What Graduate Medical Education Taught Me About Leading Through Uncertainty
There is a particular kind of leadership that doesn’t get much attention.
Not the leadership of vision statements and strategic plans. Not the leadership of bold announcements and decisive pivots.
The leadership of staying steady when the outcome is genuinely unknown. When the system is imperfect. When the resources are insufficient. When the people around you are waiting to see what you’ll do next and you’re not entirely sure yourself.
Graduate medical education has been teaching me that kind of leadership for years.
Uncertainty Is Not a Gap in the Plan
In GME, uncertainty is the operating condition.
Every July, a new class of residents arrive. Some will exceed every expectation. Some will struggle in ways no interview predicted. Programs change. Accreditation requirements evolve. Institutional priorities shift. A faculty mentor leaves. A key coordinator transitions out. A process that worked last year quietly stops working and no one notices until something breaks.
Early in my career, I approached these moments as problems to solve, gaps to close, checklists to complete, contingencies to plan for. And those things matter. Systems thinking and operational discipline are not optional in this work.
But I’ve come to understand something that took longer to learn: uncertainty is not a failure of planning. It is the nature of working with people, inside institutions, through transitions that are by definition unpredictable.
The question was never how to eliminate it. The question was how to lead through it.
What Leading Through Uncertainty Actually Looks Like
It looks like holding a vision steadily while remaining genuinely flexible about the path.
In GME, I’ve watched leaders respond to uncertainty in two distinct ways. Some tighten their grip-more oversight, more process, more documentation as if control could substitute for clarity. The systems become more rigid precisely when they need to be more adaptive.
Others do something different. They stay visible. They communicate what they know and are honest about what they don’t. They make decisions with incomplete information and explain the reasoning. They absorb institutional anxiety without passing it down to the people doing the work.
Th second kind of leader doesn’t eliminate uncertainty. They make it navigable.
And in my experience, that is the different between a team that stays functional under pressure and one that fractures.
The Non-Clinical Perspective Is an Asset, Not a Gap
I want to say something directly, because it matters in the field I work in.
Graduate medical education has a long tradition of placing clinical leaders, physicians at the helm of its institutions. There are good reasons for that. Clinical credibility matters. Understanding the training environment from the inside matters.
But there is another kind of knowledge that also matters and it is less often named.
The knowledge of how institutions actually function. How departments coordinate, or fail to. How culture gets transmitted through processes, not just people. How change meets resistance not because people are obstinate, but because systems hold memory. How to read an organization’s behavior as a diagnostic to see not just what is happening, but why, and what it would take to shift it.
This is the work of organizational leadership. And it does not require a medical degree. It requires something different: the training, the experience, and the discipline to understand institutions as living systems and to lead them accordingly.
In GME, we ask physicians to take on administrative and executive leadership roles that are genuinely distinct from clinical practice. We ask them to manage compliance, culture, accreditation, strategy, and people; often without formal preparation for any of it. And we do this while sometimes overlooking the professionals who have spent their careers developing exactly that expertise.
I am not suggesting clinical leaders don’t belong in these roles. Many of them are exceptional. I am suggesting that the field benefits when it stops treating non-clinical leadership expertise as a secondary qualification and starts recognizing it as a different and equally necessary one.
What Uncertainty Has Taught Me About Institutions
Every institution I have worked in has been, in some way, a work in progress.
Some were under-resourced. Some were navigating leadership transitions. Some had systems that had calcified over time into processes nobody could explain but everyone was afraid to change. Some were doing genuinely good work inside structures that made that work harder than it needed to be.
In each of the, the question that mattered more was not: Is this institution perfect?
It was: Is this institution willing to look honestly at itself?
The ones that were, the ones where senior leaders asked hard questions and stayed with the answers, where GME offices were treated as strategic partners rather than administrative functions, where residents’ experiences were taken seriously as organizational data; those institutions grew. Not always quickly. Not always smoothly. But in the direction that mattered.
That willingness to look honestly at systems, at culture, at gaps is not a clinical skill. It is a leadership one.
And is what I have spent my career trying to practice.
Leading Forward
I don’t know exactly what the next chapter looks like.
What I know is this: institutions that will train the next generation of physicians well are the ones that invest in their infrastructure as seriously as their outcomes. That resources their GME offices as the strategic operations they actually are. That recognize leadership expertise in all its forms and build environments where that expertise can do what it was developed to do.
I want to help build those institutions.
That is not uncertainty.
That is intention.