#futureofmeded: Leveraging Neuroscience to Optimize Leadership of Self and Others

By: Ezgi Tiryaki (@Neuro_Edu_ET) and Felix Ankel (@felixankel)

You are an associate dean for medical education at an academic health system. For the last couple of years, residency directors have done an incredible job navigating their programs through the Covid-19 pandemic. You have helped lead successful institutional and residency accreditation reviews, residencies are able to recruit top candidates, and faculty and residents have met unprecedented challenges. Yet, you feel that the culture has changed. People seem less connected. You and your colleagues appear more chronically aggrieved, autocratic, less patient, and more frequently triggered. You look for a mental model that you can learn from to understand your current situation and try to build a cohesive culture. You come across neuroleadership and the SCARF model. What is neuroleadership? What is the SCARF model?


Neuroleadership is the application of neuroscience to the field of leadership and allows for important insights into education leadership. Our brains are designed to simplify the complexity of the world around us and make predictions. This allows for rapid responses to potential threats that maximize survival. Much of this activity is carried out quickly, non-consciously, and reflexively.

Social neuroscience explores the biological foundations of the way humans relate to each other. It turns out that our motivation to minimize threats and maximize rewards drives our social behavior as well. Furthermore, the brain treats many social threats and rewards with the same intensity as physical threats and rewards.


The SCARF model was created by David Rock and offers a simple framework that captures key triggers in social situations. SCARF stands for five common domains (STATUS, CERTAINTY, AUTONOMY, RELATEDNESS, and FAIRNESS) that can activate a threat or reward response in the brain. For example, a perceived threat to one’s status activates similar brain networks as a threat to one’s life.

This can have a profound impact on our perception, attention, and problem-solving capacity. The capacity to make decisions, solve problems and collaborate with others is generally reduced by a threat response and increased by a reward response.

A threat response reduces our ability to access our frontal lobes and diminishes executive function (critical thinking, complex decision making). Our responses become less creative, open, or nuanced. A reward response enhances our ability to learn and make connections.

Unfortunately, our brain is much more attuned to picking up threats than rewards. The threat response is also more intense and longer lasting. It is therefore much easier for us to cause aggravation than it is to help others think rationally and creatively. This dynamic requires us to pay attention to when we may be inadvertently impacting the quality of our social interactions.

The SCARF model is easy to remember and helps recognize and understand the five most common drivers of threat or reward responses in social interactions. By helping to create conscious awareness of otherwise non-conscious processes, the model allows us to be proactive and be in choice: We can choose to minimize the threat response we may evoke in others, and we can choose to maximize the reward system.

SCARF Model:

  • STATUS – Our relative importance to others.
  • CERTAINTY – Our ability to predict the future.
  • AUTONOMY – Our sense of control over events.
  • RELATEDNESS – How safe we feel with others.
  • FAIRNESS – How fair we perceive the exchanges between people to be.

The challenge

One of the residency program directors is not thriving. They are a national leader in medical education and former president of their specialty residency director’s organization. Prior to the Covid pandemic, they were viewed as a technical expert and a thought leader in your medical education community, often mentoring junior residency directors. They also served as the only vice-chair for their department and oversaw academic affairs. This led to a close, reciprocal and mutually beneficial relationship with their chair. They were well-liked, well respected by peers, gave engaging in-person medical education workshops to the medical education community, and were an active participant at graduate medical education committee (GMEC) meetings. Since Covid, they have become less engaged at GMEC meetings, often arguing with peers, and sending long emails to committee members listing their grievances when the agenda comes out. You start hearing complaints from residents and faculty and are asked by their new chair to speak to them.

In speaking to them, you realize that the Covid pandemic has hit them hard. Early in the pandemic, they were a fierce advocate for personal protective equipment for residents and colleagues. They then tried leading one of their signature medical education workshops online but abandoned subsequent ones because of their difficulty managing breakout rooms on Zoom. Their department hired a new chair who restructured the department by appointing vice-chairs of operations, education, and research. The residency director is now the vice-chair of education and one of three vice chairs.

Recognizing threats

Applying the SCARF Model, you realize that the residency director has a threat to STATUS. Whereas previously, they were the only vice-chair in their department with a close relationship with their chair, their portfolio has now decreased in size, and their position feels diminished to them. Furthermore, they are grieving the loss of positive feedback and requests for mentorship that their in-person workshops resulted in.

There is a lack of CERTAINTY about when and how normal operations will resume and how their career will fare under the new chair. While they were able to successfully run workshops by themselves in the past, now they find themselves having to rely on technical support staff and others with expertise in the use of online learning platforms (AUTONOMY). They have lost the opportunity to network and engage with live audiences during their workshops and feel like they have drifted apart from their professional connections and peer group (RELATEDNESS). They also feel that they now share the attention of the chair with two other vice-chairs. They feel overlooked and their contributions not valued, especially since the vice chair for clinical operations is making a higher salary and is getting more face time with their chair (FAIRNESS).

The opportunity to create rewards

Now that GMEC meetings are returning to in-person, you ask whether they would be interested in incorporating parts of their signature workshops into residency director development programming. You elevate STATUS by giving them time to lead those sessions at the end of the GMEC meetings. You increase CERTAINTY by inviting them to collaborate on developing a medical education leadership strategic plan. You give them complete freedom in designing the content and delivery of the new professional development curriculum for program directors (AUTONOMY). You ask them to co-lead a summit on the future of medical education with you that includes institutional operational, educational and research leaders from across the health system (RELATEDNESS). You meet with all department chairs and advocate for a transparent and equitable salary structure for educational leaders. (FAIRNESS).

The residency director considers your suggestions and creates a highly successful professional development program. They become more engaged at GMEC meetings and complaints from others decrease. They thank you for helping them get through a challenging time.

Coaching others:

In our case challenge, we created a situation that included all five domains to better demonstrate the model.  Most of the time, individuals will have a predominant domain that elicits a threat response. When coaching individuals that may be struggling because of a threat response to any of the SCARF domains, consider using the following approach:

  1. Recognize: The first step is to notice when you or others have been triggered. A good clue is a lack of productivity and derailed collaboration. Applying the SCARF model makes it easier to step back and identify and label the most common social triggers in oneself (self-awareness) and others (social awareness).
  2. Reframe: Once the dynamic is recognized, it is often possible to turn a perceived threat into an intrinsic reward. With awareness comes the ability to reframe situations and create the conditions for a reward response. This reappraisal can be applied to better manage oneself or to support others in a more productive way.
  3. Refine: Since the SCARF model can be applied to the individual, to teams as well as the larger systems, education leaders can be intentional about what they pay attention to. Using leadership approaches like dialogue, appreciative inquiry, and design thinking, they can proactively create policies, processes and rules that minimize threat responses in their organizations.
  4. Reflect: In addition to adding the SCARF model to your mental toolbox, we encourage you to take a moment to reflect on your learnings. What are you discovering about your own situation as you are thinking through this model? Such application and reflection helps foster vertical development as a leader.

Photo Credit: NeuroLeadership Institute

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