Team engagement theory: a trainee perspective of trainer clinical leadership and engagement

Introduction Engagement is increasingly perceived as a key National Health Service (NHS) performance factor. The aim of this study was to characterise surgical trainees’ experiences of the 13 engagement behaviours recommended by the NHS Leadership Academy. Methods A perception survey of engagement behaviours (grouped into 4 hierarchical levels as “essential”, “proficient”, “strong” and “exemplary”) was disseminated to surgical trainees in a UK statutory education body. Trainees’ perceived experiences of these behaviours being demonstrated by their consultant trainers were graded using a four-point Likert scale. Results Responses were received from 121 trainees (75 core surgical trainees [CSTs], 46 higher surgical trainees [HSTs]). The response rate was 52.1% for CSTs and 30.7% for HSTs. Survey responses suggested that the average consultant trainer demonstrates fewer than half (49.3%) of the 13 engagement behaviours “often” or “always”. Broken down by hierarchical group, 57.6% of essential behaviours, 46.3% of proficient behaviours, 43.8% of strong behaviours and 49.6% of exemplary behaviours were demonstrated “often” or “always”. Fewer than half (49.6%) of the trainees surveyed reported experiencing more than half of the engagement behaviours “often” or “always”. On multivariate analysis, the frequency with which trainees experienced engagement behaviour was associated with trainee seniority (odds ratio [OR]: 3.05, 95% confidence interval [CI]: 1.41–6.58, p = 0.004) and ethnicity (OR: 2.35, 95% CI: 1.07–5.17, p = 0.034). Conclusions Half of the trainees surveyed rarely experienced the full spectrum of engagement behaviours from clinical leaders, with approximately one in seven perceiving little or no engagement at all. Inferior performance in the General Medical Council’s fifth professional capability domain requires focused leadership correction.