Teaching leadership skills should be done through a radiologist’s residency, allowing those reluctant to lead to get comfortable and make some mistakes in a more protected environment.

Zachary Ballenger, MD, a radiology resident and body MRI fellow at Indiana University, offered the resident’s perspective on teaching leadership in a Nov. 29 presentation titled, "Leadership: How Can We Teach It and Promote It?" Those skills can be learned, he argued, with residents being able to practice leadership techniques before “running headstrong into their careers.”

To illustrate his point, he pointed to the lessons learned by Abraham Lincoln long before he became president, when he nearly fought a duel with swords against a political rival. The incident taught Lincoln to be a calm negotiator, a skill which served him well as president of the United States.

“Think about young Mr. Lincoln, broad sword shakily in hand. I think about that sometimes,” Ballenger said. “You don’t want to put your residents out there making the kinds of mistakes which could kill a career.”

Honing those leadership skills is best done in residency, not just because of the supervised environment but because residents won’t have the time to learn on the job after graduation.

There’s also a benefit for the program directors and staff: Leadership responsibilities like academic track chair can be spread among many residents instead of a select few chief residents. Ballenger suggested teaching hospitals allow residents to gain experience with other leadership positions, like serving on hospital committees, multidisciplinary conferences or working on medical school curriculum design.

“These things are very important and residents provide a very important perspective for these committees, in addition to getting some practice,” Ballenger said.

Outside opportunities help as well. Ballenger recommended offering residents the chance to attend conferences on policy, like the American Medical Association’s delegates meetings, and starting resident fellow meetings.

Angelisa M. Paladin, MD, program director for the University of Washington’s radiology residents, offered strategies on how to implement these teaching strategies. The broad goal has to be “creating a culture” around leadership skills, not simply a curriculum.

“We don’t want this to feel like a checklist,” Paladin said. “Sometimes, as a program director, that’s what it feels like when something is suggested because there’s so much to do to train these residents.”

For Paladin, it starts even before applicants are accepted into her program. Since her mantra is every resident will be asked to lead in some way during their four-year stay, what she looks for in the interview process has changed accordingly. Instead of emphasizing board scores, interviewers are now blinded from those results before meeting with applicants. Traits like emotional intelligence and diversity are now considered over favoring more prestigious schools for undergrad degrees.

Once they’re in, residents are encouraged to tackle leadership challenges in many ways, such as running lecture and call prep series. Paladin favored a mostly hands-off approach, meeting with programs run by residents only once or twice a year.

Her advice to program directors was to be open with residents about they’ve learned from their own mistakes and to be patient, as changing the culture of a residency program to emphasizing subjects other than clinical lectures can take five to seven years in her experience.

“At first, there wasn’t buy in,” Paladin said. “I put in all this effort, I was so excited and the residents were like, ‘Well, when are we going to talk about that renal lesion?’ So the culture hadn’t been changed.”