Our work is built on years of research collaborations with leaders in medicine and healthcare.  

This work explores the connections  between personality, self-awareness, individual and organizational behavior, and performance. We value these research collaborations and are always looking for new avenues of inquiry.

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Recent Publications and Symposia

  • Fletcher KA, Friedman A, Wongworawat MD. Understanding Emotional Intelligence to Enhance Leadership and Individualized Well-Being. Hand Clin. 2024 Nov;40(4):531-542. doi: 10.1016/j.hcl.2024.06.003. Epub 2024 Aug 6. PMID: 39396332.

    The successful team concept extends beyond the operating room and into many areas of hand surgery practice. Effective leadership is critical in creating highly effective teams. Evidence suggests that leadership skills can be learned and developed. The authors synthesize and translate findings from organizational psychology to provide insight and recommendations for clinical practice. Specifically, the role of broad emotional intelligence in leadership is explored. This includes self-awareness (eg, understanding one's strengths, challenges, behavioral tendencies, and emotional reactions), emotion regulation, managing others' emotions (eg, supporting others' needs, managing interpersonal conflict, and displaying empathy), and high-quality communication and establishing/maintaining boundaries.

  • Ramirez RN, Mayerson JL, Lewis VO, Friedman A, Lattanza L. AOA Critical Issues Symposium: The Disruptive Physician: Bad Apple or Toxic Tree? J Bone Joint Surg Am. 2024 Oct 2. doi: 10.2106/JBJS.23.01262. Epub ahead of print. PMID: 39356743.

    Disruptive physician behavior has become a common problem in medicine. Individuals who conduct themselves in a manner that could negatively affect patient care, or "disruptive physicians," frequently cause stress for patients and staff, are a headache for leadership, and can require expensive remediation. We suggest that rather than "bad apples," many disruptive physicians are the fruit of a "toxic tree." That is, many physicians only become disruptive as a response to their environment. It is important for leaders to accurately identify the root causes of disruptive behavior in order to address the problem. In general, it is important for leaders to act prospectively, to examine events from all perspectives, to promote wellness and communication, and to identify external or systemic causes. We also discuss additional considerations for when the physician who has been labeled "disruptive" is a member of an underrepresented group (in orthopaedic surgery, the underrepresented groups are women and racial minorities). As a conclusion, we offer a case example of how 1 institution established a system of physician wellness to enhance prevention efforts.

  • Klifto CS, Cheung EV, Holcomb JO, Frankle MA, Duralde XA, MacDonald PB, Ricchetti ET, Aibinder WR, Amini MH, Barnes LF, Byram IR, Chalmers PN, Chuinard CR, Friedman A, Gilotra M, Gregory JM, Grogan BF, Horneff JG 3rd, Kassam H, Kazanjian JE, Kilcoyne KG, Kowalsky MS, Li X, Liu JN, Muh SJ, Munoz J, Patterson B, Phipatanakul WP, Ward AM, Waterman BR, Woodmass JM, Wright M. Are leaders born to lead, or are they made? J Shoulder Elbow Surg. 2024 Mar;33(3):531-535. doi: 10.1016/j.jse.2023.08.020. Epub 2023 Sep 28. PMID: 37777042. Copy Download .nbib Format:

    The American Shoulder and Elbow Surgeons (ASES) Leadership Development Program (LDP) was created and debuted in 2022 with the recognition that the development of future leaders is an essential task of any society or organization. Formed through the membership task force and led by Emile Cheung, Jason Holcomb, and Mark Frankle, the ASES LDP was designed to cultivate qualities necessary to lead an organization, provide strategic direction, and ensure the growth of our society and the profession at large. The program was tasked with selecting a diverse cohort of individuals to assume leadership roles in ASES for years to come and further the field of shoulder and elbow surgery.

  • Friedman A, Hancock B, Thompson PA. Data-Based Self-awareness as the Foundation for Effective Leadership. J Nurs Adm. 2021 Oct 1;51(10):478-480. doi: 10.1097/NNA.0000000000001049. PMID: 34550100.

    The AONL Nurse Executive Fellowship supports nurses who are new to an executive role in developing critical executive competencies. Participants engage in an in-depth specialized assessment process to help them understand themselves and the impact on their leadership. Learnings from the 1st 2 cohorts of fellowship participants provide insight into challenges faced by new executives and how self-awareness can improve performance to address those challenges.

  • Using Using data Driven

    Description goes here

  • Transformational and Transactional Leadership in Healthcare Seen Through the Lens of Pediatrics

    Journal of Pediatrics, 2019

    One approach to increasing the efficacy of transformational and transactional leadership within pediatrics is through leaders' self-reflection on their own personality. We suggest that physician leaders look to personality assessment experts to guide this self-reflection with the aim of gaining a deeper understanding of their own personality. If enough pediatric leaders take this step, we are confident the field will weather the challenges it faces, with a cohort of effective, self-aware leaders leading the charge.

  • Identifying the Emergency Medicine Personality: A Multi-State Exploratory Study

    AEM Education and Training

    Examined 140 emergency medicine residents across five programs. Residents showed higher hedonism and altruism than the norm, but scored lower in tradition and security scales. Generally, successful residents are vigilant, team-oriented, flexible, pragmatic and take a hands on practical approach to learning. Under stress, emergency medicine residents may be risk averse.

  • An Introduction to Leadership Self Assessment at the Society of Neurological Surgeons PGY1Bootcamp

    Neurosurgery, 2017

    Joint commission has identified failure of leadership as the second leading cause of sentinel events. Only 1 in 5 residents indicate they are getting guidance from mentors on leadership. Leadership development efforts can help with transformational leadership and there is a role of self-assessment, awareness and personality traits and tendencies.

  • Personality Factors Associated with Resident Performance Results from 12 ACGME-Accredited Orhopaedic Surgery Programs

    Journal of Surgical Education, 2018

    Data from twelve programs, 175 faculty members and 266 residents. Personality assessments can predict resident performance. The traits valued and rewarded by faculty may not be the same as those associated with improved resident performance.

  • Personality Predictors of Communication Ratings on the Objective Structured Clinical Examination Among Orthopaedic Surgery Residents

    Journal of Surgical Education

    One of the first studies to establish a correlation between specific personality traits and effectiveness of patient communication skills in a simulated setting. Personality influences physician-patient communication.

  • Self Awareness: A Tool to Build Resiliency in the Future Primary Care Workforce

    Symposia, Annual Spring Conference of the Society of Teachers of Family Medicine, 2018

  • New List Personality Assessments Predict Resident Performance on Orthopaedic Surgery Core Competencies

    Symposia, Annual Conference of the Society for Industrial and Organizational Psychology, 2017

    The validity of the traditional criteria used to select residency program applicants is, historically, poor. New ACGME requirements including interpersonal and communication skills, professionalism and systems-based practice complicate the process. This study established that the Five-Factor Model personality traits predicted important aspects of orthopedic surgery resident performance and can be a powerful tool.

  • New List Item

    ·      Fletcher, K. A., Friedman, A. M., & Wongworawat, M. D. (2024). Understanding emotional intelligence to enhance leadership and individualized well-being. Hand Clinics. https://doi.org/10.1016/j.hcl.2024.06.003

    ·      Ramirez, R. N., Mayerson, J. L., Lewis, V. O., Friedman, A., & Lattanza, L. (2024). AOA Critical Issues Symposium: The Disruptive Physician: Bad Apple or Toxic Tree?. The Journal of bone and joint surgery. American volume, 10.2106/JBJS.23.01262. Advance online publication. https://doi.org/10.2106/JBJS.23.01262

    ·      Klifto, C. S., Cheung, E. V., Holcomb, J. O., Frankle, M. A., Duralde, X. A., MacDonald, P. B., Ricchetti, E. T., Aibinder, W. R., Amini, M. H., Barnes, L. F., Byram, I. R., Chalmers, P. N., Chuinard, C. R., Friedman, A., Gilotra, M., Gregory, J. M., Grogan, B. F., Horneff, J. G., 3rd, Kassam, H., Kazanjian, J. E., … Wright, M. (2023). Are Leaders Born to Lead, or Are They Made?. Journal of shoulder and elbow surgery, S1058-2746(23)00698-5. Advance online publication. https://doi.org/10.1016/j.jse.2023.08.020

    ·      Chapter 10: Personal Development: Building Boundaries, Emotional Intelligence, Effective Communication & Leadership Skills, HCL 40.4 (Saucedo/Raizman) The Business of Hand Surgery

    ·      Friedman A, Hancock B, Thompson PA. Data-Based Self-awareness as the Foundation for Effective Leadership. J Nurs Adm. 2021 Oct 1;51(10):478-480. doi: 10.1097/NNA.0000000000001049. PMID: 34550100.

    ·      Fletcher, Keaton A.; Mir, Hassan; Friedman, Alan; Zuckerman, Joseph D. Personality Assessment and Physician Leadership: Using Data-Driven Self-Reflection for Professional Development, Physician Leadership Journal. Jan/Feb2020, Vol. 7 Issue 1, p45-52. 8p. 3 Charts.

White Papers & Case Studies

Explore the impact of our work in our case studies below.

Yale Medicine Early Faculty Pathfinder Case Study

1.

Ohio State Cancer Center OR Leadership Case Study

2.

Oregon Medical Group Physician Leadership Case Study

3.

Skagit Regional Health Culture Change Case Study

4.

Our Research, Poster Presentations, Symposia and Articles

PHYSICIAN LEADERSHIP

Building Physicians with Self-Awareness

Physician Leadership Journal  2017;4(3):40-44.Randall RM, Kwong L, Kuivila T, et al.

  • Included 75 residents from three orthopaedic surgery residency programs, Harbor UCLA, Rush Health and Cleveland Clinic.

  • Examined the need for an evolution toward a contemporary , team-facilitated, leadership approach.

  • Residents communicated the value of self-awareness tools and training to better understand and improve performance and leadership.

Continuous Leadership Education and Development at the San Antonio Uniformed Services Health Education Consortium

Military Medicine, 2017;182(7):1624-1627Bowe SN, Jones WS.

  • SAUSHEC is emphasizing leadership development with self-awareness as an integral component of emotional intelligence and enhanced interprofessional collaboration.

  • SAUSHEC Leadership Development Initiative included faculty and residents, across multiple specialties, completing an assessment, receiving the J3P Professional Practice Guide, participating in leadership development sessions and using the data for on-going mentoring.

  • The manuscript highlights personal accounts of the value of the initiative.

Personality Assessment and Self-Reflection: Tools to Improve Orthopaedic Leadership

Journal of Bone & Joint Surgery, The Orthopaedic Forum: 20 February 2019 - Volume 101 - Issue 4 - p. e13 Tornetta P III, Jacobs, J, Sterling R, Kogan M, Fletcher K, Friedman AM

  • Personality assessments are used effectively in many industries outside of the medical profession

  • There is evidence that demonstrates that these tools have promise to match candidates to specific fields of medicine, mentoring residents and developing improved leadership in the field of orthopaedic surgery

Transformational and Transactional Leadership in Healthcare Seen Through the Lens of Pediatrics 

Journal of Pediatrics,  2019; Volume 204 , 7 - 9.e. Fletcher KA, Friedman AM, Piedimonte G.

  • Reviews the link between leadership styles and personality theory for pediatric team and unit leaders and provides practical interventions designed to improve physician leadership.

  • Suggests that physician leadership look toward personality assessment experts and tools to guide self-reflection and prepare self-aware leaders.

An Introduction to Leadership Self-Assessment at the Society of Neurological Surgeons PGY1 Bootcamp: Observations and Commentary

Neurosurgery,  2017;80:201-204, Hunt MA, Heilman CB, Shutran M, Wu JK.

  • 35 neurosurgical residents participated in the Society of Neurological Surgeons – Post Grad Year 1 Boot Camp, including leadership development training with a focus on new ACGME non-clinical competencies.

  • Only 1 in 5 of residents report that they get adequate guidance from mentors on leadership.

  • Leadership development efforts can help with transformational leadership.

  • Discusses the role of self-assessment, awareness and personality traits and tendencies.

Orthopaedic Education: Mentorship in Surgical Training: Can Personality Assessment Help?

Clin Orthopaedics and Related Research,  2016;474:1125-1128 Tornetta,  P III, Bogdan

  • Using the J3P “Transition to Practice Guide” to improve mentorship and communication between residency program director and chief resident

  • Explores using personality assessment as a resource for mentors to manage residents who are struggling. 

Developing Physicians to be Leaders: Our Lives May Depend on It

Podium Presentation: Annual Conference of the Society for Industrial and Organizational Psychology; April 19-21, 2018; Chicago, IL Harvey VP, Evans S, Friedman AM, Mazzenga J & Shanley TP

Testing the Effectiveness of a Leadership Program for Early Career Physician Leaders in an Academic Medical Institution

Podium Presentation: The Ohio State University, Fisher College of Business, Leadership Initiative Academic Conference; February 22, 2018; Columbus, OH.

Satiani B, Fletcher KA, Friedman AM, Binkley P.

Healthcare Leaders Adopt Techniques to Develop Proficiency in Collaboration Through Feedback and Reflection

Submitted, Archdeacon MT, Smith I, Adams D, Friedman AM.

  • Summarizes programs at U. of Cincinnati College of Medicine’s Department of Orthopaedic Surgery, and with high potential clinical leaders at Mount Sinai Health System.

  • These programs focus on self-awareness as the foundation of leadership with data-drive assessment, training and coaching programs.

  • The programs suggest improvements in individual performance, leadership and professional collaboration.

Introduction to the J3P Healthcare Leader Wellness Assessment- a Part of the Solution

Podium Presentation: American Association for Physician Leaders, Physician Leadership Summit, April 27, 2018; Boston, MA. Roloff K & Friedman, AM.

PHYSICIAN/RESIDENT SELECTION

Personality Factors Associated with Resident Performance: Results from 12 ACGME Accredited Orthopaedic Surgery

Journal of Surgical Education, 2018 Jan - Feb;75(1):122-131. doi: 10.1016/j.jsurg.2017.06.023. Epub 2017 Jul 5Phillips D, Egol KA, Maculaitis MC, Roloff KS, Friedman AM, Levine B, Garfin S, Schwartz A, Sterling R, Kuivila T, Paragioudakis SJ, Zuckerman JD.

  • A validation study establishing that personality assessment can predict residency performance.

  • The traits that faculty value, often differ from those actually associated with performance.

Correlation of Personality Assessments with Standard Selection Criteria for Neurosurgical Residency Applicants

Journal of Neurosurgery 2016;125:986-994 Lubelski D, Healy AT, Friedman A, Ferraris D, Benzel EC, Schlenk R.

  • Explores the correlation between personality scores and other residency selection criteria, including USMLE Score, publications and class rank.

What Makes Us Tick: Implications of Personality Differences Among Otolaryngology Residents and Faculty

The Laryngoscope 2018, doi:10.1002/lary.27727
Villwock, J. A., Bowe, S. N., Rotich, D. C., Beltramo, A. , Friedman, A. and Kraft, S. M.

  • Looking at 104 residents and 78 faculty from nine otolaryngology programs.

  • Identifies potential implications for mentoring, communication, education and professional development.

Using Organizational Science to Improve the Resident Selection Process: An Outsider's Perspective

Am. J. Med. Qual.,2016;31:486-488. Friedman AM.

  • Summary of the failings of the traditional residency selection approach and proposing that personality assessment shows promise for improving the resident selection process, especially in light of recent ACGME requirements for mastery of competencies such as interpersonal communication and professionalism.

Investigating the Role of Personality-Based Behavioral Assessments in the Residency Match Process

Podium Presentation: American Orthopaedic Association Council of Orthopaedic Residency Directors; June 24-25, 2016; Seattle, WA. Bartels DW, Levine B, Frank R, Zuckerman JD, Friedman AM.

  • Individual evaluation of medical students’ personalities may allow for identification of applicants who have the best overall fit with the profile of an individual program

Poster Presentation: Annual Meeting of the Mid-American Orthopaedic Association; April 13-17, 2016; Bonita Springs, FL.

  • On 9 scales applicants matched the “ideal profile”
    Assessing Resident Fit Across Specialties: Implications for

Resident Professional Development and Performance

Poster Presentation: Annual Symposium of the American Academy of Family Physicians; March 24-28, 2017; Kansas City, MO. Pallay R, Maculaitis MC, Quinlan JD, Kim G, Friedman AM

  • Family Medicine and Orthopaedic surgery profiles largely overlapped suggesting similar characteristics may be relevant for successful performance across these specialties.

  • Gaps between the profile and resident self-report may help identify areas of focus for professional development.

Personality Assessments Predict Resident Performance on Orthopaedic Surgery Core Competencies

Podium Presentation: Annual Conference of the Society for Industrial and Organizational Psychology; April 27-29, 2017; Orlando, FL. Roloff K, Maculaitis MC, Terrazas JMB, Friedman AM, Connolly P.

  • Personality scales predict all five outcome variables: Interpersonal skills, Professionalism, Practice-based learning, System-based practice and Overall performance.

Using Personality Assessment to Predict Program Fit and Rank List Position

Poster Presentation: Annual Association for Hospital Medical Education Conference; May 18-20, 2016; Fort Lauderdale, FL Timoney N, Ferraris D, Maculaitis MC, Friedman AM, Pittman T.

  • Measures of applicant’s personality tendencies distinguished between those who were on the final “rank list” and those who were not

  • Certain tendencies could be used to populate final “rank list

PHYSICIAN PERFORMANCE and WELLNESS

The “Big 5” and the “4 E’s”: Personality Predictors of Communication Ratings on the Objective Structured Clinical Examinations Among Orthopaedic Surgery Residents

Journal of Surgical Education (Submitted for publication)Phillips D, Maculatis MC, Friedman AM, Zuckerman JD, Holmes KS. Manuscript

  • Personality traits can predict empathic patient communication effectiveness.

  • Provides a foundation for using personality assessment as a tool to improve physician communication skills.

Identifying the Emergency Medicine Personality: a Multisite Exploratory Study

AEM Educ Train. 2018 Apr; 2(2):91-99. PMID: 30051075. Jordan J, Linden JA,

Maculatis MC, Hern HG, Schneider JI, Wills CP, Marshall JP, Friedman A, Yarris LM.

  • Looking at the personality traits of 140 emergency medicine residents across five nationally ranked programs.

  • Under stress, emergency medicine residents may be risk averse

The Orthopaedic Personality - Does it Exist?

Manuscript, Boston Medical Center
McApline K, Tornetta P, Friedman AM, Maculatis MC.

Poster Presentation: Annual Meeting of the American Orthopaedic Association; June 20-24, 2017; Charlotte, NC.

Gender and Personality in Emergency Medicine Residents

Poster Presentation: Academic Assembly, Council of Emergency Medicine Residency Directors, March 31-April 3, 2019, Seattle, WA.Jordan J, Linden JA, Maculatis MCH, Gene Hern H Jr, Schneider JI, Willis CP, Marshall JP, Friedman A, Yarris LM.

  • Compared to opposite sex counterparts, male EM residents may be more likely to engage in strategic behavior and be socially proactive, whereas female EM residents may have a greater tendency to behave in an organized and dependable manner.

Self-Awareness: a Tool to Build Resiliency in the Future Primary Care Workforce

Symposia: Annual Spring Conference of the Society of Teachers of Family Medicine (STFM); May 5-9, 2018; Washington, D.C. Kelly CM, Pallay R, Friedman AM.

  • Presented on importance of self-awareness of personality characteristics for burnout prevention for students and residents.

  • Identify tools that can be used at medical institutions to gain self-awareness and models that have been piloted.

  • Develop action steps that educators, administrators, residents, and students can take back to their institution to incorporate self-awareness into their curriculum.

Personalities in Orthopaedics: What Can We Do with Them?

Symposia: Annual Meeting of the American Orthopaedic Association; June 20-24, 2017; Charlotte, NC. Tornetta P III, Jacobs J, Sterling R, Friedman AM.

• Presentation of selection and development behavioral assessments and strategies for orthopaedic surgical residents and practicing faculty members.

OTHER PUBLICATIONS

Personality Assessment Utilization is Changing Organized Neurosurgery to Improve Patient Satisfaction, Quality and Safety Initiatives and Physician Leadership

Congress Quarterly, The Congress of Neurological Surgeons, Fall, 2018 Alan Friedman

Demystifying Self-Awareness in Healthcare – Assessment Tool Provides Objectivity, Competitive Edge for Residency Candidates

New Physician, American Medical Student Association, January- February, 2017

Self-Awareness: The Ladder to Leadership Success

Chief Learning Officer, CLO Media, 2017
Joseph D. Zuckerman, MD, Alan Friedman, and Mekayla Castro