SynthesisImplementation science : IS2023
Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare.
Synthesis in Implementation science : IS, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- From interface to outcome: a 4I framework for AI-linked functionality in electronic health records.BMC medical informatics and decision making · 2026Pooled it
- Leadership training in healthcare: a systematic umbrella review.BMJ leader · 2025Pooled it
- Can we ever have evidence-based decision making in orthopaedics? A qualitative evidence synthesis and conceptual framework.BMC medical informatics and decision making · 2025Pooled it
- The compass project: comprehensive overview of European perceptions of non-technical skills in surgery.Surgical endoscopy · 2026Article
- Leading with Impact: Transformational Leadership Among Women Surgeons - A Qualitative Study.Journal of healthcare leadership · 2026Article
- Why orthopaedics and trauma surgery loses part of its future workforce - a cross-sectional study of gender differences in medical students' specialty choice.BMC medical education · 2025Article
- An examination of the literature surrounding leadership and change management to implement a Golden Theatre Initiative: Reducing inefficiencies within a neurosurgical operating department.Journal of perioperative practice · 2025Review
- Building Real-World Evidence Infrastructure to Improve Health and Healthcare in the United States: Part III-Questions for Translational Science and Action Theory.International journal of translational medical research and public health · 2025Article
- Workflow disruptions in robot-assisted surgery.Journal of robotic surgery · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHealthcare systems invest in leadership development of surgeons, surgical trainees, and teams. However, there is no agreement on how interventions should be designed, or what components they must contain to be successful. The objective of this realist review was to generate a programme theory explaining in which context and for whom surgical leadership interventions work and why.
methodsFive databases were systematically searched, and articles screened against inclusion considering their relevance. Context-mechanism-outcome configurations (CMOCs) and fragments of CMOCs were identified. Gaps in the CMOCs were filled through deliberation with the research team and stakeholder feedback. We identified patterns between CMOCs and causal relationships to create a programme theory.
resultsThirty-three studies were included and 19 CMOCs were developed. Findings suggests that interventions for surgeons and surgical teams improve leadership if timely feedback is delivered on multiple occasions and by trusted and respected people. Negative feedback is best provided privately. Feedback from senior-to-junior or peer-to-peer should be delivered directly, whereas feedback from junior-to-senior is preferred when delivered anonymously. Leadership interventions were shown to be most effective for those with awareness of the importance of leadership, those with confidence in their technical surgical skills, and those with identified leadership deficits. For interventions to improve leadership in surgery, they need to be delivered in an intimate learning environment, consider implementing a speak-up culture, provide a variety of interactive learning activities, show a genuine investment in the intervention, and be customised to the needs of surgeons. Leadership of surgical teams can be best developed by enabling surgical teams to train together.
conclusionsThe programme theory provides evidence-based guidance for those who are designing, developing and implementing leadership interventions in surgery. Adopting the recommendations will help to ensure interventions are acceptable to the surgical community and successful in improving surgical leadership.
trial registrationThe review protocol is registered with PROSPERO (CRD42021230709).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.