Amy Pearlman, MD

	My scrubs have become a canvas. The powder blue is the background to a color palette of yellows, reds, and browns. This color palette has become the literal representation of the blood, sweat, and tears of both my patients and myself. The Betadine that once cleansed the skin of my patient now exists as a stain on my pant leg that passers-by on my way from the operating room to my office will assume is someone else’s stool. And it very well could be.

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 painted only part of the picture. With just a handful of weeks left of residency, the final piece of this collage has to do with leadership. And, reminiscent of my struggle to create a masterpiece with acrylic paint, a brush, and a canvas, my journey into developing as a leader has proven equally difficult to master.

	As I think about these last eleven months holding what I would consider to be my most significant leadership experience so far in life, I have developed a new understanding of what leadership entails. Just prior to my chief year, I pictured myself on the brink of greatness. I pictured myself leaving a urology legacy as one of the best chiefs to have gone through the program.

	Now, as my time as a urology resident is winding down, I have come to realize that my sense of what being an effective leader entailed could not have been further from the truth. My new truth is humbling. My new truth comes from these seven lessons:

		Humility, rather than arrogance, commands respect.

		Seeking to understand others means allowing others to express their frustration and concerns, even if they are with me, and having the confidence not to have to explain myself every time someone does this.

		Inspiring others means setting expectations, then providing opportunities to exceed them.

		Learning from my junior residents means realizing that sometimes, maybe even oftentimes, they may know more than I do.

		Self-improvement necessitates acknowledging my shortcomings, yet being OK with their existence.

		Being a leader is about advocating for my team members without expecting anyone to advocate for me.

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	One of the biggest lessons that I've learned, however, is that sometimes, legacies are not meant to be left. Come June 24th, my time as a resident will merely be remembered by some pictures hanging on the wall outside of the residents’ office. This coveted chair in which I currently sit will be replaced with someone else’s bottom. This revelation of understanding my replaceability initially hit me like a patient phone call at 2 a.m. mid-slumber. In this moment, however, it’s quite comforting.

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"Learning from my junior residents means realizing that sometimes, maybe even oftentimes, they may know more than I do," writes Amy Pearlman, MD.

A chief urology resident’s 7 lessons in leadership

	It's only been 4 years, or it's already been 4 years. Depending on my mood when I reflect on my time as a urology resident, my sense of time passed can vary greatly. I have the bags under my eyes as proof of the former, but the smile on my face that favors the latter.

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	I am now a chief resident. In a year, I will have completed my 5-year urology residency. Though I have learned an incredible amount of urology over the last 4 years, I have also learned a lot of intangibles, particularly regarding teamwork and leadership. Perhaps the most important thing I have learned, however, is that I have the capacity to overcome.

	When I initially started reflecting on my time as a urology resident, I wrote about being grateful for those Wednesday nights when I had operated all day and was at home finishing up a PowerPoint I had to present in front of my department in no more than 3 hours. During these times, the only thoughts going through my head were, "I'm so tired," "How should I paraphrase this article?" "I wonder if that animation is too much," and "OMG, how am I going to finish this presentation in time for 6:30 a.m. conference?”

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	I thought I was grateful for moments like these, when I felt so overwhelmed. What I realized later is that I was not actually grateful for these experiences in and of themselves. Rather, I was thankful for what I had learned from them; namely, that I had the capacity to persevere.

	In her book, "The Charisma Myth: How Anyone Can Master the Art and Science of Personal Magnetism," Olivia Fox Cabane explains the “rewriting reality” technique. She describes how she felt "nauseated, exhausted, and emotionally spent," at 4 a.m., just a few hours before she would be addressing 300 senior executives of a multinational corporation. She asks herself, "What if this unfortunate, unpleasant experience is absolutely perfect just as it is-the insomnia, the nausea, the fact that this is happening the very night before a high-profile assignment? In what way can this turn out to be absolutely perfect for me?"

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	Cabane arrives at the following answer: "Maybe I'll somehow do well tomorrow and come to know that even sleep-deprived, and in a foreign language, I can still do all right. Maybe this knowledge will be key someday when I'm faced with an even more important assignment. And I'll be grateful for having had the uncomfortable experience I'm living through now."

	So as I reflect on the last 4 years, it is with a sense of pride and accomplishment that I remember these unfortunate, unpleasant experiences. It’s these moments, more so than the pleasant ones, that remind and will continue to remind me that I can do it, whatever "it" happens to be.

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As she nears the end of her residency, Amy Pearlman, MD, reflects on what stressful moments from her time in urology have taught her.

Author | Amy Pearlman, MD

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A chief urology resident’s 7 lessons in leadership

The most valuable lesson of my residency