M. E. Byrnes1, T. A. Engler1, C. C. Greenberg2, B. T. Fry1, J. B. Dimick1 1University Of Michigan,Department Of Surgery & Center For Health Care Outcomes And Policy (CHOP),Ann Arbor, MI, USA 2University Of Wisconsin,Department Of Surgery & Wisconsin Surgical Outcomes Research Program (WiSOR),Madison, WI, USA
Introduction:
The “surgical personality” is a mostly negative academic and cultural image of the surgeon as egotistical, paternalistic, and inflexible. Because of this image, surgeons have been viewed as resistant to change and some behaviors, vulnerability for example, are viewed as “suspect” because they seemingly threaten professional competency. We report on exit interviews of surgeons who participated in a coaching program and demonstrate how their narratives challenge the surgical “personality” and forge an evolving and more open professional surgical identity suggesting a shift in surgeon identity and culture.
Methods:
We interviewed n = 34 bariatric surgeons at the end of a two-year surgical coaching program. Transcribed interviews were analyzed in NVivo, computer-assisted qualitative data analysis software. Coding of transcripts were approached through iterative steps. We utilized an exploratory method; each member of our team independently examined three transcripts to evaluate emergent themes early in the investigation. The team met to discuss our independent themes and develop the codebook collectively. We created a descriptive framework for our first round of coding based on emerging themes. We employed a second round of coding to further our analysis using an interpretive framework.
Results:
Three major themes emerged from our data. Participants in this study discussed the ways that participation in the coaching program initially conflicted with their identity as a competent professional. Surgeons were acutely aware how participation might have destabilized their surgical identity because they might be viewed as vulnerable. Despite these concerns about image, surgeons were open and committed to their own professional or personal improvement via coaching. Surgeons largely reported that coaching allowed them to reflect on their practices and find spaces of vulnerability in a profession that does not always value reflection. Finally, surgeons report that the safe spaces of intentional coaching contributed to their ideas about how surgeons, and ultimately surgery, can change.
Conclusion:
The surgical “personality” did not exist in our data as it has been described in the literature. Surgeons do report having recognition and concern for their image yet, this professional image is related to their success as a competent professional and not because of some psychological defect or “paranoia”. Participation in a coaching program challenged how surgeons thought of themselves in relationship to social and peer expectations. Our results indicate that surgeons do feel peer and social pressures related to identity but are much more complex and nuanced than what social scientists have imagined. The safe space of intentional coaching allowed participants to practice vulnerability and commit to improvement without their commitment being viewed as suspect or incompetence.