Interprofessional Communication in Surgical Residency: Insights for Training and System Improvement.

OBJECTIVE: To characterize interprofessional communication challenges experienced by general surgery residents and identify modifiable factors to inform targeted training and system improvement. DESIGN: Prospective direct observational study with inductive thematic analysis of resident-reported communication encounters. SETTING: A general surgery residency program at a tertiary referral, level 1 trauma center. PARTICIPANTS: Thirty-one general surgery residents (PGY 1-5) participated. Research assistants observed residents during routine clinical activities over approximately 670 hours and recorded interprofessional communication encounters. RESULTS: A total of 624 encounters were recorded, with 240 (38.5%) rated below the highest score. Four major themes described communication challenges: emotional experience and professional growth (31.7%), internal team communication (31.7%), between-team communication (30.4%), and system and workflow barriers (14.2%). Emotional strain frequently occurred during vulnerable moments in training, including uncertainty and evolving responsibility, often in the presence of attending physicians. Communication challenges were observed both within and between teams, with overlapping issues such as relational strain and communication breakdowns, but with distinct manifestations across contexts. System-level barriers, including unreliable technology and unclear protocols, further contributed to inefficiencies and discomfort. Among the highest-rated encounters (61.5%), protective factors included supportive leadership, learner development, psychologically safe team environments, and effective communication. Notably, positive experiences occurred even in complex situations, suggesting that communication quality is influenced by modifiable interpersonal and system-level factors. CONCLUSIONS: Interprofessional communication challenges are a common and expected component of surgical training, shaped by emotional, relational, and system-level factors. Targeted interventions - including interprofessional communication training, leadership development for senior trainees and faculty, and system-level improvements - may enhance resident experience, team function, and patient care.