I am in the middle of anesthesia training right now. Most days I am doing at least two jobs at once.
The first is the obvious one. Airway management. Hemodynamic stability. Drug dosing. The clinical work I am there to learn, which is already enough to fill your working memory because the stakes are real and the patient is right there.
The second job nobody assigned me. Every day I work with a different attending, and before I can focus on the medicine I am already building a model of that person. How they like cases presented. What they notice. What earns a correction. Whether they want me to ask questions or just demonstrate what I know. I am doing this in the background while managing the anesthetic.
There is a third layer on top of that. I am constantly trying to sort out what an attending is actually teaching me versus what is just their preference. Those are not the same thing, and from the outside they can look identical. A senior clinician's habits and sound clinical practice can be impossible to tell apart until you have enough context to know which is which. Getting that context is its own job.
Three things running at once. One of them is about the patient.
I do not think this is unique to residency. I think this is what it feels like to work under any leader who has not made themselves legible.
Brené Brown has a line I keep coming back to: clear is kind. She says it in the context of hard conversations, but it reaches further than that. When a leader is clear about what they expect, what they value, and what good work looks like to them, they return that bandwidth to the people working under them. The adjustment work shrinks. Attention goes back to the actual job.
The opposite follows. An unclear leader creates overhead for everyone around them, even when that is the last thing they intend.
Leaders do not feel the drag they create. That is what makes it so hard to fix.
If you are in charge, you are at the top of your own adjustment hierarchy. The people below you are modeling you. You are not modeling them. You feel none of the cognitive overhead your behavior generates in the people trying to read you. You can be a significant source of drag with no signal that it is happening, because it never reaches you.
The leaders I have worked under who generated the least of this were not always the most technically skilled. They were the most readable. You knew where you stood. You knew what they valued before the work started. That clarity did not just make things more pleasant. It made the work better, because everyone's attention was on the problem instead of on decoding the person in charge.
That is not a soft skill. That is a performance decision.
The Short Version: Every leader creates overhead for the people around them just by having unstated preferences and inconsistent expectations. Most never feel it because they are not the ones doing the adjusting. The most effective leaders I have worked under were not the most technically impressive. They were the easiest to read. Clarity is not a courtesy. It is a competitive advantage.
Try This Now: Think about the best leader you have ever worked under. Not the most impressive one. The one who was easiest to work for. Write down one thing that made them readable. Then ask yourself honestly whether your team would say the same about you.
Carlo DelDonno, MD, CPT