Although the OR may seem like a highly regimented environment, each member of the surgical team will serve as both a “leader” and a “follower” at different points during the operation. This includes everyone from the most senior attending surgeon to the most junior medical student. Within the OR, the surgical attending has ultimate responsibility for the patient. However, surgical residents will often act as leaders to junior residents and medical students. In the setting of “progressive autonomy” for surgical trainees, the attending surgeon may also formally or informally cede control of the case to the resident or fellow and may take a follower role him or herself. In fact, more often than not, the surgical attending will assist a senior resident through a case, rather than perform the operation with the resident’s assistance. In the OR, the team leader is responsible for setting the tone. It is up to the leader to make sure that all team members have a shared understanding of how the day will proceed as well as any potential problems that may arise. In many cases, the surgical attending does not arrive to the OR until the patient has arrived, been intubated, and prepped and draped. In this case, it is up to the senior-most resident to lead the team. A resident who arrives early, completes the surgical timeout in a thorough but efficient manner, and moves the room forward is much more effective than one who arrives late or is not familiar with the patient or the case. While an extensive discussion of successful leadership traits is outside of the realm of this chapter, in general a good leader is one who outlines a clear vision of the work that needs to be accomplished while also empowering those around them to take ownership over their individual work. While leadership is a commonly discussed topic, what is less commonly discussed is the importance of “followership.” While there are several different descriptions of the various types of “followers” on any given team, many focus on a spectrum from passive to active and from dependent, uncritical thinking to independent, critical thinking. Compared to the field of leadership, the study of followership is relatively new, but it is generally agreed that effective followers are those who are paying attention to what is going on around them, taking an active interest in the process, and questioning or challenging leadership or the status quo when necessary. This last point is especially critical. In the OR, being a good follower is a crucial component to maintaining patient safety as it is incumbent upon the followers (including residents, medical students, nursing staff, and all other participants) to speak up if they notice that something is going wrong or that the environment has become unsafe. Especially for more junior members of the team, it can be intimidating to alert the attending that he or she may be making a mistake or misjudging the situation. However, it is important to remember that such actions, when carried out with tact and respect, are in the best interest of the patient and may actually prevent serious harm from occurring.
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