NEW Book Blog!!! Only One Captain on a Starship – Organizational Culture and Leadership
Book Blog: Only One Captain on a Starship – Organizational Culture and Leadership (5th Edition)
Adrian Singson, MD, FACP | Member AIAMC & National Initiative Project Team Leader
A very good friend once told me, “There can only be one captain on a starship.” He and I are both enormous Star Trek nerds and I never entered the GME world to become one of its captains. In fact, one of the reasons I left my first job was to avoid becoming a program director. Irony of ironies, I would become the second Program Director to an inaugural IM residency program in a GME-naive location. It is one of the fundamental milestones in my career: exciting, life-altering, and terrifying. And like many of us who have been in the captain’s chair, I felt I had no idea what I was doing.
There are several (now graduated) residents from that program who remember a sunny day in September of 2022 when I was precepting in the clinic. Between cases, I would catch up on administrative tasks, emails, and read articles sent by those wiser than me as part of my development as a neophyte program director. One of those pieces was about Edgar Schein’s Organizational Culture and Leadership.
Those same residents probably remember that I shot up out of my chair and started pacing frantically, scratching at my beard, messing with my glasses, or rubbing a hand through my ponytail (I had one at the time) as I was struck by several revelations. Schein’s book illustrated stages in organizational evolution and hinted at organizational symptoms that eerily reflected what our young program was going through.
Our program was just over two years old when I was in that precepting room. We started in the middle of a pandemic, sending residents across two very different healthcare hospital systems a time zone apart, and working alongside a sponsoring institution that was unaffiliated with either hospital. We were very active: producing >100 presentations and publications, making waves at local, regional, and national conferences, and our residents and faculty were securing positions including ERAS, ACP, GME Committees. But we also had academically struggling residents, exhausted faculty, work that kept piling onto only a select few of the program leadership and even had a death among one of our interns.
Organizational Culture and Leadership put all of that, the good and the bad, in perspective. This book made me realize that these challenges were not failings. They were signs the program was ready for the next stage of development, that we were ready to go from the infancy of “new program” to the midlife of an “established program.” These were symptoms of programmatic readiness…and the only mistake was not adapting our methods and culture to our organizational life stage (adolescence).
Through cases of organizations that leveraged culture, anticipated internal and external forces impacting culture, and the used mechanisms of culture change, Schein illustrated organizational eras, symptoms of readiness, and a perspective that those symptoms are exciting milestones to celebrate rather than just challenging frustrations.
As a neophyte program director, Organizational Culture and Leadership gave me what I most desperately needed: a strategic vision, one distinct from my predecessor’s and uniquely my own. It crystallized my role in the program’s lifespan for the remainder of my time there.
“There can only be one captain on a starship.” After reading this book, I felt ready to sit in the captain’s chair.
About Adrian Singson, MD, FACP is an Associate Program
Director at Mountain Area Health Education Center Internal Medicine Residency
Program in North Carolina. Previously, he was the Program Director – Southwest
Indiana Internal Medicine Residency and Professor of Clinical Medicine –
Indiana University School of Medicine.