786
THE RED SECTION
nature publishing group
Leadership in Medicine: Do We Need a New Approach? Eamonn M. M. Quigley, MD, FRCP, FACP, FACG, FRCPI1
All of us who practice medicine are called upon to exercise leadership in a variety of roles; in some instances, a position of leadership will be enshrined in a title, whereas in others the role will be less outwardly apparent but no less critical. Fundamental to success in leadership in modern medicine is the recognition that we now work in teams whose members are interdependent; leaders must learn the skills necessary to motivate, guide, and develop teams and team members. Communication is a key skill for the leader of today; effective communication, its various methodologies and styles, can be learned and improved upon. Am J Gastroenterol 2014; 109:786–788; doi:10.1038/ajg.2013.438
The context
Why, you may well ask, should I spend time reading about leadership in medicine? The very simple answer is that by definition, whether you realize it or not, you, by virtue of your profession, are a leader. You may well hold a title (division chief, department chair, dean, chair of medical staff, director of endoscopy, and so on) that conveys to all around you that you are in a leadership position, or you may not; either way you are a leader to your patients, colleagues, students, trainees, clinic or office staff, endoscopy team, or community. Each of these constituencies expects you to guide, direct, and mentor them. You are a leader or will be one in some capacity in your work. Recognize this, embrace it, and learn the basics that will help you be an effective (and minimally stressed) leader in a modern medical environment.
effected and brought to conclusion—the goal, of course being the health of your patient and the integrity and professional development of the team. The days of the medical demagogue are truly over, as are leadership by screaming and shouting and decision making by feat. Modern medicine is no longer pyramidal in governance but rather has assumed a more horizontal and integrative organizational structure in which consultative decision-making has become the norm. Can, you will ask, anything get done in such a flat, apparently leaderless environment? The answer, as I hope to convince you, is absolutely yes. Not only can decisions be made and effected in such a world, but leadership, utilizing a very different approach, is more important than ever. Welcome to the new environment where the days of shouting and screaming are over, intimidation will not work, listening is critical, and consensus is desirable, if appropriate.
“I suppose leadership at one time meant muscles; but today it means getting along with people” —Mahatma Gandhi
Leadership styles and team dynamics
This quote from one of the most inspirational leaders of the twentieth century is remarkably prescient and anticipated by several decades the change that has occurred not only in medicine but in many areas of modern life: a shift from individual autocratic leadership to teamwork. As in so many fields of endeavor, the complexity and interdependence of modern medicine means that the “solo run” is no longer possible, nor is it desirable; modern medicine is very much a team game and leadership in medicine now centers on making teams work. No gastroenterologist is “an island”; the success of your practice and academic endeavors relies on many others. What gets done and the success or failure of its outcomes depends on your interactions with many others—how they are
Goleman (1), in his insightful review, identified six different leadership styles and advocated utilizing each of them in the right context and with the appropriate group, as follows (Table 1): The pacesetting leader expects and models excellence and self-direction; his/her motto could be simply stated as “do as I do, now!” This style is most useful and appropriate when the team is already motivated and skilled and the leader needs quick results—for example, while performing a complex procedure in the endoscopy suite. This approach must not be inappropriately applied or overused as it has the potential to overwhelm team members and squelch innovation. The visionary leader mobilizes the team toward a common vision and focuses on end goals, leaving the means to achieve them up to each individual. Here
1
Division of Gastroenterology and Hepatology, Houston Methodist Hospital, Houston, Texas, USA. Correspondence: Eamonn M. M. Quigley, MD, FRCP, FACP, FACG, FRCPI, Division of Gastroenterology and Hepatology, Houston Methodist Hospital, 6550 Fannin St, SM 1001, Houston, Texas 77030, USA. E-mail: [email protected]
The American Journal of GASTROENTEROLOGY
VOLUME 109 | JUNE 2014 www.amjgastro.com
THE RED SECTION
Table 1. Leadership styles •
Pacesetting
•
Visionary
•
Affiliative
•
Coaching
•
Commanding
•
Democratic
Based on Goleman (1).
the abiding principle could be stated as “come with me”. This approach works best when the team needs a new vision because circumstances have changed, or when explicit guidance is not required. Visionary leaders inspire the team to work toward a common goal; this context is encountered frequently in our hospitals and/or academic institutions when change is predicated and the leader needs to motivate the team to implement this change (2). It should not be used when the leader finds himself or herself working with a team of experts who know more than him/her; they will not be inspired and will not engage. The affiliative leader works to create emotional bonds that bring a feeling of bonding and belonging to the organization. Here the slogan is “people come first”. This approach is most appropriate in times of stress, when team members need to heal from a trauma, or when the team needs to rebuild trust. Regrettably, we can all readily envision contexts in our life at work when this approach was relevant. Although highly effective in such contexts, this style should not be used exclusively, as a sole reliance on praise and nurturing can foster mediocre performance and a lack of direction. The coaching leader develops people for the future by encouraging them to “try this”. This style is appropriate when the leader strives to help team members build lasting personal strengths that make them more successful overall; we can all recognize this as the process of mentorship as it should be practiced in training and education. It will be least effective when team members are defiant or unwilling or if the leader lacks the necessary expertise. The commanding leader demands immediate compliance: “Do what I tell you!” This approach can be readily seen to be most effective in times of crisis or during an actual emergency. It can also be used to control a problem team member when all else has failed. Outside of crises, this style should be avoided as it can alienate people and stifle flexibility and inventiveness. Parenthetically, it should be noted that in the latest version of the Advanced Cardiovascular Life Support (ACLS) provider manual considerable emphasis has been placed on the importance of team dynamics, emphasizing, even in the context of the ultimate medical crisis, the need to “understand not only your role but also the roles of other team members” (3). The democratic leader builds consensus through participation, asking team members “what do you think?” This style is most effective when the leader needs the team to buy into or have ownership of a decision, plan, or goal, or if he or she is uncertain and needs fresh ideas from qualified team members. This is not the best approach in a crisis, or emergency, © 2014 by the American College of Gastroenterology
or when the team is not sufficiently informed to offer guidance to the leader.
Leadership in action
How can we put this theory into practice? Putting it simply, be flexible, understand who you are with, and be sharply attuned to context! Recognizing the personalities, proficiencies, and expectations of your team members is critical. Learn to identify the different personalities that you will find in your group, from the task specialist whose sole goal is to get the task done as quickly as possible, to the expressive individual who seeks attention and needs, above all, to be heard, the amiable/relationship specialist who wants to simply get along with everyone, and, finally, the technical specialist, the analyst who seeks precision above speed and accuracy above all else. Your task, as a leader, is to harness these disparate but highly recognizable individuals and use their different approaches to help the entire team achieve its goal. “A leader is best when people barely know he exists, when his work is done, his aim fulfilled, they will say: we did it ourselves” —Lao Tzu Although few of us would relish, as leaders, being nonexistent, this quote does emphasize two important points. First, that leadership should be about the common goals, challenges, and achievements of the team, not about you. Second, and a direct corollary, one should not assume a leadership position if one does not have confidence in oneself, in one’s status and career. A division chief or department chair who is insecure in his or her own level of success or concerned about peer perception of his or her status will focus primarily or even fixate on progressing their own career to the detriment of the division or department. In other words, your own insecurities will cramp your leadership style and contaminate the working environment. As Alberts (4), the editor-in-chief of Science, has pointed out, appointing a poorly qualified person as leader can have far-reaching, negative consequences. The unqualified, insecure leader will not strive to surround him or herself with the best but rather with individuals who will neither threaten nor overshadow him or her, leading to what he refers to as “a propagating chain of mediocrity that degrades the entire institution”. Credibility is the number one reason people follow someone. Furthermore, leaders are viewed as credible if they are knowledgeable, authoritative, confident, honest, and trustworthy (5). As a leader, you are obliged to be informed; do not “wing it” in meetings no matter how insignificant they may seem to be; be prepared! “Don’t find fault, find a remedy” —Henry Ford
Communication and emotional intelligence
Communication has become a critical skill for all leaders today; you must communicate effectively in each and every forum and by every means that is available to you: running a meeting, communicating by email, discussing an issue one-on-one with a colleague, The American Journal of GASTROENTEROLOGY
787
788
THE RED SECTION
or resolving a dispute or problem. Each of these contexts ultimately relies on communication skills, which, despite what some may say, can be learned and improved upon. The key components of communication are strategy (how to plan and implement), writing (including email and on social media), and speaking. In addition, leaders should possess emotional intelligence, practice cultural literacy, know how to chair meetings and manage teams, mentor, and, above all, listen. Of these, the one quality that may not be familiar to a medical readership is emotional intelligence, a concept introduced by Goleman (6) and defined by Bar-On and Parker (7) as “the ability to be aware of, understand, and express yourself, relate to others, deal with strong emotions, control your impulses, and, finally, adapt to change and solve problems of a personal or a social nature”. In relation to medicine, emotional intelligence has not only been shown to promote effective leadership but has also been shown to positively contribute to the doctor–patient relationship, teamwork, communication skills, and stress management (8). Learn to use all means of communication optimally and appropriately. Do not, for example, resort to using email as the sole means of communicating with others; although readily available at your fingertips, this electronic interface, devoid of true personal interaction, should be used only as a means of providing general information, such as announcements or schedules, and should never be your sole vehicle for resolving problems, imposing changes, or issuing new directives. One-on-one meetings are essential when dealing with an issue, complaint, or problem that is particular to a given individual. Despite the vast panoply of media available to us, I firmly believe that face-to-face group/divisional/ departmental meetings must remain regular, scheduled events in the life of every group; this is where common business gets done and group members have an opportunity to contribute. Experts have identified key steps in communication: establish the working climate, employ ways to improve communication, communicate regularly with key personnel, and promote consensus. In the ideal working climate, organizational and individual goals are congruent; individual group members are flexible, responsive to organizational needs, and willing to accept responsibility, while the leader adopts an approach that is appropriate to individual and organizational needs. Your own openness to your colleagues and co-workers can be signified by something as simple as your office door. An open door portrays openness and ensures interaction but you risk being swamped by trivia and being perceived as more accessible to some than to others. On the other hand, a closed door, although allowing you to arrange appointments that can be scheduled in order of priority and importance, may signal aloofness and risk your becoming out of touch with what is going on around you. Myatt (9), writing in Forbes magazine, listed 10 secrets to better communication, which are listed in Table 2 but can be encapsulated as follows: Know what you are talking about but be prepared to listen.
The “bottom line”
Medicine has changed and has rapidly evolved into a team endeavor; modern leadership must acknowledge this shift. The American Journal of GASTROENTEROLOGY
Table 2. 10 Communication secrets •
Be trusted
•
Get personal
•
Get specific
•
Focus on the leave-behinds; not the take-aways
•
Have an open mind
•
Shut up and listen
•
Replace ego with empathy
•
Read between the lines
•
Know what you are talking about
•
Speak to groups as individuals
Based on Myatt (7).
Leadership will be expected of you; leadership training should be an essential component of every physician’s education (10). There are different leadership styles; none is ideal for all occasions. You will need to draw on each of them in specific situations and contexts; learning how and when to act is a key attribute of successful leaders. Know your team members, their personal styles, and harness them effectively; understand the working climate. Communication is an essential component of every leadership role; select the correct means for each situation. Your interactions with your colleagues should be about common goals and problems and not about you. Learn to listen. You must be credible. CONFLICT OF INTEREST
Guarantor of the article: Eamonn M. M. Quigley, MD, FRCP, FACP, FACG, FRCPI. Specific author contributions: Eamonn M. M. Quigley wrote the article in its entirety. Financial support: None. Potential competing interests: None. REFERENCES 1. Goleman D. Leadership that gets results. Harvard Bus Rev 2000;80: 82–3. 2. Effective Resuscitation Team Dynamics. In: Sinz E, Navarro K (eds). Advanced Cardiovascular Life Support. Provider Manual. American Heart Association: Dallas, 2011, pp 17–23. 3. Harolds JA. Tips for leaders, part III: leadership during a time of change. Clin Nucl Med 2011;36:904–5. 4. Alberts B. On effective leadership. Science 2012;338:443. 5. Kouzes JM, Posner BZ. Transformational leadership. The credibility factor. Healthc Forum J 1993;36:16–24. 6. Goleman D. Emotional Intelligence. Bantam Books: New York, 1995. 7. Bar-On R, Parker JDA (eds). The Handbook of Emotional Intelligence: Theory, Development, Assessment, and Application at Home, School and in the Workplace. Jossey-Bass: San Francisco, 2000. 8. Arora S, Ashrafian H, Davis R et al. Emotional intelligence in medicine: a systematic review through the context of the ACGME competencies. Med Educ 2010;44:749–64. 9. Myatt M. 10 communication secrets of great leaders. http://www.forbes. com/sites/mikemyatt/2012/04/04/10-communication-secrets-of-greatleaders/ (accessed 11 July 2013). 10. Warren OJ, Carnall R. Medical leadership: why it’s important, what is required, and how we develop it. Postgrad Med J 2011;87:27–32.
VOLUME 109 | JUNE 2014 www.amjgastro.com
THE RED SECTION
nature publishing group
Leadership in Medicine: Do We Need a New Approach? Eamonn M. M. Quigley, MD, FRCP, FACP, FACG, FRCPI1
All of us who practice medicine are called upon to exercise leadership in a variety of roles; in some instances, a position of leadership will be enshrined in a title, whereas in others the role will be less outwardly apparent but no less critical. Fundamental to success in leadership in modern medicine is the recognition that we now work in teams whose members are interdependent; leaders must learn the skills necessary to motivate, guide, and develop teams and team members. Communication is a key skill for the leader of today; effective communication, its various methodologies and styles, can be learned and improved upon. Am J Gastroenterol 2014; 109:786–788; doi:10.1038/ajg.2013.438
The context
Why, you may well ask, should I spend time reading about leadership in medicine? The very simple answer is that by definition, whether you realize it or not, you, by virtue of your profession, are a leader. You may well hold a title (division chief, department chair, dean, chair of medical staff, director of endoscopy, and so on) that conveys to all around you that you are in a leadership position, or you may not; either way you are a leader to your patients, colleagues, students, trainees, clinic or office staff, endoscopy team, or community. Each of these constituencies expects you to guide, direct, and mentor them. You are a leader or will be one in some capacity in your work. Recognize this, embrace it, and learn the basics that will help you be an effective (and minimally stressed) leader in a modern medical environment.
effected and brought to conclusion—the goal, of course being the health of your patient and the integrity and professional development of the team. The days of the medical demagogue are truly over, as are leadership by screaming and shouting and decision making by feat. Modern medicine is no longer pyramidal in governance but rather has assumed a more horizontal and integrative organizational structure in which consultative decision-making has become the norm. Can, you will ask, anything get done in such a flat, apparently leaderless environment? The answer, as I hope to convince you, is absolutely yes. Not only can decisions be made and effected in such a world, but leadership, utilizing a very different approach, is more important than ever. Welcome to the new environment where the days of shouting and screaming are over, intimidation will not work, listening is critical, and consensus is desirable, if appropriate.
“I suppose leadership at one time meant muscles; but today it means getting along with people” —Mahatma Gandhi
Leadership styles and team dynamics
This quote from one of the most inspirational leaders of the twentieth century is remarkably prescient and anticipated by several decades the change that has occurred not only in medicine but in many areas of modern life: a shift from individual autocratic leadership to teamwork. As in so many fields of endeavor, the complexity and interdependence of modern medicine means that the “solo run” is no longer possible, nor is it desirable; modern medicine is very much a team game and leadership in medicine now centers on making teams work. No gastroenterologist is “an island”; the success of your practice and academic endeavors relies on many others. What gets done and the success or failure of its outcomes depends on your interactions with many others—how they are
Goleman (1), in his insightful review, identified six different leadership styles and advocated utilizing each of them in the right context and with the appropriate group, as follows (Table 1): The pacesetting leader expects and models excellence and self-direction; his/her motto could be simply stated as “do as I do, now!” This style is most useful and appropriate when the team is already motivated and skilled and the leader needs quick results—for example, while performing a complex procedure in the endoscopy suite. This approach must not be inappropriately applied or overused as it has the potential to overwhelm team members and squelch innovation. The visionary leader mobilizes the team toward a common vision and focuses on end goals, leaving the means to achieve them up to each individual. Here
1
Division of Gastroenterology and Hepatology, Houston Methodist Hospital, Houston, Texas, USA. Correspondence: Eamonn M. M. Quigley, MD, FRCP, FACP, FACG, FRCPI, Division of Gastroenterology and Hepatology, Houston Methodist Hospital, 6550 Fannin St, SM 1001, Houston, Texas 77030, USA. E-mail: [email protected]
The American Journal of GASTROENTEROLOGY
VOLUME 109 | JUNE 2014 www.amjgastro.com
THE RED SECTION
Table 1. Leadership styles •
Pacesetting
•
Visionary
•
Affiliative
•
Coaching
•
Commanding
•
Democratic
Based on Goleman (1).
the abiding principle could be stated as “come with me”. This approach works best when the team needs a new vision because circumstances have changed, or when explicit guidance is not required. Visionary leaders inspire the team to work toward a common goal; this context is encountered frequently in our hospitals and/or academic institutions when change is predicated and the leader needs to motivate the team to implement this change (2). It should not be used when the leader finds himself or herself working with a team of experts who know more than him/her; they will not be inspired and will not engage. The affiliative leader works to create emotional bonds that bring a feeling of bonding and belonging to the organization. Here the slogan is “people come first”. This approach is most appropriate in times of stress, when team members need to heal from a trauma, or when the team needs to rebuild trust. Regrettably, we can all readily envision contexts in our life at work when this approach was relevant. Although highly effective in such contexts, this style should not be used exclusively, as a sole reliance on praise and nurturing can foster mediocre performance and a lack of direction. The coaching leader develops people for the future by encouraging them to “try this”. This style is appropriate when the leader strives to help team members build lasting personal strengths that make them more successful overall; we can all recognize this as the process of mentorship as it should be practiced in training and education. It will be least effective when team members are defiant or unwilling or if the leader lacks the necessary expertise. The commanding leader demands immediate compliance: “Do what I tell you!” This approach can be readily seen to be most effective in times of crisis or during an actual emergency. It can also be used to control a problem team member when all else has failed. Outside of crises, this style should be avoided as it can alienate people and stifle flexibility and inventiveness. Parenthetically, it should be noted that in the latest version of the Advanced Cardiovascular Life Support (ACLS) provider manual considerable emphasis has been placed on the importance of team dynamics, emphasizing, even in the context of the ultimate medical crisis, the need to “understand not only your role but also the roles of other team members” (3). The democratic leader builds consensus through participation, asking team members “what do you think?” This style is most effective when the leader needs the team to buy into or have ownership of a decision, plan, or goal, or if he or she is uncertain and needs fresh ideas from qualified team members. This is not the best approach in a crisis, or emergency, © 2014 by the American College of Gastroenterology
or when the team is not sufficiently informed to offer guidance to the leader.
Leadership in action
How can we put this theory into practice? Putting it simply, be flexible, understand who you are with, and be sharply attuned to context! Recognizing the personalities, proficiencies, and expectations of your team members is critical. Learn to identify the different personalities that you will find in your group, from the task specialist whose sole goal is to get the task done as quickly as possible, to the expressive individual who seeks attention and needs, above all, to be heard, the amiable/relationship specialist who wants to simply get along with everyone, and, finally, the technical specialist, the analyst who seeks precision above speed and accuracy above all else. Your task, as a leader, is to harness these disparate but highly recognizable individuals and use their different approaches to help the entire team achieve its goal. “A leader is best when people barely know he exists, when his work is done, his aim fulfilled, they will say: we did it ourselves” —Lao Tzu Although few of us would relish, as leaders, being nonexistent, this quote does emphasize two important points. First, that leadership should be about the common goals, challenges, and achievements of the team, not about you. Second, and a direct corollary, one should not assume a leadership position if one does not have confidence in oneself, in one’s status and career. A division chief or department chair who is insecure in his or her own level of success or concerned about peer perception of his or her status will focus primarily or even fixate on progressing their own career to the detriment of the division or department. In other words, your own insecurities will cramp your leadership style and contaminate the working environment. As Alberts (4), the editor-in-chief of Science, has pointed out, appointing a poorly qualified person as leader can have far-reaching, negative consequences. The unqualified, insecure leader will not strive to surround him or herself with the best but rather with individuals who will neither threaten nor overshadow him or her, leading to what he refers to as “a propagating chain of mediocrity that degrades the entire institution”. Credibility is the number one reason people follow someone. Furthermore, leaders are viewed as credible if they are knowledgeable, authoritative, confident, honest, and trustworthy (5). As a leader, you are obliged to be informed; do not “wing it” in meetings no matter how insignificant they may seem to be; be prepared! “Don’t find fault, find a remedy” —Henry Ford
Communication and emotional intelligence
Communication has become a critical skill for all leaders today; you must communicate effectively in each and every forum and by every means that is available to you: running a meeting, communicating by email, discussing an issue one-on-one with a colleague, The American Journal of GASTROENTEROLOGY
787
788
THE RED SECTION
or resolving a dispute or problem. Each of these contexts ultimately relies on communication skills, which, despite what some may say, can be learned and improved upon. The key components of communication are strategy (how to plan and implement), writing (including email and on social media), and speaking. In addition, leaders should possess emotional intelligence, practice cultural literacy, know how to chair meetings and manage teams, mentor, and, above all, listen. Of these, the one quality that may not be familiar to a medical readership is emotional intelligence, a concept introduced by Goleman (6) and defined by Bar-On and Parker (7) as “the ability to be aware of, understand, and express yourself, relate to others, deal with strong emotions, control your impulses, and, finally, adapt to change and solve problems of a personal or a social nature”. In relation to medicine, emotional intelligence has not only been shown to promote effective leadership but has also been shown to positively contribute to the doctor–patient relationship, teamwork, communication skills, and stress management (8). Learn to use all means of communication optimally and appropriately. Do not, for example, resort to using email as the sole means of communicating with others; although readily available at your fingertips, this electronic interface, devoid of true personal interaction, should be used only as a means of providing general information, such as announcements or schedules, and should never be your sole vehicle for resolving problems, imposing changes, or issuing new directives. One-on-one meetings are essential when dealing with an issue, complaint, or problem that is particular to a given individual. Despite the vast panoply of media available to us, I firmly believe that face-to-face group/divisional/ departmental meetings must remain regular, scheduled events in the life of every group; this is where common business gets done and group members have an opportunity to contribute. Experts have identified key steps in communication: establish the working climate, employ ways to improve communication, communicate regularly with key personnel, and promote consensus. In the ideal working climate, organizational and individual goals are congruent; individual group members are flexible, responsive to organizational needs, and willing to accept responsibility, while the leader adopts an approach that is appropriate to individual and organizational needs. Your own openness to your colleagues and co-workers can be signified by something as simple as your office door. An open door portrays openness and ensures interaction but you risk being swamped by trivia and being perceived as more accessible to some than to others. On the other hand, a closed door, although allowing you to arrange appointments that can be scheduled in order of priority and importance, may signal aloofness and risk your becoming out of touch with what is going on around you. Myatt (9), writing in Forbes magazine, listed 10 secrets to better communication, which are listed in Table 2 but can be encapsulated as follows: Know what you are talking about but be prepared to listen.
The “bottom line”
Medicine has changed and has rapidly evolved into a team endeavor; modern leadership must acknowledge this shift. The American Journal of GASTROENTEROLOGY
Table 2. 10 Communication secrets •
Be trusted
•
Get personal
•
Get specific
•
Focus on the leave-behinds; not the take-aways
•
Have an open mind
•
Shut up and listen
•
Replace ego with empathy
•
Read between the lines
•
Know what you are talking about
•
Speak to groups as individuals
Based on Myatt (7).
Leadership will be expected of you; leadership training should be an essential component of every physician’s education (10). There are different leadership styles; none is ideal for all occasions. You will need to draw on each of them in specific situations and contexts; learning how and when to act is a key attribute of successful leaders. Know your team members, their personal styles, and harness them effectively; understand the working climate. Communication is an essential component of every leadership role; select the correct means for each situation. Your interactions with your colleagues should be about common goals and problems and not about you. Learn to listen. You must be credible. CONFLICT OF INTEREST
Guarantor of the article: Eamonn M. M. Quigley, MD, FRCP, FACP, FACG, FRCPI. Specific author contributions: Eamonn M. M. Quigley wrote the article in its entirety. Financial support: None. Potential competing interests: None. REFERENCES 1. Goleman D. Leadership that gets results. Harvard Bus Rev 2000;80: 82–3. 2. Effective Resuscitation Team Dynamics. In: Sinz E, Navarro K (eds). Advanced Cardiovascular Life Support. Provider Manual. American Heart Association: Dallas, 2011, pp 17–23. 3. Harolds JA. Tips for leaders, part III: leadership during a time of change. Clin Nucl Med 2011;36:904–5. 4. Alberts B. On effective leadership. Science 2012;338:443. 5. Kouzes JM, Posner BZ. Transformational leadership. The credibility factor. Healthc Forum J 1993;36:16–24. 6. Goleman D. Emotional Intelligence. Bantam Books: New York, 1995. 7. Bar-On R, Parker JDA (eds). The Handbook of Emotional Intelligence: Theory, Development, Assessment, and Application at Home, School and in the Workplace. Jossey-Bass: San Francisco, 2000. 8. Arora S, Ashrafian H, Davis R et al. Emotional intelligence in medicine: a systematic review through the context of the ACGME competencies. Med Educ 2010;44:749–64. 9. Myatt M. 10 communication secrets of great leaders. http://www.forbes. com/sites/mikemyatt/2012/04/04/10-communication-secrets-of-greatleaders/ (accessed 11 July 2013). 10. Warren OJ, Carnall R. Medical leadership: why it’s important, what is required, and how we develop it. Postgrad Med J 2011;87:27–32.
VOLUME 109 | JUNE 2014 www.amjgastro.com
