Purpose <p>Effective preoperative preparation is critical for successful surgical outcomes and patient safety, particularly in emergency settings. However, little is known about how novice surgeons cope with this process under time pressure and uncertainty. This study aimed to explore the psychological and behavioral challenges experienced by novice surgeons during emergency preoperative preparation and to identify factors that hinder their readiness.</p> Methods <p>This qualitative study involved semi-structured interviews with 20 general surgery residents in postgraduate years&#xa0;3–5 who participated after providing consent, drawn from a Japanese university-affiliated hospital network. Interviews were conducted via video conferencing, transcribed verbatim, and analyzed using thematic analysis with a constructivist approach. The expert performance framework guided interpretation.</p> Results <p>Three major categories of conflict emerged: (1) conflicts with senior surgeons, including uncertainty in decision-making authority, communication difficulties, and perceived lack of trust; (2) conflicts in communicating with patients and families, such as projecting confidence while under pressure, conveying risk rapidly, and managing emotional responses; and (3) conflicts in collaborating with nurses and ancillary staff, including multitasking overload and institutional inconsistencies. These factors initially hindered the novices’ ability to perform thorough and confident preoperative preparation but also served as catalysts for adaptation and growth over time.</p> Conclusion <p>Novice surgeons encounter complex interpersonal and systemic challenges during emergency preoperative preparation. Interventions such as structured emergency protocols, mentorship, and communication training can promote psychological safety and readiness. Surgical education programs should address these issues to better prepare trainees for high-stakes clinical situations.</p>