Leadership in ENT training shapes registrars into team leaders in wards and theatres. It’s not just a CV point; it’s essential for effective patient care and team management.
Leadership is a term that is present throughout ENT training. Even before applying for specialty training, trainees start getting involved in all sorts of leadership roles. Some might be Mess presidents, some might be leaders of their local football club, some take a post graduate course on leadership and management. Everyone is doing their best to get this extra point on their portfolio that counts them as a leader. Or, rather, this was the case until recently, when ENT national recruitment removed leadership from the ST3 interview portfolio requirements.
But how relevant is leadership in ENT training? Was it always just a point on a trainee’s CV or is it far more important than we consider it to be? Mr Waddell, ENT Consultant and Associate Medical Director at the Great Western Hospital (Swindon, UK) feels that leadership is present in nearly every aspect of our ENT everyday life. Here, we present our interesting discussion regarding ENT training and leadership and how these two are inseparable.
Ward round and patient management
Everyone seems to wait for you to start their day. It feels weird but suddenly, as an ENT registrar, you are the sole leader of the ENT team and the ward round. Even with the on-call consultant present, they often step back and allow you to shine. All members of the team expect you to lead the way to the ward, know the patients, have a plan and, of course, ask questions to your seniors if needed. However, you are considered the leader and, to be absolutely fair, you are indeed the frontrunner. Nurses are asking you questions, junior doctors expect occasional help and your senior colleagues and consultants request a brief overview of the ward situation before carrying on with their day. There is no difference with a true team leader, as ENT registrars throughout training are managing the ENT team, making decisions, designing the day and sorting out inpatients by delegating the appropriate jobs and resolving all present issues. In our discussion with Mr Waddell we highlight that leadership skills are required to fulfil day to day tasks as an ENT registrar and it is not an extra element of a charismatic personality.
Theatres
Then the theatre safety brief starts and you are again a leader but in a completely different looking team. No more nurses and junior doctors, but scrub teams, theatre coordinators and anaesthetic senior colleagues. The question is, have you consented everyone and also, is the order of the list correct? Theatre is a performance, hence the name perhaps. We are all trying to perform our best for the patient and our team. The leader of the performance is the ENT registrar and later on the ENT consultant as per Mr Waddell, deciding on the order of the list, instruments, cancellations or additions and timings in an attempt to coordinate an efficient ENT theatre list. Either way a good theatre brief indicates a good theatre day. Being a leader in this diverse environment, where all members are parts of different teams with a variety of backgrounds, is challenging and requires high emotional intelligence, understanding and diplomacy.
When things go wrong with a patient in theatre, the team looks up to the leader expecting a plan, an immediate solution of some sort. Then the next leadership skillset is ready to be used. Coordinating a concerned and anxious team and calming the members while simultaneously delivering the best care for the patient is crucial and requires high levels of knowledge and acute situation management. Significant dexterity is also required in order to debrief and lead a conversation on what went well or wrong, ensuring everyone stays inspired to work together towards a common goal.
Rota coordination
How about coordinating schedules, annual leave requests, three-way complicated swaps and last-minute sick leave or duty cancellations? Leading the rota and maintaining a good flow of everyone’s programme in the department is an essential skill for every ENT registrar. At some point, the majority of the ENT trainees will be asked to support the rota coordination and this is when they again need to employ their leadership skills. Deciding what activity is important, balancing the needs of the members of the team and the timely distribution everyone’s timetable is crucial to ensure normal flow of the ENT department.
Everyday life in ENT
A patient will see you in clinic and they will request that you be the leader of their health, the decision maker of their path to heal. Is this actually leadership? Well, Mr Waddell thinks that leadership is extremely broad. The term is such a big umbrella, hence its relevance to every aspect of ENT registrar life. How about audits and quality improvement? Again, leading an audit and suggesting change is a reflection of leadership. What else is leadership, if not identifying weaknesses and resolving them? The majority of ENT trainees will also hold temporarily a leadership role to some local, regional, national or even international committee. As their alpha personalities drive them, high achievers should pursue more change and participate in various committees to advocate for change or work to improve ENT. In addition, more niche areas that perhaps not all ENT trainees will pursue such as research, teaching or innovation, surely demonstrate other areas in which leadership skills are essential keys to success. Whoever decides to be the clinical lead, or ascend the management ladder even more will require robust leadership skills and strong managerial traits to perform appropriately and deliver their role adequately. Mr Waddell believes that change and leadership exist in everything, let alone when getting involved with management roles.
Are we underestimating leadership then?
Definitely. Leadership is not just a line in the CV of ENT trainees; it is a vibrant and crucial part of ENT everyday life, being present in all activities and duties they deliver. Either subtle or dominant, all ENT personalities will have an aspect of a leader to be able to perform their main activities. Cultivating this trait, learning about leadership and consciously incorporating these skills in ENT practice is pivotal. Taking courses, observing consultants and senior colleagues, and reflecting on one’s performance are all efficient ways to become a good leader. Effective leadership among ENT trainees involves not only honing clinical expertise but also navigating the different aspects of team dynamics, improving practice, advancing the ENT science and progressing their personal knowledge and surgical dexterity. By emphasising the importance of teamwork, clear communication and individual skills tailored to the unique challenges of ENT, ENT trainees as leaders can contribute significantly to creating a safer and more efficient healthcare environment that will work better for everyone.
Declaration of competing interests: None declared.
