“Leaders don’t create followers, they create more leaders.” — Tom Peters
I have been ruminating for the past few months over the bureaucracy of federal medicine and the importance of selfless service to our veterans and their families. Occasionally, a series of events in my career will focus my thinking (Admittedly, this process gets slower and more difficult as I age.) on a topic and in a way that crystallizes an issue that has been knocking around in my frontal lobes. The catalyzing events for the previous two editorials that, in turn, have birthed this third editorial of the unintended trilogy, included the Uniformed Services University (USU) annual Operation Bushmaster exercise and the American Society of Anesthesiologist keynote address by D. Michael Abrashoff. Both of these events occurred in October in quick succession.
Operation Bushmaster, a weeklong event for USU senior medical students and some nursing students, serves as a practical final exam for their Military and Contingency Medicine course. I recently served as faculty for this event for my third year and commented on this exercise last year in this column. For a taste of what this event entails, I recommend the following Internet link: https://www.youtube.com/watch?v=IWNJ6kdQpqY (accessed Nov. 2, 2015).
I look forward to this experience each year, if only to don the old uniform and go play Army. (You can retire the boy out of the Army, but the Army always remains within the boy.) It is a unique medical educational event unparalleled in scope or intensity by any other medical education institution of which I am aware. Student participants in Bushmaster are placed in purposefully stressful field exercises and asked to provide complex medical care in conditions about as close to actual combat as can be achieved without actually deploying and shooting at them. This experience, perhaps more than any other, defines for the uniformed medical student that medicine is, indeed, medicine, but military medicine is something wholly different and special. As a young second lieutenant and USU student many years past, my own Bushmaster experience was foundational to my development as an Army medical officer.
The Military Emergency Medicine (MEM) department at USU is responsible for the content and execution of the annual Operation Bushmaster that presently has a home at Fort Indiantown Gap, PA. Volunteers from all services nationwide and overseas make themselves available to serve as faculty, and most have had firsthand experience from previous deployments to war zones. As you might imagine, the planning and logistics for an exercise of this magnitude begins as soon as the previous Bushmaster ends. The MEM staff is to be commended for pulling this particular “rabbit out of the hat” on an annual basis, particularly Melissa Givens, MD, COL USA, the officer in charge of this year’s exercise.
Each year, MEM strives to improve on the student experience by making small adjustments and tweaks based on faculty and student input from the previous year. This year was somewhat different in that the entire evaluation system was replaced with a new scheme focused on building leadership skills and understanding. USU is developing a leadership curriculum for its students (the USU Leadership Education and Development [USU LEAD] program) under the direction of a triumvirate of senior medical educators at USU, retired Lt. Gen. Eric Schoomaker, MD, PhD, retired Col. John McManigle, MD, and Neil Grunberg, PhD. These USU leaders pored through any and all materials they could find on leadership to devise a structure for what might be the first medical school curriculum specifically focused on leadership skill development for medical students. This innovative curriculum construct breaks individual leadership into four components: personal, interpersonal, team and organizational. In short, a leader must be self-aware of his/her strengths and challenges, able to personally set an example, work with others, function within a team and understand the strategic significance of their activities to the broader organizational mission. This is nested within personal leadership attributes of character, competence, context and communication.1 Leaders must work to develop these attributes to become effective in their leadership. USU is providing its students the tools and conditions to mature these attributes as part of the medical school training.
The new Bushmaster evaluation system was centered on these terms and concepts. I found the new evaluation system to be a positive and refreshing change, particularly since it emphasized that part of being a good leader is knowing when it is necessary to be a good follower. It struck me that my editorial ravings for the past two months were actually a plea for improvements in our collective federal medicine leadership at all levels.
This idea was further crystallized when I went to the recent keynote address of the American Academy of Anesthesiologists annual meeting in San Diego right after Bushmaster. The keynote speaker was retired Capt. D. Michael Abrashoff, author of “It’s Your Ship: Management Techniques from the Best Damn Ship in the Navy.” While I was very familiar with this book and I recommend the title to anyone with an interest in leadership, I had not previously heard the author speak in person. In his address, Abrashoff made the point that, historically, it was enough to be personally technically proficient within your trade to be successful, but as both technology and systems have become ever more complex, individual competence, although required, was no longer enough. The complexity of most of the endeavors in our modern world necessitates task specialization and functional teams for success. Although individual leaders often get credit for new technologies, engineering projects or major science discoveries, critical review of these accomplishments will reveal the team that is actually responsible for the success.
Modern medicine is certainly an example of the complex systems Abrashoff was describing that necessitate good leaders within functional teams. From my perspective, Abrashoff was validating the USU effort I had just experienced at Bushmaster. I believe he would approve of USU efforts to include leadership training in this next generation of physicians or, perhaps better stated, physician leaders.
I came to the conclusion that what I have been exploring in my previous two editorials is the dearth of leadership at all levels that is creating dysfunctional teams in the face of an increasingly complex medical environment. Imagine my satisfaction to learn my alma mater was not only alert to this issue but was producing medically proficient physicians, nurses, scientists and others who also are receiving training in personal management, interpersonal relations, functional qualities in leading and being a team member and understanding the team’s role in organizational mission completion. Furthermore, I do not mind telling you that the performance of the students I observed during this year’s Bushmaster exercise was outstanding, both technically and as leaders.
So I end this unintended trilogy of editorials and the year on a high note. As has been the case in Bushmaster exercises of the past, my federal medicine batteries are recharged, for the event reminds me in no uncertain terms why I continue to tilt with the federal medicine windmill — because it’s good for soldiers. More importantly, I am refreshed to learn that the next crop of federal medicine jousters will be even better prepared to lead federal medicine into the complexities of 21st century military medicine and provide an even brighter future for the organization moving forward.
1 https://www.usuhs.edu/content/new-leadership-curriculum-developed-usu (Accessed Nov. 2, 2015)
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