Defining the Essential Leadership Skills for Surgical Residents Leading Inpatient Teams: A Modified Delphi Study

•We defined the essential leadership skills for surgical residents on inpatient teams.•The skills list was developed via a modified Delphi process with 16 experts.•Twenty-seven observable behaviors grouped into 8 domains achieved consensus.•The skills were incorporated into a novel assessment instrument, I-LEAD.•I-LEAD can help facilitate workplace-based assessment and curriculum development. Leadership is an important competency for surgical trainees but traditionally overlooked in residency programs. Existing leadership curricula are limited by a lack of standardized objectives and validated assessment tools. This project seeks to define the most essential leadership skills for surgical residents leading inpatient teams and to develop an instrument that can be used as a workplace-based assessment. We surveyed the literature to compile a preliminary list of relevant leadership skills. We then recruited national experts in surgical resident leadership to participate in 2 rounds of a modified Delphi process. In the first round, panelists voted to keep, modify, or remove the preliminary items, or to add additional ones. Insufficient agreement to keep a skill necessitated revision. In the second round, panelists rated their agreement with revised items’ inclusion, with consensus indicated by content validity index >0.75. Leadership behaviors were mapped onto a quality rating scale. REDCap online forms. Sixteen experts including senior surgeons, surgical educators/social psychologists, and advanced practice providers participated in both rounds of the Delphi process. The preliminary list included 26 behaviors grouped into 9 domains. After the first round of the Delphi process, 18 items were modified, 3 were removed, 3 were added, and 2 domains were merged. After the second round, all 27 revised behaviors in 8 domains achieved consensus. We incorporated them into the Inpatient Leadership Assessment Device (I-LEAD). We used a consensus of national experts to define essential leadership skills for surgical residents and created a workplace-based assessment tool. I-LEAD provides a shared mental model for residents and team members, and clear objectives for educators seeking to develop leadership curricula. These efforts align with current trends toward competency-based education and can underpin the establishment of formal leadership training programs for surgical residents on a wider scale.