The Physician Leader as Learner with Tosca Bruno-van Vijfeijken

by Jen Barna MD | Courses and Coaches, Leadership, Physician Leadership, Podcast, Resilience

Today we talk with leadership expert, Tosca Bruno-van Vijfeijken from 5 Oaks Consulting about different leadership styles and physician leader as learner.

“So what motivates you as a leader is important to know from the beginning.” -Tosca Bruno-van Vijfeijken 

All physicians are leaders.

In today’s episode, DocWorking Founder and CEO, Dr. Jen Barna talks about physician leadership with internationally recognized leadership expert Tosca Bruno-van Vijfeijken. In this conversation they discuss multiple different styles of leadership, including leader as learner, transactional, post heroic and more. Tosca points out the importance of knowing what motivates you as a physician leader. Tosca Bruno-van Vijfeijken has offered leadership development and coaching, change management and facilitation services to international and US-based public sector and nonprofit and philanthropic leaders for 30 years, in practice, in academia and as an independent consultant. Tosca has designed and delivered 25+ leadership development training programs. She also enjoys coaching on virtual team leadership, organizational strategy, gender and leadership and diversity, equity, inclusion and belonging strategies. We hope you enjoy this conversation and future conversations with Tosca Bruno-van Vijfeijken, and maximize your potential as the best leader you can be. 

Tosca is a public thought leader and co-author of the book Between Power and Irrelevance: the Future of Transnational NGOs’ (Oxford University Press, 20202) and host of the podcast NGO Soul+Strategy. At the start of her career, Tosca worked as international development practitioner for a European think tank, the World Bank, a US nonprofit, and the United Nations. After leaving the Netherlands, her home country, Tosca lived in Zimbabwe, Cambodia and Vietnam, before settling once again in Upstate New York, USA in 2001; she is a dual national (USA and Netherlands).

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Podcast produced by: Amanda Taran

Please enjoy the full transcript below

Tosca: So, what motivates you as a leader is important to know from the beginning.

[DocWorking theme]

Jen: Welcome to DocWorking: The Whole Physician Podcast. I’m Dr. Jen Barna and I thank you for being here with me today, because I’m so excited to bring to you a guest, who is internationally known, Tosca Bruno-van Vijfeijken. Tosca is the owner of Five Oaks Consulting and a good friend. She’s an internationally known expert on leadership. While her background is predominantly in the NGO sector, she and her team have a fantastic course on leadership development that I find really ideal for physicians and the healthcare sector. So, Tosca, because we’ve had so many conversations over the years about leadership and we’ve noticed a significant overlap between healthcare and the NGO sector, I’m honored to have you here. Welcome to DocWorking: The Whole Physician Podcast.

Tosca: It is my absolute honor and pleasure, Jen, to be on your podcast. Let me add a few things about my profile in case that’s helpful. Yes, indeed I do a lot of work on leadership development including virtual leadership development, which is related to the course that you just mentioned, Jen just wanted to specify that. I also wanted to clarify, just for our audience in case the word ‘NGO’ is not familiar here in America, often the term is used for nonprofits. So, indeed, my primary focus is on working with leaders of international nonprofit organizations or non-government organizations as Jen already said is to work on them with leadership development, change management, and organizational culture work.

Jen: So, Tosca, tell me a little bit more about your background and how you came to specialize in leadership development.

Tosca: Yeah. I’ve had a little bit of a funny background and very little of it was planned as life tends to do. I used to be an international development practitioner, that means I worked on poverty reduction in developing countries in Sub-Saharan Africa as well as in Southeast Asia. Then became what I call jokingly an accidental pracademic at Syracuse University here in the US. So, I’m Dutch by background but I’m a dual citizen. I worked there with a team on the governance, leadership, and leadership development, and the organizational effectiveness of these international NGOs or nonprofits. Then two years ago I turned towards full-time independent consulting through my company, Five Oaks Consulting.

Jen: One thing that I find really interesting about your work on leadership is this concept of the leader as a learner. Can you tell me a little bit about what that means to you and how that plays out in terms of leadership?

Tosca: The concept of the leader as a learner is not a concept by the way, that originated with me. I want to first make sure that I say that outright. But I’ve noticed that in the last maybe 10 years, senior leaders in international nonprofits organizations, and let’s remind ourselves, there are, of course, here in the US too, a lot of both hospitals as well as medical societies and associations that are also nonprofits. I noticed that this concept came up, the idea was not that the leader would be a heroic leader, and I know, Jen, that at some point, you also want us to talk about post-heroic leadership. So, at that time, we can distinguish those two. But the leader as a learner. What do we mean by that? The leader needs to have a strong foundation of robust self-awareness, including how do I deal with adversity and failure? That gets us to the topic of personal resilience.

So, how do I view adversity as well as failing, what is my personal resilience in the face of adversity or failing, and how can I develop more resilience? Those are some of the things that one can connect to the concept of a leader as a learner. So, this is not the concept of the leader as the all-knowing person. It is much more, it is related to growth mindset, these ideas that lead us to need to continue to focus on being open to new information and continuing to learn being open to feedback.

Jen: That brings up a great question, which is in the healthcare sector which, as you point out, is to a large degree, not for profit. Many organizations in the medical sector are not for profit. There are a couple of things that I think overlap there. One is the concept of people who go into these lines of work, both for not for profits and/or healthcare in general tend to be people who are do-gooders or they have an intention about why they chose to do this work. I’m curious about your perspective on recognizing in an honest way, the motivation for how we choose the work we do and how that influences our leadership style?

Tosca: Wow, that’s a complex question. Let me approach it from one angle and then totally feel free to just probe and guide me to where you want to go. So, one thing about robust self-awareness is related to what motivates you. Some leaders are motivated by achievement. They’re highly task oriented and they need to have goals that are constantly motivating them. Some are motivated by affiliation or relating to other people. So, they’re very process but also relationship oriented. Obviously, in most organizations, we need both task orientation and relationship orientation. Some leaders are very motivated by power. Now, I do not necessarily mean it as a negative thing but the sense of having control and being able to drive the kind of leader as driver if you will and that relates back to heroic leadership is still an important concept. So, what motivates you as a leader is important to know from the beginning. And then when it comes to personal resilience and how to process and cope with adversity and failure, which we all experience, of course, as individual leaders, that comes up again.

For instance, here in America, often there is the assumption that we as top leaders or as team leaders that the buck always stops with us. We are ultimately accountable. Now, of course, that is true to a certain extent. We do need to be clear about where ultimate accountability lies and we need to be transparent about where we have made mistakes. I understand that in the healthcare system and in healthcare, that is a particularly tricky angle, but that is really important to know that actually in many cases, when your team, or your organization or you yourself experience adversity or particularly failure, it is because you did not control all the factors that went into a context. Being clear about where you don’t control everything and therefore, when things go wrong, it’s more I would argue your responsibility as a leader to make sure that you learn from the experience of back to the leader as learner, then to always put everything on your shoulder and say the buck totally stops here. I don’t know if this makes sense so far.

Jen: Yes. So, leader as learner ties into building resiliency-

Tosca: Yes.

Jen: -because if you’re acknowledging your failures and learning from them-

Tosca: Yes.

Jen: -demonstrate to your team in addition to becoming more resilient over time.

Tosca: And learning more, so learning towards continuous improvement. I just want to reinforce the point that you just made, Jen, about that modeling of being seen to be open to first of all new information that you may not have thought about before or that doesn’t fit with your mental models of the world, your set up often unspoken belief systems and assumptions about how something should have worked, and then it didn’t. Being seen to be open to feedback, seeking proactively feedback from your team including, importantly from the people who work laterally at the same level as you, peers, and even more importantly seeking feedback from people who work for you, who are your supervisors. So, that openness to know information and feedback and to for instance, doing after-action reviews or other forms of learning exercises when something has gone well or not well is incredibly important to model that. Because that signaling value of such leadership behavior really cannot be underestimated.

Jen: One thing that I’m curious about that I find in the healthcare sector is, we tend to be on the receiving end of a lot of negative feedback. So, while I think from a leadership perspective, it is important to encourage acknowledgement of failure and feedback from your team including those at all levels and I think that increases transparency, so I see how that could benefit the whole team. By the same token, physicians who are surveyed report a large amount of negative feedback from within their workplace and it’s interesting to think about whether people are more likely to criticize certain people on a team or feel more comfortable criticizing certain people on the team and if that relates to gender or something else. So, anyway, I’m just curious to throw that out and ask if that’s a question that you’ve heard before.

Tosca: Wow. There’re a lot in your question. With the limited time we have, I’m only going to be able to address it from one or two angles. There is much more we could say about how to deal with feedback and I’m pretty sure that in one of your previous podcasts, you have already spoken with others who have a lot to offer on that. So, in terms of negative feedback particularly in the healthcare sector, where you may be at the receiving end of a lot of that. So, being really careful for instance, I find as an individual leader, is to be really careful, again, coming back to self-awareness, at what point in the day from a biorhythm perspective and from an overall wellbeing perspective, and my most able to be open for new information, particularly, if it’s information that is not particularly welcome that I wish had been different.

For instance when I seek and receive feedback, I will take that in in the morning when I’m well rested, and I’m more able to be open to new information because otherwise, I’m at risk of either experiencing negative feedback as crushing and I’m overinterpreting it and putting too much emphasis on it or most likely, most of us will go into a defensive routine, where we will reject the negative feedback and say, “Oh, no, this person is not right because that was really not my fault, or it’s the system, or what have you.” So, that’s one element.

One more element may be whether people feel more comfortable to criticize some over others. Obviously, there are many team and organization cultures in which awkward feedback is not at all encouraged and in which people will get punished for doing it if they dare to do it. So, that’s why so many top leaders often no longer have the skill to be open to new information that doesn’t fit with their reading of the world, including about themselves, because they haven’t received such feedback in a long time. So, they haven’t exercised that muscle of self-reflection and also humility.

Women tend to get critiqued for different facets. So, female doctors get critiqued for different attributes than male doctors. For instance, when a woman exhibits a good sense of authority and is direct in her expression that is seen as controlling behavior, that is seen as being overly that terrible word, bossy, and so on. When a man exhibits the same behavior, it is seen as natural self-confidence as bestows a leader. In other words, men are expected to behave like that. So, that’s just two answers to a very broad question that you asked me.

Jen: Yes, okay. That’s really an excellent point. So, in terms of the leader as a learner concept, first of all, all physicians are leaders, and so whether you lead just a small team or whether you’re a leader within your organization on a higher level, you are leading as a physician, you’re also leading patients and their families. So, in terms of basically the three concepts that we’ve talked about outside of today, talking about openness, accountability, and as you mentioned before being seen learning.

Tosca: If I may just interject accountability and transparency, tempered by a realistic sense of what was in my or our control as a team or as an organization, and what was not. Otherwise, it affects our resilience to overcome adversity negatively.

Jen: Okay. So, with accountability it’s important to step back and as the leader take responsibility for what happened, but by the same token to also examine and look at what could I control, what could I have done differently versus some things that maybe are always going to be outside of your control?

Tosca: Yes. To be clear about how to distinguish those two, that will help with your personal resilience in the face of adversity and it will help you to continue to learn about those factors that you could control and that next time you should deal with in a different way.

Jen: So, tell me about dealing with failure from your perspective. What are the steps to deal with failure?

Tosca: You know what, first of all, there is this perspective on the world that everything can be going the way I want it to if I’m planful, if I plan ahead, so the idea that you can control your context if only you’re planful and if you plan everything ahead. That is not a helpful concept for dealing with failure because of course, things do not work that way in the world. So, seeing instead how your working world is like a kaleidoscope, there are lots of interlocking factors, things that happen, events, etc., and there is a lot that is not under your control. That’s one thing I’d say to deal with failure.

The second thing is to assume therefore that you, I, we all will fail often. I often say to my small team, I fail every day. So, feel free for you also to be transparent or where you felt that you didn’t step up enough because I fail every day. So, as a leader, again modeling, I have to say when it’s my fault. I have to say that was on me. I should have done that differently. So, that’s helpful, I think, in dealing with failure. Then obviously seeing failure primarily, it’s almost a cliche but as an opportunity to learn.

Again, I also don’t feel that way every day in every moment of the day, so it depends on how well I am feeling about my overall state of being. But those are just a couple of things from failure as an opportunity to learn. As long as we keep learning and as long as we hold ourselves accountable for the learning rather than only for the failures.

Jen: Excellent point. As far as physicians go, I think we tend to beat ourselves up over failures. So, perhaps maybe giving a limited time to reflect prior to asking forgiveness of yourself also, and of course, of the others who are affected by the failure. But then also, there’s an elephant in the room for us, which is malpractice.

Tosca: Yeah.

Jen: And I think that ultimately what you’re talking about can really benefit us as physicians because if we’re leading a team in a transparent way and encouraging people to step up and say, “Are you sure that’s what you meant or you don’t usually do it that way, did you mean such and such or something?” That actually can help you in a huge way because they know that you’re not perfect and of course you’re not going to be perfect and it’s much better if you can encourage your team to work as a team to say, “We’re all trying to help the patient.” So, if you see anything that concerns you, please tell me right away.

Tosca: Voicing culture, yeah, including importantly by those who are below you in terms of positional power.

Jen: Right and I think that can work well for everyone because if someone sees something that they’re not comfortable with or they have a question about, if they come right to the physician who is the leader in that situation and say, “Hey, this concerns me,” or “Hey, did you mean this?” or however diplomatically they may want to ask it. Number one, sometimes they just might see something and misinterpret it and it gives the physician an immediate opportunity to say, “Oh, no, the reason I did it differently this time is because of ABC and explains something.” But alternatively, if the physician meant to say one thing to the patient and said left instead of right or whatever it may be, that’s an opportunity to fix something immediately, and then make no long-term consequence. So, I think embracing failure and encouraging that transparency within a team is so critical.

Tosca: It’s so critical but in the classical leadership models, particularly, in the private sector and particularly here in the US more so than for instance, in Europe, where I’m from, that hero-based leadership model used to stand in the way of the very wholesome practices that you just described. So, that’s why I think linking this topic maybe to a future conversation about post-heroic leadership or if you want, we can go into it now. I think it is a useful one. Post-heroic leadership is broader than that but it certainly encompasses that.

Jen: I would love to hear a definition of post-heroic leadership and then definitely delve into it in another conversation on a future podcast for sure.

Tosca: Okay. So, I’ll just give you a one paragraph definition for now. So, post-heroic leadership comes broadly speaking out of the school of leadership models, that is called transformational leadership models, if you look at the academic literature in particular, but also the practice. So, post-heroic leadership also is closely aligned with feminist leadership, which maybe is an interesting topic to talk about another time as well. What it means is, it is no longer hero leadership where I am, it’s a very masculine leadership model. The hero-based leader is the person who knows everything, who has the long-term vision, and who’s driving everybody, the whole organization or the team towards that future state if you will. It’s the opposite of that.

So, what does that mean? It is a leadership that sees leadership, as you already very rightfully pointed out, leadership is a distributed something in an organization. It’s not just about those with formal positional power, it is also those that have informal power that are very important to hubs in a network in an organization, where a lot of people will go to them for information because they respect them, etc. So, it’s a leadership model that pushes leadership down across the organization. It is very developmental in nature. What do I mean by that? In post-heroic leadership, it is one of my primary responsibilities as a leader to help others develop themselves. So, it’s very focused on mentoring, and sponsoring, and offering stretch opportunities, so that you continue to distribute these leadership characteristics, and attributes, and skills throughout the organization. It is also a leadership model, post-heroic leadership that is focused on collaborative skills. So, collaborative problem solving of which there often is too little in organization. So, those are a couple of ways in which I would define post-heroic leadership.

Jen: And do you find that post-heroic, that style of leadership is growing in use? We talk about a new era of leadership certainly within our sector and I’m curious if you see that increasing in terms of leadership style and also if you see it in specific subgroups within a leadership culture.

Tosca: I would say my answer is a cautious yes. So, yes, I see both the broader school of thinking around transformational leadership as different from transactional leadership that has been on the ascendancy for probably about roughly at least 20 years or so. Post-heroic leadership or there are some other names that one can give, I have seen on the rise definitely in international NGOs or not for profits, in some large UN agencies for instance, in some private companies and sectors, under different names again, you see it’s definitely on the rise. Sometimes, it’s also linked to intergenerational leadership and the fact that many organizations, private sector, public sector, nonprofits are somewhat asking themselves the question, how do we need to lead millennials and Generation Y and Z? So, yeah, I would say it’s on the ascendancy across a number of sectors.

 Jen: Wonderful. I agree and I think it’s encouraging to see that transformation happening. Do you have a piece of advice for someone who’s listening, who is a leader that may be interested in exploring their style of leadership and looking into the concept of leader as learner?

Tosca: Yeah, a couple of tips. First of all, I wholeheartedly support your point that leadership can only start with robust self-awareness and that means that you need to learn about what are your natural tendencies as a leader, what models were you infused with through your family culture, your national culture, your corporate culture, your sectoral culture, etc., and then I would say that leader as learner is something that means I have to assume that I always have to keep improving. So, I have to keep investing in my leadership capabilities and that can mean so many different ways. It means asking for feedback frequently and informally rather than waiting for official performance review processes. So, those are a couple of things and humility obviously. Humility is really, really important. So, staying self-aware that as we rise in positional power, we need to be really careful what that power does to the brain and that’s another topic that I’d love to talk to you about some time, but we become more likely to get closed off to being a leader as a learner, the more we have access to power.

Jen: Well, Tosca, this has been a wonderful conversation and I feel like we’ve just scratched the surface. So, I’m excited to talk with you more specifically on so many of these areas in future conversations, and I am so grateful to you for being my friend and for coming on the podcast. It’s wonderful to have you here.

Tosca: It’s been my absolute pleasure, Jen, to do this together today. It is also my honor. So, I’m very happy for you and I to have these conversations again. I look forward to that.

Jen: And thank you for being here and listening with us today on DocWorking: The Whole Physician Podcast.


Jill: Let’s face it. Sometimes, in medicine, leaders end up in their positions because of their achievement not because of their leadership skills. If you’re in medicine, and you’re a leader, and you want to improve your skills, or perhaps you’re a physician who would like to be a leader someday, if either of those things are true, then you need to hire a physician leadership coach, somebody with lots of experience working with physicians to help them identify what kind of a leader they want to be to help them implement a plan to become that leader, and to help them leverage their strengths, so that they can be the best they can be in a leadership position.

Amanda: I’m Amanda Taran, producer of DocWorking: The Whole Physician Podcast. Thank you for being here. Please check us out at and please don’t forget to like and subscribe. Thank you for listening.


Board-certified practicing radiologist, founder and CEO of DocWorking, and host of top ranked DocWorking: The Whole Physician Podcast

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