differentially predict active versus reactive cooperation. Pers Individ Dif. 2013; 54(5): 598-603. [Print].  Back to cited text no. 2
Tannenbaum AS, Schmitt WH. How to choose a leadership pattern. Harv Bus Rev 1958;36:95-101.  Back to cited text no. 3
Westwood R. Humility: The Secret to Confident Leadership. Forbes Web Site; 5 February, 2015. Available from: . [Last retrieved on 2015 Nov 25].  Back to cited text no. 4
Simonton DK. Presidential IQ openness, intellectual brilliance, and leadership: Estimates and correlations for 42 U.S. chief executives. Polit Psychol 2006;27:511-639.  Back to cited text no. 5
Lizza R. Leading from Behind. The New Yorker Web Site; 26 April, 2011. Available from: . [Last retrieved on 2015 Nov 03].  Back to cited text no. 6
Mandela N. Long Walk to Freedom: The Autobiography of Nelson Mandela. Boston: Little, Brown; 1994.  Back to cited text no. 7
Kibbe M, Chen H. Leadership in Surgery. London: Springer; 2015.  Back to cited text no. 8
Lewis CS. Mere Christianity: A Revised and Enlarged Edition, With a New Introduction, of the Three Books the Case for Christianity, Christian Behaviour, and Beyond Personality. New York: Macmillan; 1952.  Back to cited text no. 9
Heifetz RA, Linsky M, Grashow A. The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World. Cambridge, MA: Harvard Business Press; 2009.  Back to cited text no. 10


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