J. N. Riesel1,3, M. Hammond-Mobilio3, C. Moulton2,3 1The Hospital for Sick Children, Plastic And Reconstructive Surgery, Toronto, ONTARIO, Canada 2University Health Network, General Surgery, Toronto, Ontario, Canada 3University Health Network, The Wilson Centre, Toronto, Ontario, Canada
Introduction:
Fear can affect attention, memory, risk-tolerance, and decision-making, yet there is little research regarding how surgeons manage fear in the operating room (OR). We aimed to understand why and how surgeons experience fear in the operating room, as well as how they navigate that experience of fear.
Methods:
Using a constructivist grounded theory approach, we conducted semi-structured interviews with 18 attending surgeons at the University of Toronto. Snowball and purposive sampling were used to achieve diversity in surgical sub-specialty, gender, and time in practice. Data collection and analysis was iterative and guided by theoretical sampling.
Results:
Most surgeons described feeling fear in the operating room irrespective of their time in practice or their chosen surgical specialty. Causes of fear can be broadly categorized into losing control, encountering the unfamiliar or uncertain, and anticipating protentional consequences of action or inaction. The experience of fear is distinctly aversive and can have long-lasting effects. Those that experienced fear in the operating room reported sensations of isolation: “You're very alone…you're with a third-year resident and nice nurses and nice anaesthetists, but it's your problem” (P5). Those who experienced little to no fear reported a strong sense of workplace support: “The good thing about our group is that if we run into problems, we can always call on our colleagues and they can come and rescue you. I think that environment [is] so important as a surgeon. If you work in a department where people do not help you, that's really scary because you're kind of left alone.” (P4) Many surgeons who reported intense sensations of fear also endorsed the concept of identity enmeshment in which the personal and professional identity are considered the same: Every complication is… shortening my lifespan. …Everything that happens to my patient is a direct impact on my identity as a surgeon. My career. My personal life.” (P16). The strongest mitigating mechanism for managing intraoperative fear was calling a trusted colleague for help.
Conclusion:
Most surgeons in this study experience fear in the operating room. Surgeons who do not routinely experience fear in the operating room endorsed a strong sense of workplace community and support. This study offers an initial glimpse into the experience of surgeon fear in the operating room, highlighting the importance of collaborative colleagues, emotional regulation, and identity management in surgical practice and education.