"Stepping Out of a Comfort Zone": Evaluating the Impact of a Leadership Skills Curriculum on Surgical Residents' Transition to Senior Roles.

Objective: We previously designed and implemented a 4-part leadership skills curriculum for rising senior general surgery resident physicians at 2 institutions. To evaluate the utility of this curriculum, we explored participants' perceptions about how it impacted their transition to senior resident roles.

Design: Semi-structured interviews were performed with residents who previously participated in our leadership curriculum and then completed one of their first rotations as a clinical team leader. Transcripts were analyzed inductively, and thematic analysis performed. A conceptual model was developed with consideration to prior work.

Setting: Two large, academic general surgery residency programs in the United States.

Participants: Eleven third-year surgical residents.

Results: The most salient aspect of becoming a senior resident was gaining more complex roles and responsibilities, including maintaining positive team dynamics, teaching their team members, developing their own abilities, and above all delivering excellent patient care. All too often, these demands seemed like they were at odds with one another, causing many residents to feel anxiety about the transition. However, the curriculum helped them to develop a deliberate approach to their leadership. Residents enacted several behaviors prompted by the curriculum which improved their performance and experience as leaders: practicing self-awareness, upholding standards, developing their team members, and building a team culture.

Conclusions: Our conceptual model demonstrates that a dedicated leadership curriculum can facilitate residents' transition to senior roles by equipping them with frameworks and specific skills which create synergies across their multiple responsibilities. In all, this study supports the utility of targeted interventions to enhance residents' overall leadership development, as a combination of instruction, reflection, and feedback can optimize cycles of experiential learning. Future research could explore the effects of this leadership curriculum on other team members and patients, and ways to promote leadership development longitudinally throughout residency.