Dare to Lead summary | The Leader's Library - a professional development book clubIn April 2019, a group of intrepid readers embarked on an adventure together: the debut session of The Leader’s Library, ALiEM’s new career development book club. Learners and instructors from around the world read and discussed Dr. Brené Brown’s newest book, Dare to Lead, on a 5 day journey via Slack. Each day had its own theme (Rumbling with Vulnerability, Values, Empathy and Shame, Learning to Rise, and Toolkit), and the asynchronous discussion was robust. A day-by-day breakdown of our conversation, along with tangible takeaways and recommendations for further reading, is summarized below.

dare to lead book

This was a lively day of dialogue. We started with Why? – thoughts on why we read books like Dare to Lead. It can be hard to contribute our best to organizations, and the group expressed feelings of a lack of guidance for “stepping up” to leadership roles. We also collectively mused that the people who most need to read this book and work on their vulnerability are the least likely to pick it up with an open mind and, sadly, we didn’t have any solutions for this paradox.

Participants were encouraged to take the Daring Leadership assessment. Recognizing the inadequacies of any measure of “daring leadership,” many were brave enough to share their scores, as well as deeper reflections prompted by the numbers.

From here we launched into discussing Daring Leadership / Rumbling with Vulnerability as a concept: what it is and what it looks like. Some participants’ ideas:

  • “Confronting the difficult emotions– judgement, being upset/angry, disappointed, or even disagreement”
  • ”It’s entering into an uncomfortable space and staying there while I am uncomfortable. Images (well, sounds) of thunder: a low, deep sound, signifying some discord deep beneath the surface. And a rumble is not fragmented–it is a continuous sound.”
  • ”Intentionally marinating in emotional and self-worth dissonance with no real answers… and being ok with it.”

Psychological safety is a complex concept, but this safety to take interpersonal risk is essential; that fear of others’ response to our risk-taking prevents us from being vulnerable (Armored, rather than Daring, Leadership) and holds us back from achieving our highest potential.

Day 2 was TOUGH! We kicked things off by asking participants to name their core 2-3 Values [PDF list of values], those which drive our thoughts and actions. As Dr. Brown writes, “We can’t live into Values that we can’t name.”

Values are easy to read on paper but difficult to make concrete. While concepts behind chosen Values were similar for the group, surprisingly, no two people had the same list of 2-3 Values. Being a group of educators and learners, it wasn’t a surprise that Learning was frequently listed; Integrity and Courage were close behind. As the group wrestled with the concepts, two methods seemed to help narrow in on the choices. First was to group a few choices together under common themes and identify the linking Values. Another was to focus on times when one felt very angry; anger often emerges when our Values are violated and, thus, anger can help dial into one’s core Values.

The discussion then moved into reflecting on behaviors that demonstrate core Values, slippery behaviors that undermine living into our Values, and an example of fully living a particular Value, before closing with examples of operationalizing our Values. Compelling examples were shared by many, a displayed a spectrum of experiences, from listening to a refugee tell her story to finding the courage to speak up in an extremely hostile EHR implementation meeting.

We closed the day with a discussion on how to operationalize our Values, integrating them into our daily personal and professional practices.

Day 3 was an intense day, opening up the Shame we’ve felt when we don’t live up to expectations, whether those are our own or those of others. We discussed important quotes from Dr. Brown regarding the intersection of Shame and Empathy (the antidote to Shame), the key points being that Shame thrives in secrecy, silence, and judgement. We talked about how difficult, and yet how important, it is to be vocal of our beliefs and stand up for injustices when we see them, even in difficult situations such as in the clinical arena. Using Empathy, visualizing yourself in the role of the other person, is important. Examples we used to talk about how to do that is with the emerging role of virtual reality in high fidelity medical simulation exercises.

The role that Shame plays in leadership styles was also discussed and many shared their negative experiences of how leaders used Shame in detrimental ways. We also discussed how Shame and Empathy are important, and debated if it’s even possible to empathize with all of our patients. Could we risk becoming paralyzed by emotions and unable to manage the emergency department? Others felt that while it is important to function as a doctor, to empathize with our patients means to maintain our humanity and joy for our work – which is critically important. Dr. Papanagnou closed with an eloquent summary:

“Through our shared experiences, it is evident that Empathy is the antidote to Shame; but we must be mindful of ourselves, exercise self-compassion, and always ‘remain curious’ if we want our empathic connections to remain sustainable.”

The fourth day was spent discussing “learning to rise.” Failure is inevitable when we’re courageous and vulnerable and try new things; how do we systematically approach failure and recovery from it? As in, how can we perform a history, physical exam, assessment, and plan for failure? The day was facilitated with 5 questions.

1. Do you have a strategic and operational plan for failure?

Several people shared their systematic approach to failure. Common themes were advanced preparation (having a script in mind), modeling appropriate behavior (including self-care!), and reflective practice. An critical step was swiftly acknowledging and moving past the “shitty first drafts” and “stories we tell ourselves,” and on to better and brighter things.

2. What is your preferred offloading phenotype when you’re emotionally hooked (history)?

Offlloading (a.k.a. avoidance) strategies that were discussed included Chanderliering, Bouncing Hurt, Numbing Hurt, Stockpiling Hurt, The Umbridge, and Hurt and the Fear of High Centering. The majority of participants had a context-dependent variety of offloading mechanisms, although Numbing was the most common by far (distracting ourselves with fun stuff or, more commonly, more and more work until we don’t feel our pain). We talked about obtaining “Stumbling Mentors,” or “Failure Friends”– people we trust who will help us confront our emotions and grow from failure.

3. What kind of stories do you tell yourself when in failure mode (physical examination)?

A very common theme was telling ourselves that we’re not good enough and never will be– embodiment of “imposter syndrome.” We even took an Imposter Syndrome Scoring quiz (see Suggested Resources) and compared results.

4. How do you get more information about the situation, people, and yourself when in failure mode (assessment)?

We talked about conceptualizing the problem utilizing the Drama Triangle and directly asking stakeholders for more information– “approaching discomfort with inquiry.” With more information, we could switch from “‘What the F&*#?’ to ‘what’s their frame?.’” Two common techniques discussed to openly engage with others include “the story I am telling myself is…” and “let me circle back with you on…” For getting information about ourselves, we discussed and reinforced the importance of a good therapist/mental health professional in coping with the immense stress of our jobs; we need to normalize this in our field!

5. How do you approach stories that decrease your lovability? Your belief system? Your creativity? (plan)

Balance/mindfulness (and getting outdoors) was a common way to reinvigorate our lovability and creativity after failure, as was interacting with those who depend on us, whether as a parent or as a mentor– anything to get us out of our heads and back into the world.

The finale of the week, where we tried to put it all together. One thing we found was that different roles and career status can affect what you want in your toolkit. Our breakdown went into categories of trainees, junior faculty (<10 years out of residency), mid and senior faculty, and then a general toolbox.

Trainee Toolkit

  • Imagining yourself as your leader, and what their side looks like
  • Clear is kind – being clear on details and clarification
  • Use TASC checklist for guidance on who to go to for what
    • T: who owns the task?
    • A: do they have the authority to be held accountable?
    • S: are they set up for success?
    • C: do we have a checklist of what needs to get done to be successful?
  • “What does done look like?” can be a very important question for a trainee to ask – this can be similar to getting feedback ahead of time

Junior Faculty Toolkit

  • Setting boundaries is essential, as junior faculty learn to establish themselves in their careers.
  • Grounded confidence can help you remember that you have value and be brave to show that value, as well as help you combat imposter syndrome.
  • Clinical and Administrative/Leadership roles can be different and develop at different rates. Don’t feel like they are always tied to one another.
  • Find a sponsor for a project you’re excited about, and ask them to help talk it up!

Mid/Senior Faculty Toolkit

  • Provide direct goal setting and feedback, to end fake vulnerability.
  • Name and reframe the rumbly emotions.
  • Commit to 3 core values to help guide your ship, and avoid pitfalls that cause unhappy moments and feelings.
  • Leadership can require uncomfortable emotions like vulnerability, anxiety, and fear. If you avoid them, you will likely miss out on the opportunities those emotions provide and not be as successful as you could be.
  • Never doubt the positive impact you can have on others.

General Toolkit

  • Developing a shared language with your team– it might not include “Brené Brownisms,” but needs to be consistent.
  • Nurture curiosity.
  • TASC checklist
  • Clear is kind, unclear is unkind.
  • Acknowledge and name emotions.
  • Rumble when able.
  • “Paint done for me.”
  • Create boundaries (“It’s OK to… but it’s not OK to…”)
  • What does support look like for you?
  • Practice empathy, rather than reflexive sympathy.
  • Let me circle back with you (to learn more about the situation, the other person, and/or myself)
  • Normalizing the practice of feedback giving and receiving.
  • Consider debriefing after every single shift: “How could that shift have been 1% better?”

More on this topic

Books

Other Reading

Audio/Video

Tools

Overall, the inaugural session of The Leader’s Library was an overwhelming success, and we look forward to learning with you next time, when we read Radical Candor by Kim Scott. Stay tuned for signups!

Dina Wallin, MD

Dina Wallin, MD

ALiEM Series Editor, The Leader's Library
Assistant Medical Director of Pediatric Emergency Medicine
Zuckerberg San Francisco General Hospital;
Assistant Clinical Professor of Emergency Medicine and Pediatrics
University of California San Francisco
Victoria Brazil, MD MBA

Victoria Brazil, MD MBA

Emergency Physician
Director of Clinical Simulation
Bond University Faculty of Health Sciences and Medicine
Victoria Brazil, MD MBA

@SocraticEM

Emergency physician and medical educator - simulation, technology, speaking on stage| 🌈 | Bond Uni | #FOAMed #FOAMsim
Victoria Brazil, MD MBA

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Robert Cooney, MD MSMedEd

Robert Cooney, MD MSMedEd

Chief Strategy Officer, 2018-20 ALiEM Chief Resident Incubator
Director of Faculty Development
Department of Emergency Medicine
Geisinger Medical Center
Robert Cooney, MD MSMedEd

@EMEducation

Dad of 3, Part time adventurer, Emergency Medicine Doc and Director of Faculty Development for @GeisingerHealth
Rosny Daniel, MD

Rosny Daniel, MD

Medical Education Fellow
Department of Emergency Medicine
University of California, San Francisco
Rosny Daniel, MD

@rosnydaniel

Haitian, EM doc in SF, looking for tasty food and places to run, I love social justice, medical education and mentorship
Rosny Daniel, MD

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Michael Gisondi, MD

Michael Gisondi, MD

Associate Professor and Vice Chair of Education
Department of Emergency Medicine
Stanford University
Editor, ALiEM EM Match Advice series
Michael Gisondi, MD

@mikegisondi

Vice Chair of Education, Department of Emergency Medicine. Principal and Founder, The PEARL, Stanford University.
Tanner Gronowski, DO

Tanner Gronowski, DO

Chief Operating Officer,
ALiEM Chief Resident Incubator 2018-19
USACS Firefighter/Traveling Emergency Physician
Tanner Gronowski, DO

@MOX13

Emergency Medicine Doc, outdoor enthusiast, amateur photogeek, Idaho raised, husband, and father. #MoreThanMedicine cohost of @EMoverEasy #FOAMed #Gryffandor🦁
Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University
Nikita Joshi, MD

@njoshi8

Emergency Medicine Doctor Associate Editor of ALiEM Gun Sense Advocate #FOAMed #Docs4GunSense #MomsDemandAction Tweets represent my own views and opinions
Resa Lewiss, MD

Resa Lewiss, MD

Director, Division of Point of Care Ultrasound
Professor of Emergency Medicine
Thomas Jefferson University
Resa Lewiss, MD

@ultrasoundREL

Doctor • Global soul • #POCUS#MedED#HealthDesign#Leadership#Equity • Opinions my own · RT≠endorsement
Dimitrios Papanagnou, MD, MPH, EdD(c)

Dimitrios Papanagnou, MD, MPH, EdD(c)

Vice Chair for Education
Department of Emergency Medicine
Assistant Dean, Faculty Development
Department of Emergency Medicine
Thomas Jefferson University Hospital
Philadelphia, PA
Dimitrios Papanagnou, MD, MPH, EdD(c)

@dmitripapa

em doc @jeffersonuniv. educator. simulation nerd. patient safety aficionado. designer of learner-centered, interprofessional educational interventions.
Felix Ankel, MD

Felix Ankel, MD

Professor
Department of Emergency Medicine
University of Minnesota Medical School
Regions Hospital
Felix Ankel, MD

@felixankel

Clinician Educator, Professor of Emergency Medicine, #MedEd, #Futureofmeded, #FOAMed, #systemsthinking, IHI quadruple aim, learner, views are my own
Felix Ankel, MD

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