Leadership

Leadership

Learners will practice:

1. Naming who is leading
2. Stay at the foot of the bed
3. Think out loud
4. Flat hierarchy

Case start

Rapid response to S408

Sign-out: “81M, SVT, now stable.”

Now: HR 160, MAP 85 -> 70, lightheaded.

A bedside nurse says: “He looks worse.”

Prompt: How do you begin leading this rapid?

Say the sentence

Try:

“I’m [name], the senior medicine resident responding to the rapid. Who is currently coordinating this response?”

Paths you might take depending on the response:

“Okay, I’ll run the room.”

“Can I take over?”

“Okay, how can I help?”

Failure modes

Ways this commonly goes wrong:

• It is not clear what each person’s role is.
• Power dynamics make someone else the de facto leader.
• Handoff in roles has not occurred.
• Everyone assumes someone else is leading.

Who leads is less important than that someone leads.

Stay at the foot of the bed

If you are leading:

• Stay at the foot of the bed.
• Keep the patient and monitor in view.
• Stay visible and findable.
• Delegate instead of becoming the task person.

Think out loud

Try:

“I think [problem] is the issue. I’m worried about [risk]. My plan is [plan].”

Then ask:

“What are we missing?”

Flat hierarchy

Airline crew resource management keeps a clear leader and makes speaking up expected.

Psychological safety makes speaking up expected.

Korean Air 801 is a cautionary CRM case: NTSB identified failed monitoring/cross-checking and training gaps.

Sources: NTSB Korean Air 801 investigation; FAA AC 120-51E CRM Training.

Summary

Four moves

1. Name the leadership state.
2. Stay at the foot of the bed.
3. Think out loud.
4. Flatten hierarchy by inviting expertise.

Return to Modules Page