Qualitative Assessment and Description of Intraoperative Attending Surgeons' Leadership Skills

Leadership is one of the nontechnical skills that attending surgeons must apply in clinical settings. Effective leadership skills are fundamental for surgeons to lead the team and accomplish the goals of surgery. This study aimed to uncover how attending surgeons from a United States academic medical center apply leadership skills in the operating room (OR).

This qualitative study was conducted at an urban academic medical center from February to August 2022. Data were collected through nonparticipant observations of the attending surgeons operating with surgeons in training, and other surgical team members in the OR. Surgical teams were observed during the entire patient's time in the OR. Members of the study team took field notes to document the attending surgeons' behaviors related to their leadership skills. We used inductive and deductive thematic analysis using the Surgeons' Leadership Inventory framework. We used MAXQDA for data organization and retrieval.

We conducted 179 observations involving 27 surgeons in training, operating with 45 attending surgeons from ten different general surgery subspecialties for a total of 351 hs. Our findings highlighted how leadership skills employed by attending surgeons spanned various domains outlined in the Surgeons Leadership Inventory framework. These skills encompassed ensuring resource availability, making timely decisions, delegating tasks proficiently, providing clear instructions, offering educational opportunities, attending to trainees' needs, sharing crucial information, and navigating challenging situations.

Attending surgeons applied leadership skills to orchestrate the activities of surgical team members and educate trainees in the OR. Future studies should investigate the effect of attending surgeons' leadership skills on patient's and trainee learning outcomes.