Why future leaders should be trained like surgeons

For more than two hundred years, medicine has understood something that many other professions are only beginning to rediscover. True expertise is built through practice, not observation. 

A surgeon does not graduate and operate simply by attending lectures on anatomy or analysing cases where an operation did not work properly. Medical graduates possess the knowledge; however, they are not allowed to practise unless they observe experienced practitioners, practice under supervision, make decisions, reflect on mistakes, and gradually assume greater responsibility. It takes years for them to be trusted to operate independently. 

Business education has historically followed a different path. We prepare future leaders through lectures, case studies, exams, and written assignments. Obviously, these are all useful ways to understand the underlying concepts. I believe that we prepare future leaders to perform well in academic environments rather than to deal with the realities of leadership. 

The classroom is not the boardroom. The difference between the two matters because CEOs do not operate with perfectly structured problems, unlimited time, or carefully curated information, nor do they handle conflicts in meetings under the direct supervision of an observer. They work with incomplete data, different priorities, competing agendas within organisations, ethical dilemmas, and decisions whose consequences cannot simply be revised and resubmitted. Success depends not only on what leaders know — especially in the age of AI — but also on how they exercise judgement when certainty does not exist. 

This idea is not new in other fields. Pilots spend hundreds of hours in flight simulation before they take on the responsibility of flying a plane. These simulated environments deliberately create uncertainty and unexpected situations, including equipment failures and communication breakdowns. In such an environment, in an almost perfect replica of the real-world situation, future pilots can practise working under pressure, make decisions and learn from their mistakes without real world consequences.  

Nobody expects a violinist to master Beethoven’s violin concerto by reading the score. Performance only emerges through repeated rehearsals. 

Business has changed. Uncertainty is no longer an occasional disruption; it is becoming the normal operating environment. This is mainly a result of geopolitical tensions and artificial intelligence, which are transforming industries and reshaping supply chains. In the complex cultural, technological, and regulatory environments that our students will enter, can they be expected to succeed without the kind of practical training received by pilots or surgeons? 

This requires a shift in emphasis from teaching about business to training for business. We should start to imagine programmes where students spend a substantial part of their education working on genuine organisational problems rather than analysing historical case studies. They should learn how to analyse imperfect information, negotiate with stakeholders who have conflicting interests, and experience the consequences of their decisions. This would prepare students better for work and make business education better value. 

Many business schools have already started integrating these approaches into their curricula through consultancy projects and work integrated learning. In most cases, however, these opportunities remain additions to otherwise conventional programmes rather than becoming the organising principle around which a programme is designed. 

Designing a programme based on real world practice does not remove theory from the curriculum. Surgeons do not enter their profession after years of neglecting medical science, and pilots are intensively trained in a wide range of topics related to aviation. In both cases, practice is strongly underpinned by disciplinary expertise. Business education should adopt a similar approach. Students should learn strategy, finance, operations, and marketing, but they should also have repeated opportunities to apply those ideas in practical situations. These opportunities enable students to develop confidence as well as competence. 

Perhaps the future business school would look like a teaching hospital. That comparison is more than a metaphor. Medical education integrates knowledge acquisition with supervised professional practice throughout the learning journey rather than treating practice as something that happens after graduation. Business schools could adopt a similar philosophy by embedding authentic leadership experiences throughout the curriculum rather than concentrating them in a single capstone project or internship. 

The challenge facing business schools, therefore, is not simply to produce graduates who know more. If we would not trust a surgeon trained only through lectures, why are we still comfortable doing exactly that with tomorrow’s CEOs?