The first, the few, the many: pathways to leadership
Nadine Caron, MD
“The president would like to speak with you,” said the unfamiliar voice on the phone. She was referring to the president of the university which, just 18 hours earlier, had granted me a degree. Although I had never graduated from medical school before, I knew this call was unusual. Was the president calling every student in my class?
Moments later, the president’s confident voice boomed through the receiver. “Congratulations,” was his message. “Thank you, sir…” I responded as I gathered the wits to ask the question so obvious to me. “But do you mind if I ask… why are you calling me?”
He hesitated ever so slightly, then happily explained, “Why, you are our first female First Nations student to graduate from our university’s school of medicine. We are so proud!”
The words “our” and “proud” sounded to me like the clash of cymbals in an elementary school band. Although the president had sounded sincere, I oscillated between the polite and likely expected “Canadian” thank you and the question I felt compelled to ask.
“Thank you, sir,” I replied again, before taking a deep breath to ask what I would spend years contemplating. “But it’s 1997 — is me being the ‘first’ really something we should be proud of?”
That morning, I realized that it can be quite odd what we, as a society, deem to be a success. Being first is often automatically considered something positive, something to cheer for. As if all firsts should lay claim to the classic spirit of “on your mark, get set, go” with the assumption that everyone starts the same race, at the same time, with the same rules. And that coming in first must be rewarded and celebrated as though it had always been the ultimate goal, the purpose of the effort.
Medical school was not a race that I set out to win. Every graduate had “won,” as we all gained the initials MD after our names. That was the purpose of our journey. Surely my classmates and I felt as much of an accomplishment becoming doctors as the graduates in years before us? Medical students graduating these days seem just as thrilled at their achievements as we did.
Although the “first” our president had referred to was something that had never been done before at our university, this was not the achievement I was celebrating. The suggestion that we should applaud this landmark highlighted a vital lesson that was not part of our medical school curriculum: there are times when being first is more the result of filling a void than achieving a goal. To me, my being first did not reflect success; it shone a critical light on society’s failures. Top
My conversation with our university president taught me that we do not all necessarily agree on the goalposts that define success. I learned that we must be careful when choosing what measuring stick to use when evaluating our progress or when setting goals, whether they be in the eyes of our profession, the public, or even our personal lens.
Back on that day, if we peeled away the layers that made “first” sound so positive, we would have seen elements in Canada’s history that should have raised great concern. Not celebration. Nor pride. In this scenario, our country, academic institutions, and the medical profession at large should have been prompted to examine our past for injustices, misguided decisions, and indifference to see what kept the generations before me from even having this opportunity the university president was calling me about.
Indigenous communities face socioeconomic, political, and educational barriers — to name a few — that my being first actually revealed. The impact of these factors may not have been obvious to some, but to those who have heard this music before, it continues to sound like a crescendo in a symphony.
This unexpected telephone call created a watershed moment in my life: I could continue to celebrate the success of each individual in our graduating class or start to examine the failures of the country in which we had achieved it. I could ask, “Why was my graduation so significant?”
The fact that apparently no female First Nations student had previously completed medical school at that university had nothing to do with me. The paucity of Indigenous university students in our country, and the relative void of Indigenous health care professionals throughout Canada, was not my fault, but overnight it became a part of who I was. Even years later, when I am being introduced as a panelist at a national meeting or the keynote speaker at an international conference, I often hear a list of adjectives as I stand by the stage, waiting to speak. When I am described as the “first X doctor” to do this or the “first Y surgeon” to do that, I cannot help but recognize the role of history behind those descriptors. I aimed to achieve the nouns — I wanted to be a doctor, a surgeon — yet history assigned the adjectives, emphasizing words such as First Nations, Indigenous, female, and northern, while society added the five-letter word first. Together, these adjectives create the perfect word storm that, on the surface, can sound like hallmarks of success.
Do you ever wonder, “Why was there no one before?”
We should redefine what we consider celebrating when we combine an individual’s achievement with the history of our country or profession. While we should certainly continue to celebrate the individuals — the firsts — for achieving their personal goals, it should be because of their commitment, skill, and quality of their work, not just for the voids they fill. While we should acknowledge the potential impact when the first comes along and cheer for a long-awaited step in the right direction, it takes more than just one individual to bridge the chasm from “never before” to an endpoint that carries long-lasting effects. We must never risk confusing the “first” with the “only.” Although anticlimactic, a fundamentally vital moment to celebrate as true success is when “the first” — in whatever field, for whatever void — becomes simply “one of many.”
When the Truth and Reconciliation Commission (TRC) released its report in 20151 almost 20 years after my graduation from medical school, they clearly documented 94 calls to action. These calls to action were intended to move Canada in the direction of healing from our history of Indian residential schools, assimilation policies, and other attempts at cultural genocide that still plague our nation today.
Under the category of “health,” TRC call to action number 23 includes the requirement to increase the number of Indigenous health care professionals. This was an identified need despite multiple Indigenous firsts, such as the first surgeon, the first obstetrician, and the first family physician, already marked off on the proverbial checklist. In this report, firsts have officially been discarded as a target endpoint for a profession, university, or country. An empowered workforce of Indigenous health care professionals working for and with Indigenous Peoples in Canada is needed and the TRC report clearly demands this. Top
To illustrate this difference between the first and the many, we can look briefly to the history of voting rights in Canada. Although our country values the principles of democracy, the battle for women’s right to vote was long and passionate. Women first cast their votes in a Canadian federal election in 1917 (initially on behalf of their male family members in battle overseas) and those rights extended to most women by 1919 (presumably with the right to voice their own opinions at the ballot box).2 Vital to this narrative is that First Nations Peoples were still waiting for this fundamental right, which came over four decades later, when they cast their first-ever votes in a federal election in 1960.3
We should know this history because it is as much a part of our country’s fabric as gold medal hockey games, our universal health care system, or the maple leaf itself. Although this history is not one we are proud of, it serves as an example of just how long sought-after change can take before it eventually becomes embedded in our society. This story highlights true success: since those first ballots were cast in 1960, the right to vote has become something that we as Canadians expect. During our most recent federal election, I heard no one protesting, saw no one cheering, read no storyline in the national media about the fact that women or Indigenous Peoples were voting. It is the norm. As a First Nations woman waiting in line to vote, I was one of many. No one even noticed me.
It should come as no surprise that as a female Indigenous health care provider in Canada, I believe that success within our profession and our society is not embodied by the next First Nations surgeon. It is not carried forward by the first Inuk dentist. Nor the next Métis doctor. Not the first Indigenous justice of the Supreme Court of Canada. Success is when we no longer pay attention to the adjectives but celebrate the talent, the commitment, the voices of those who dreamed of the nouns and took on these roles in society. Success is when our children and the generations that follow know that the goal they aspire to has been reached before — by people like them. It is possible. It will happen again. We hear examples of success by stories that begin with, “remember when…”
Where then does the concept of leadership apply in our profession when it comes to our firsts?
The day the university president singled me out also marked the moment when, seemingly overnight, I was conferred with a leadership role. I struggled for a long time to understand the difference between being first and being a leader, even though I had signed up for neither title. In September 2017, during a TEDx Talk entitled “The Other Side of Being First,” I reflected on some of the leadership roles I have assumed over the years… and leadership roles people assumed that I have.4 I shared how it sometimes feels to be the first to do something — especially when that something is far from innovative or ground-breaking in and of itself. Being first, I told the audience, is not always indicative of leadership. Leadership is an active role, not a passive descriptor. Leadership is an accepted responsibility, with the fundamental purpose being change. Top
Firsts within the medical profession are often leaders who accomplish something unique and innovative for the benefit of their patients. Their discoveries include new treatments, ground-breaking procedures, and diagnostic advances. Where would medicine be without the science, innovation, and the leaders to get us there? These historical icons led progress in our profession, not because of who they were but because of what they did. Some surgeons have procedures and surgical instruments named after them. Many physicians’ names are the answers to questions medical students are asked on hospital rounds with their attending physician. Which surgeon completed the first liver transplant? Who discovered insulin? Who discovered penicillin? The history of medicine does not focus on individuals who were not followed by the many. Progress is filled with names of firsts who intentionally chose to do something never done before, shared their ideas, and inspired others to follow. They are leaders in their fields because the many who followed changed their clinical practices because of them. These leaders changed their profession.
Those who became firsts by filling in the gaps created by history, political agendas, and professional bias may also become leaders. With time, I realized being first was not a burden to carry by myself; one cannot lead if no one follows. If you are first, it is challenging to lead others to a place you have never been. There are the challenges of being a mentor while seeking a mentor and of saying, it is possible, when it has not been done. With momentum toward change, these firsts can also change our profession.
That telephone call, as challenging as it was, unknowingly set me on my career path. I had a president who respected my salient question, “Should we really be proud?” I stayed at that university, which has worked toward something to be truly proud of. In 2014, the University of British Columbia opened the Centre for Excellence in Indigenous Health (health.aboriginal.ubc.ca) where the majority of the staff are Indigenous and work passionately in areas, such as student recruitment and retention into the health care fields, development of a curriculum that applies an Indigenous lens, and research in the areas most plagued by health disparities between Indigenous Peoples and the rest of Canada. Courageous, innovative, inspiring, passionate are just some of the adjectives that I would use to describe the people whose paths have merged to create and sustain this centre. The centre was created for the purpose of change. In the place of a first, there are now many. That is something to be celebrated.
I concluded my TEDx talk by asking the audience to imagine “the first” reaching his or her goal. To picture them walking through a grass field to reach their desired destination. After one person — the first — walks through, the grass easily springs back up. The impact that person leaves in the grass field lasts about as long as the media story of this single person’s achievement (Figure 1). When a few people follow that path, their cumulative impact can create the suggestion of a trail, where the grass is partly compressed, hopefully long enough for the next person to find the path and know that what they pursue is indeed possible (Figure 2).
Now consider this subtle trail in the transition from the only, then the few, to one of many. When this point is reached, the grass remains trampled into a permanent path (Figure 3). It becomes a blazed trail that those following can readily find. It is a clear path whose creation we can celebrate. It is a well-marked route whose barriers, both perceived and real, have been overcome. I suppose that when the first guides those who follow, when the path they leave is more inspiring and more permanent than a path they could have ever left by themselves, then they can be a leader after all. Top
To me, leadership means encouragement
Leadership is often misunderstood. We often believe that being a leader means that you must be the first, the best, the most talented, or all of these. That is not always the case. Think about the next generation, my generation. What do you do to encourage, motivate, and inspire us, tomorrow’s leaders?
I can relate to the example of being in a running race. When you race your teammates, you know everyone, their skill level, their endurance, and how you compare to them. Sometimes, you know that one runner is faster or has greater endurance than you. That is the one you expect to encourage you and others, the one you go to for advice, the one you want to learn from. Leaders should have the capacity to support others to improve, not just the ability to win.
Parents, grandparents, teachers, and coaches are my mentors. They encourage me to push past my perceived limits. They are the people who, no matter what, believe in me. Their experience and knowledge and their leadership capabilities help me reach beyond my goals. They help me get to a place and accomplish things that I may not have even known were possible.
When I was asked what leadership meant to me, the word “encouragement” was at the top of my list. I need encouragement from those whom I consider leaders. As someone who believes in the power of leadership, I need to encourage others.
How do you encourage the next generation? How are you our leaders? Leaders must recognize that it is not sufficient to show us how, they must also show us why. Someone who leads by being the first to do something shows everyone why, especially my generation, because we learn about the impact it has. These “firsts” show us that it can be done and that the possibilities are endless. They encourage us without words, in fact without ever meeting us. They show us the importance of knowing that being a first is not just filling the void of “never before” but teaching my generation why they did it.
I wonder what “first” I will be?
Aliah Turner is 12 years old and goes to Lac des Bois Elementary school in Prince George, British Columbia. She enjoys trail running, cross-country skiing, biathlon, basketball, and soccer. She aspires to be someone to whom others turn for encouragement as she pursues her goals. Top
1.Honouring the truth, reconciling for the future: summary of the final report of the Truth and Reconciliation Commission of Canada. Winnipeg: Truth and Reconciliation Commission of Canada; 2015. Available: https://tinyurl.com/njt3vd8
2.Strong-Boag V. Women’s suffrage in Canada. In The Canadian Encyclopedia. Toronto: Historica Canada; 2016. Available : https://tinyurl.com/y7w5u4nm (accessed 7 Oct. 2018).
3.Leslie JF. Indigenous suffrage. In The Canadian Encyclopedia. 22 March 2018, Historica Canada. Available: https://tinyurl.com/ybdx7e59 (accessed 7 Oct. 2018).
4.Caron N. The other side of “being first.” Presented at TEDx Conference, Prince George, BC; Sept. 2017. Available: https://tinyurl.com/ycnu6596
Nadine R. Caron, MD, MPH, FRCSC, is a member of the Sagamok First Nation, an associate professor in UBC’s Northern Medical Program, and co-director of the university’s Centre for Excellence in Indigenous Health.
This article has been peer reviewed.