June 2025 Edition — COA BulletinProfessional Growth

Kristen Barton, MD, PhD, FRCSC
Clinical Fellow, Colorado Joint Replacement

Gord Aker, BEng, MEng, MCC
Professional & Executive Coach

“There are leaders and there are those who lead. Leaders hold a position of power of influence. Those who lead inspire us. Whether individuals or organizations, we follow those who lead not because we have to, but because we want to. We follow those who lead not for them, but for ourselves.” -Simon Sinek

Traditionally, a surgeon’s competence has been defined by technical ability, knowledge, and diagnostic acumen with little focus ever given to management skills¹ or leadership ability. Today, nontechnical abilities such as communication skills and leadership skills ultimately translate into enhanced patient safety, experience, and outcomes. The operating room remains a well-controlled setting where the surgeon is considered the leader and where many opportunities exist to transform the operating room into a rich learning environment¹. In addition, with an ongoing shift toward patient-centered care, surgeons work more frequently as members of multidisciplinary teams¹ thus increasing the importance of creating and sustaining positive workplace relationships and organizational culture.

It is increasingly recognized that leadership skills are a key requirement in being successful in surgery, regardless of speciality and at all levels of experience and seniority². Where the emphasis was previously on technical ability, knowledge, and diagnostic acumen, non-technical skills such as communication and leadership contribute significantly to patient safety, experience and outcomes, and should be valued accordingly².

Upon completion of clinical and academic training, many orthopaedic surgeons hold leadership positions including roles as department heads or principal investigators. However, medical school and residency education focuses largely on medical competency and very little training is focused on professional and leadership development. Along the path, there is little (if any) training for the other “parts of the job” – running a business, motivating employees, developing a team, mentoring employees, negotiating deals, leveraging success, and learning from failures. When individuals become surgeons, they become leaders, yet, most surgeons are not adequately prepared or trained to succeed in this role. Running an operating room, managing a laboratory, coordinating an office, negotiating with hospital administrators, raising funds for research, and leading diverse personnel are daily activities that are often learned through a process of trial and error. There is a presumption that these tasks can be easily accomplished as surgeons transition to the next phase of our careers, however this is not necessarily the case. Fortunately, these are skills that can be developed and refined.

Leadership training should begin in medical school and continue throughout residency training and in clinical practice³. Formal programs can provide surgeons with a structured approach to gaining insight, sharing experiences, and developing relevant skill sets⁴. Leadership skills are used in everyday practice and are particularly valuable when shifting roles or taking on new positions, whether at your home institution or within national organizations³. Ultimately, physician leaders are responsible for leading health care and will directly impact the quality of care delivered to our patients² both in the short and long terms.

Every day surgeons lead teams on the wards, in clinics and operating theatres, but most trainees and some surgeons do not consider themselves as leaders⁵. As previously reported, leadership has been identified as one of ten core surgical competencies in the Royal Australasian College of Surgeons, but leadership curricula within surgical training programmes are not well defined⁵. Currently, there is limited opportunity for formal leadership training and development prior to becoming a surgeon.

Leadership skills are increasingly important for surgeons, who need knowledge of organizational structure and policy, management strategy and team dynamics to deliver and improve health care in resource-constrained environments⁶. However, most surgical leadership development courses are focused on preparing pre-identified leaders. Demonstrating leadership in the operating room requires the ability to consider and adopt different styles and approaches to best meet the needs required by specific circumstances. The style used to guide the team can vary; coercive, visionary, affiliative, democratic, pacesetting, and coaching are all important styles in team leadership. The ability to adapt to different needs in the operating room by using the appropriate style is an important element in leadership^{7, 8}.

The health of Canadians is improved significantly by effective clinical leaders who can champion the discovery of innovative health practices, and implement safe, efficient, and compassionate health care. Orthopaedic surgeons play a key leadership role in research and clinical care initiatives. Unfortunately, dedicated time for training to lead, influence, manage, communicate, and to delegate tasks is not a standard part of the academic training, potentially impacting the orthopaedic surgeon’s future ability as leaders in health care. This lack of training in leadership not only limits innovations in direct patient care, but also affects the physician’s ability to contribute effectively to administrative and health advocacy type leadership positions in orthopaedic surgery. Therefore, greater attention on formal leadership training is necessary for cultivating strong orthopaedic surgeon leaders and building leadership competency early in their career is particularly valuable. A leadership curriculum within the Canadian Orthopaedic Association (COA) was developed to address these competencies. It is the goal of the COA to better prepare its members for taking on these leadership roles by providing training specifically designed to aid in their careers and community engagement.

Innate talent plays an important role but is insufficient on its own to produce a surgical expert⁹. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson’s theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate considering our training curricula⁹. The literature suggests that leadership competence is reached through practice, with upwards of 70% of leadership skills being learnable^10-13. The development of great surgeons requires talent, the acquisition of knowledge, the development and practice of skills and the opportunity to work under the guidance and tutelage of strong mentors and coaches. The same is true for the development of great leaders.

How do you want to lead your team in the operating room?

References

1. Maykel JA. Leadership in surgery. Clin Colon Rectal Surg. 2013;26(4):254-8.
2. Suliman A, Klaber RE, Warren OJ. Exploiting opportunities for leadership development of surgeons within the operating theatre. Int J Surg. 2013;11(1):6-11.
3. Torres-Landa S, Thiels CA, Davids JS, Borman KR, Longo WE, Smink DS. Evaluation of leadership curricula in general surgery residency programs. Am J Surg. 2021;222(5):916-21.
4. Patel VM, Warren O, Humphris P, Ahmed K, Abboudi M, Ashrafian H, et al. What does leadership in surgery entail? ANZ J Surg. 2010;80(12):876-83.
5. Barnes T, Rennie SC. Leadership and surgical training part 1: preparing to lead the way? ANZ J Surg. 2021;91(6):1068-74.
6. Barnes T, Rennie SC. Leadership and surgical training part 2: training toolkit for leadership development during surgical training. ANZ J Surg. 2021;91(6):1075-82.
7. Arnold D, Fleshman JW. Leadership in the setting of the operating room surgical team. Clin Colon Rectal Surg. 2020;33(4):191-4.
8. Peters W, Picchioni A, Fleshman JW. Surgical leadership. Clin Colon Rectal Surg. 2020;33(4):233-7.
9. Sadideen H, Wilson D, Moiemen N, Kneebone R. Surgical experts: born or made? Int J Surg. 2013;11(9):773-8.
10. Boerma M, Lorenz R, Palmer B, Meyer J. Point/Counterpoint: Are outstanding leaders born or made? Am J Pharm Educ. 2017;81(3):58.
11. De Neve JE, Mikhaylov S, Dawes CT, Christakis NA, Fowler JH. Born to lead? A twin design and genetic association study of leadership role occupancy. Leadersh Q. 2013;24(1):45-60.
12. Li WD, Arvey RD, Zhang Z, Song Z. Do leadership role occupancy and transformational leadership share the same genetic and environmental influences? Leadersh Q. 2012;23(2):233-43.
13. Arvey RD, Rotundo M, Johnson W, Zhang Z, McGue M. The determinants of leadership role occupancy: genetic and personality factors. Leadersh Q. 2006;17(1):1-20.

Dana Miller
Manager, Communications
Canadian Orthopaedic Association

The second annual National Grand Rounds, presented by the COA Orthopaedic Chairs of Canada and hosted by the University of Toronto, explored the evolving role of artificial intelligence (AI) in healthcare. Dr. James N. Weinstein, Senior Vice President of Microsoft Health and a prominent orthopaedic surgeon and health policy leader, delivered the keynote address. Introduced by Drs. Kishore Mulpuri and Peter Ferguson, Dr. Weinstein drew on decades of experience in medicine, health systems, and AI research to outline both the promise and challenges of AI integration in healthcare systems.

Dr. Weinstein emphasized that AI represents more than a technological shift—it demands a redesign of the underlying systems in which it operates. He cautioned that layering AI on top of inefficient or outdated healthcare infrastructure risks amplifying existing problems, such as administrative burdens, access issues, and disparities in care. Drawing parallels to historical innovations like the electrical grid enabling the lightbulb, he argued that AI must be embedded within a thoughtful and functional ecosystem to be effective. He also highlighted the similarities in systemic challenges between Canada and the U.S., including burnout and wait times, and suggested that Canada is well-positioned to lead in AI-driven transformation—especially in orthopaedics.

Throughout his presentation, Dr. Weinstein showcased the practical applications of AI tools like GPT-4 in clinical care, research, and education. He demonstrated how AI can assist with literature synthesis, simulate patient encounters for training, personalize patient communications, and reduce time spent on documentation through tools like Microsoft Copilot and DAX. He underscored the need for a national digital infrastructure to support real-world data collection and sharing, proposing the development of a national orthopaedic network in Canada. This, he argued, could improve patient outcomes, reduce bias in research, and facilitate collaboration across institutions.

Ethical considerations such as data ownership, equity, and bias were addressed directly. Dr. Weinstein clarified that Microsoft does not collect or train on user data and reiterated that institutions should maintain control over their information. He encouraged attendees not to be passive observers of this technological shift but to actively lead change by experimenting with tools, forming collaborations, and advocating for system-level improvements. As a closing takeaway, he recommended participants begin using tools like Bing with Copilot to explore the capabilities of AI firsthand and bring that knowledge back to their clinical and academic environments.