Leadership is a core competency required by the ACGME. This study links leadership behaviors from senior residents to significant short-term and long-term impact on junior resident well-being. Strong leaders positively impact individual growth, psychological safety, resident education, teamwork, and wellbeing. This highlights the need for leadership training programs and curricula in general surgery, especially those that that cultivate Transformational Leadership styles as opposed to Transactional Leadership alone.
Summary:
Background: Addressing well-being within surgery residency training has become a focus for the ACGME given high rates of burnout. Most interventions are focused on individual level skills and not ways in which residents can impact the well-being of those around them. There is a gap in research on the role that resident leadership has on co-resident and team well-being. Therefore, a needs assessment was conducted prior to establishing a leadership development program at one of the largest academic residency programs in the US (OHSU).
Study design: A semi-structured question script was administered to surgical residents by a research team that included 2 surgical faculty, a social scientist with education expertise, and a surgical research fellow. Residents were asked about traits of senior residents who were regarded as great leaders versus those seen as poor leaders, and about how they impacted the resident’s well-being, both positively and negatively. Six focus groups were created by the core research team divided by PGY level, all performed virtually for 60 minutes. Data analysis was performed using grounded theory and the focus groups were conducted until data saturation was reached. The transcripts were coded and analysis performed through the consensus amongst the core research team.
Results: A total of 30 (47%) surgical residents from the program participated in the focus group with 63% women and 37% men. Participants from each class participated: PGY1 (10), PGY2 (6), PGY3 (5), PGY4 (5) and PGY5 (4). Effective resident leaders were noted to emphasize similar behaviors including 1) being supporting and empowering; 2) focusing on team building by creating a common goal, psychological safety, camaraderie and caring for others; 3) showing proficient management skills by setting expectations, plans, delegating tasks and providing feedback; 4) having high levels of emotional intelligence; 5) effectively communicating through a clear message and actively listening to junior residents and 6) proactively engaging in teaching. The consequences of the above traits were promoting individual residents’ growth and was directly linked with residents well-being, allowing them to prioritize their own optimized mental state. Residents deemed poor leaders were found to be not supportive and did not empower fellow team members, seemed unapproachable and unwilling to help, did not advocate for junior residents, lacked communication skills and did not focus on creating a team environment, and lacked management skills and emotional intelligence. The consequences of a poor leader were creating an overwhelming amount of negative emotions, lack of psychological safety, poor team dynamics and broken workflows. Mixed leadership behaviors, described as effective in some ways but ineffective as others were perceived by some residents as effective and ineffective to others.
Discussion: Leadership today requires a more team-focused, holistic approach that aligns the group’s collective goals. Transformational Leadership (inspirational, create a common mission) as opposed to Transactional Leadership (task oriented, give and take) can improve team well-being, build psychological safety, and potentially impact team efficiency and patient safety. This study demonstrates some of the actions of effective and ineffective resident leaders and shows the impacts they can have on their teams. An important takeaway is the finding that different PGY levels have different needs from their leaders, requiring leaders to tailor their leadership style to each team member. The link between leadership and well-being argues for the need to develop leadership curricula in general surgery residency.