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Podcast: Improving leadership in surgery

In this podcast, Helen Saul, Editor in Chief of NIHR Evidence, speaks with Amy Grove, Professor of Implementation Science and NIHR Advanced Fellow, University of Warwick; and Peter Hutchinson, Director of Clinical Research, Royal College of Surgeons of England. They discuss key elements of leadership training: feedback, personal characteristics and atmosphere. Read a full transcript of the episode here.

What makes leadership training effective?

Researchers reviewed existing evidence on leadership training for surgeons. Their analysis suggested that successful leadership training:

  • includes feedback that is timely, repeated, constructive and delivered by a trusted team member
  • is delivered to surgeons who are aware of their need to improve their leadership skills and motivated to do so
  • is carried out in a positive atmosphere, and tailored to individuals’ specialty, and stage of career.

People who design, develop, and conduct leadership training for surgeons could use the findings to improve their schemes.

For more information on leadership training opportunities, visit the NHS website.

What's the issue?

The NHS is paying increasing attention to leadership within clinical teams. Surgical leaders are responsible for developing an effective team; they have to understand the needs of patients and inspire and manage their team to meet those needs.

Leadership training can be delivered in different ways, for example, to the team leader alone or to all team members. However, it is not clear what approaches work best. Researchers examined the existing evidence.

What’s new?

The analysis included 33 studies. The researchers identified 3 elements that were essential to the success of leadership training for surgeons.

  1. Feedback

Feedback was best delivered by trusted and respected team members soon after the event it related to. Providing feedback multiple times reinforced learning. Positive feedback could be given in front of the team; negative feedback was better given in private. Senior-to-junior or peer-to-peer feedback could be given directly, but many juniors preferred to give feedback to seniors anonymously.

  1. Surgeon characteristics

Leadership training was most effective when delivered to surgeons who were aware their leadership skills needed improvement (or when other team members had suggested this). Training was best delivered to surgeons who were confident in their technical surgical skills, and therefore able to focus on leadership improvement.

  1. Atmosphere

A positive, intimate environment, in which interactive learning activities could be delivered, was helpful. Training as a team was better than training team leads alone. Surgeons benefitted when training was tailored to their specialty and stage of career. Time and money invested in training increased people’s engagement.

Training was most effective when surgeons could go on to apply and practise their learning in a supportive environment with a speak-up culture. Trust, friendship, and respect made team members feel valued and allowed leadership to flourish.

Why is this important?

The findings provide guidance for those designing, developing, and implementing leadership development for surgeons. The researchers say their suggestions could make training more effective and acceptable to the surgical community.

The study highlighted the importance of training as a team. The researchers compared training individual leaders alone to learning surgery from a textbook. Surgeons need real environments and interaction with team members is needed to get the most out of leadership development.

What’s next?

The researchers are developing new methods of evidence-based training for surgeons, in collaboration with the British Orthopaedic Association and the British Hip Society. They are reimagining what leadership training looks like and exploring how it can be integrated into training earlier in a surgeon’s career.

You may be interested to read

This is a summary of: Gauly J, and others. Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence‑based leadership in healthcare. Implementation Science 2023; 18. DOI:10.1186/s13012-023-01274-3.

Consensus report from the Royal College of Surgeons of England: Advancing the Surgical Workforce.

The Faculty of Medical Leadership and Management (FMLM) provides leadership development.  

Funding: Three of the study authors are supported by the NIHR Advanced Fellowship Programme and the NIHR Applied Research Collaboration West Midlands.

Conflicts of Interest: None declared.

Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.

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