The Pygmalion effect in surgical training-how labeling and expectations affect trainees: a narrative review

Expectation effects-particularly the Pygmalion, Galatea and Golem effects-are well recognized in educational psychology but have been insufficiently explored within surgical training. This narrative review examines how supervisor expectations and reputational labeling influence learning opportunities, entrustment, performance, and well-being among surgical trainees.

Evidence from education and organizational psychology shows that expectations influence learners through four mechanisms: socio-emotional climate, instructional input, opportunities to demonstrate ability, and the nature of feedback. Emerging research in surgical education demonstrates similar patterns. Qualitative studies describe residents engaging in extensive impression management to meet perceived expectations, often suppressing help-seeking behaviors to avoid negative labels. Experimental work demonstrates that prior learner handover can significantly bias assessments; identical trainee performances are rated more favorably when preceded by a positive reputation. Informal faculty word-of-mouth remains a dominant source of trainee labeling, with implications for entrustment decisions and progression. Negative expectations can erode self-efficacy, heighten anxiety, contribute to burnout, complicate remediation, and may increase attrition. Conversely, high yet supportive expectations, combined with explicit performance goals and formative feedback, are associated with enhanced skill acquisition, motivation, and resilience.

Expectation effects represent a powerful but modifiable influence within surgical education. Training programs should cultivate growth-oriented expectations for all learners, minimize prejudicial labeling in assessment and handover processes, and design remediation pathways that support rather than stigmatize struggling trainees. Creating a culture that emphasizes coaching, transparency, and psychological safety is likely to improve trainee development, well-being, and patient care.