The Challenge
Graduate medical education (GME) leaders frequently experience complex decisions and crisis situations.1 GME leaders have multiple stakeholders who may have competing interests (eg, trainees, faculty, associate program directors/administrative teams, hospital/university leaders). Leadership mistakes in GME are not only common but expected, especially during difficult and high-stakes situations. Responding appropriately to a mistake can make a big difference in how leadership teams move forward and grow. Understanding how to respond and recover from mistakes is crucial to maintain trust, psychological safety, and effective team dynamics.
What Is Known
A strong leadership team intentionally develops trust and cohesiveness within the group, which can lay the groundwork to prepare for the inevitable future crisis.1 Leadership errors can be opportunities for a leader’s growth and for developing trust within the team. Research shows that how a leader responds to mistakes is more important than the mistake itself.2 Concepts such as psychological safety, shared mental models, and a growth mindset are essential when navigating leadership challenges.3 Examples of GME leadership mistakes include making a decision before having input from all stakeholder groups, managing a difficult interpersonal situation with inadequate sensitivity, and not recognizing or acting on an emerging residency problem.
How You Can Start TODAY
Pause and seek immediate feedback; obtain diverse perspectives. In the midst of a crisis, one feels pressured to make quick decisions. Consult a trusted set of advisors who represent different viewpoints from your own.3 Most decisions will require input from trainees, even when it is not possible to do exactly what they wish. Also engage your leadership team so that you can make a well-considered decision. Acknowledge that you may not reach consensus and that you must make the final decision. Even when the team does not agree on the course of action, you will have a better plan because of their input. This has the added benefit of getting your team invested in the final decision as well as creating trust and a shared mental model for managing difficult situations.
Conduct a pre-mortem analysis to anticipate potential failures. A pre-mortem analysis4 imagines that the decision under consideration did not work and brainstorms explanations for the hypothetical failure.4 Identifying possible failures allows you, the leader, to refine the decision or re-frame it. Engaging your team or advisors in this process will help to unearth hidden opposition or concerns: everyone will function as a “devil’s advocate.” Pre-mortem analysis promotes psychological safety and trust, as no one worries about upsetting the leader when the objective is to find the flaws in the decision process.
Own your mistakes and commit to improve. When a mistake occurs, the most trusted leaders acknowledge it openly and immediately, share what they’ve learned, and commit to do better.5 Clearly describing your mistake and apologizing (if appropriate) normalizes the experience within the team culture, so that mistakes committed by other members on the team can be shared quickly and mitigated. Admitting mistakes builds credibility and models a growth mindset. Admitting your own mistakes to your leadership group and constituents requires vulnerability, honesty, and courage. Use these strengths and remember that the dread before the admission is the worst part.
Normalize mistakes made by others. Normalizing a mistake is not minimizing it. Normalizing a mistake occurs when leaders acknowledge that a team member made a mistake. Then the leader must turn the focus to understanding the context and contributors to the mistake and what steps could be taken to minimize impact. This is a more objective way to deconstruct a mistake and is like the “systems” approach in root cause analysis.6 Rather than focusing on the leader’s personal shortcomings, the team focuses on processes that would facilitate better future choices. Consider publicly congratulating a teammate for trying something new, even when it did not work out. When appropriate, leaders can share a past mistake they made, to demonstrate that they do not expect perfection.
What You Can Do LONG TERM
Do not confuse discontent with mistakes. Identifying a leadership mistake can be challenging because not all stakeholders are satisfied with the decision. Negative emotions, like discontent and anger, may reflect the state of the person providing negative feedback, rather than the decision itself. Not every decision you make will be well received. Often the tougher decisions are the right ones. Before labeling a leadership decision as a mistake, be sure to reflect on disagreement. Is it discontent with information you failed to consider or information that makes a good case for a changing strategy?
Create safe spaces for input. Ensure all voices are heard. Instead of requesting “feedback,” ask for advice from stakeholders and those affected by leadership decisions. The word “advice” can be more inviting and models a growth mindset. Look for clues that dissent is not being voiced, and welcome input from those involved. Establish regular forums for open discussion.
Lead culture change—success cause analysis.6 Focusing only on what went wrong misses the opportunity to apply root cause analysis methodology to examine what contributed to a decision’s success. Incorporate success cause analysis into your established or new forums to highlight what contributed to success. Develop shared mental models and core values within your program. Consider drafting a set of core values or a mission statement at your annual program evaluation.
Engage in and model continuous improvement. Build a diverse leadership or advisory group to provide balanced perspectives. Ideally, these advisors have the same goals and values but bring an array of viewpoints to the group. Monitor, solicit feedback, and evaluate your leadership decisions for continuous improvement, while being honest about your mistakes and celebrating successes.
RIP OUT ACTION ITEMS
Pause before making an important decision; seek diverse input to build trust and shared mental models.
Conduct a pre-mortem analysis to identify potential failures and refine decisions, while promoting psychological safety.
Own mistakes openly: acknowledge errors, share lessons learned, and commit to improvement to model a growth mindset.
Normalize team mistakes by focusing on systems and processes, not personal shortcomings, to support learning from failure—and success.
References and Resources for Further Reading
- 1.Fletcher KE, editor. Leading Through Crisis: Intimate Stories of Teamwork, Caring, and Character in Graduate Medical Education. Ten16 Press; 2024. [Google Scholar]
- 2.Morton M. We can work it out: the importance of rupture and repair processes in infancy and adult life for flourishing. Health Care Anal. 2016;24(2):119–132. doi: 10.1007/s10728-016-0319-1. doi: [DOI] [PubMed] [Google Scholar]
- 3.Brown B. Dare to Lead—Brave Work, Tough Conversations, Whole Hearts. Vermillion; 2018. [Google Scholar]
- 4.Klein G. Performing a project premortem. Harv Bus Rev. 2007;85(9):18–19. [Google Scholar]
- 5.Edmondson AC. Learning from mistakes is easier said than done. J Appl Behav Sci. 1996;32(1):5–28. doi: 10.1177/0021886396321001. doi: [DOI] [Google Scholar]
- 6.Behrhorst J, Gale B, Manaoat C. The evolution of root cause analysis. Patient Safety Network. Published 2025. Accessed January 27, 2026. https://psnet.ahrq.gov/perspective/evolution-root-cause-analysis.