Family Medicine Vital Signs

By Sonja Van Hala, MD, MPH, FAAFP

I was young and inexperienced, and knew it, but also had a sense of adventure. I don’t think I knew what it meant to serve as residency program director. I was only a few years out of residency. And I definitely didn’t know how to supervise faculty, all who trained me, or supervise staff, or address resident performance concerns, or address accreditation requirements. So there I was, having said “yes, I’ll do it”. I won’t say I was terrified, but I did have a keen sense of vulnerability. As if I was exposed. Like 80% exposed.

And that was a good way to start.  And it’s been a good way to continue. Whenever I am feeling exposed, I now know that I have an opportunity in front of me to learn and grow.

But I handle the vulnerability differently now than in my early years. Initially, I carried the discomfort alone, grappling around to orient myself and then create my best plan to move forward. I was pretty hard on myself for missteps and inefficiencies. I realized the isolation of leadership. The isolation felt immense and omnipresent. That was then.

Sometime several years in, I realized that the problems I was trying to solve weren’t just my problems; they were the residency’s too. I knew I had a team of capable partners, but I wasn’t good at delegation. I worried about people’s reactions to assignments. I worried about creating accountability. I worried about the outcome not being perfect. I felt vulnerable. Yet, I also knew in my bones that learning delegation was essential to my professional survival. I started reaching out and sharing the dilemmas, sharing the challenges, and best of all, sharing the solutions. It’s a different experience, this leadership, when shared with a team. And it was born out of vulnerability.

I was once coached that the most important work a leader can do is to reflect. See my strengths. See my weaknesses. Hear others when they tell me my shortcomings. That’s the hardest feedback, from others. To be honest with myself, and say “I’m not very good at this. I’d like to be better. I’m going to work on it.” It’s a vulnerable space, but the space with greatest potential.

I believe that we all have an innate ability to lead, and that we all do lead, whether intentional or not, desired or not. I have heard physicians say, “I never wanted to lead.” And yet, when the opportunity appears, some say yes. Then, after landing in the middle of that, physicians often discover that they need more leadership skills than their medical education offered.

I am a teacher. When searching for how to teach leadership to resident physicians, I came up empty-handed. I found innumerable resources on conceptual models of leadership, most targeted to executive leadership positions. I found many programs that teach leadership to residents. But nothing that defined what early career leadership skills look like. Given that my primary growth as a leader has born from self-reflection, it seemed that the best starting tool for residents would facilitate introspection. Over several years work, my team and I developed a validated leadership self-assessment for young physicians. Its premise is that to grow as a leader, one begins with reflection, finds the personal starting point, and rises from there. Whenever we exercise self-reflection, it is, at its very core, an acknowledgement of our individual willingness to be vulnerable, right here, right now, with a belief that we can be better.

Sonja Van Hala, MD, MPH, FAAFP, is the Program Director for the Family Medicine Residency Program in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.