The Growing Momentum of Leadership Education in General Surgery Training: A Systematic Review

Leadership is a core competency in surgery, critical for guiding interprofessional teams in high-stakes environments such as the operating room and trauma bay. While competency frameworks mandate leadership development during residency, training opportunities remain variable and inconsistently evaluated. This systematic review summarizes published curricula on leadership training for general surgery and subspecialty residents.

A systematic search identified studies describing leadership development interventions for surgical trainees. Data were extracted on study characteristics, intervention design, delivery methods, curriculum content, and evaluation strategies. Outcomes were synthesized narratively with emphasis on effectiveness and educational approaches.

Nineteen studies published between 1987 and 2024 were included. Most originated from the United States, with additional contributions from Australia and Canada. Interventions targeted a range of trainees from interns to fellows, with participant numbers ranging from 8 to 180. Curricula varied in duration, from single-day workshops to multi-year longitudinal programs. Delivery methods included lectures, case-based discussions, simulations, coaching, and hybrid models. Early curricula emphasized practice management and career preparation, whereas more recent initiatives focused on non-technical skills, resilience, diversity, and inclusivity. Most programs provided protected time, and about half mandated participation. Evaluation was predominantly via post-session surveys, though some incorporated validated tools such as the Internal Strength Scorecard, NOTSS, and structured video assessments. Participants consistently reported improved confidence, leadership behaviors, and team communication. Randomized studies demonstrated significant gains in leadership performance during simulated and real clinical settings.

Leadership training for surgical residents has evolved from management-focused lectures to interactive, competency-driven curricula. While evidence shows consistent learner benefit, the literature remains limited by reliance on self-reported outcomes and heterogeneity in evaluation methods. Future efforts should prioritize rigorous assessment, longitudinal follow-up, and integration across surgical specialties. Embedding structured, evidence-based leadership training into residency is essential for preparing surgeons to lead interprofessional teams effectively and improve patient outcomes.