Identifying general surgery trainees' perception of leadership, leadership needs, and development of a leadership curriculum.

Objective: Leadership is an essential competency for surgeons. Despite its importance, leadership is not explicitly taught in many residency programs. The objective of this study was to explore general surgery residents' perceptions of leadership, its domains and competencies, and the need for and structure of its development in residency.

Methods: Semistructured interviews were conducted with 18 general surgery residents of varying postgraduate year levels at a single academic residency program. The interviews were recorded, transcribed, and coded inductively by two researchers using thematic analysis. Coding discrepancies were reconciled through consensus.

Results: Residents viewed leadership training as a critical competency and expressed a desire to grow their skills regardless of their current confidence level. Residents' perception of essential leader characteristics and leadership competencies varied, with most describing a leader as a confident, caring person who empowers and develops others by demonstrating strong teamwork and communication skills. Residents made a clear distinction between leadership and authority. The leader-follower relationship was perceived as dynamic, and, depending on the circumstances, anyone could be a leader regardless of their position or role. Residents believed that gender influences how leadership is perceived and practiced. They indicated that observational learning, a major component of social learning theory, plays a key role in how residents acquire leadership skills. Approaches to leadership training encompassed a wide variety of methods.

Conclusions: A diverse list of leadership competencies, characteristics, and approaches to training were noted as important by general surgery residents. Observational learning, modeling, and emulation are the current modus operandi of leadership training in surgical residency. Consequently, to train residents to be effective leaders, it is imperative that faculty and staff undergo leadership development as well. Structured feedback given to residents and faculty on their leadership skills is essential to this process. Regardless of the leadership training method used, residents preferred a tailored, individualized, and longitudinal learning experience.