“The captain of the ship.” a qualitative Investigation of surgeon identity formation

The impact of human cadaveric dissection on professional identity formation in medical students

BACKGROUND

As technology advances, some schools are moving away from human cadaveric dissection to teach anatomy, leading to concern regarding the possible loss of a professional identity building experience. This study explored the role of dissection in students' professional identity formation.

METHODS

A mixed-methods study was conducted using survey methodology and semi-structured interviews of medical students at an American-style graduate-entry medical school in Singapore. The questionnaire adopted the conceptual framework of the Ring Theory of Personhood and the MacLeod-Clark Professional Identity Scale was used to measure professional identity, followed by semi-structured interviews of students using Braun and Clarke's six-phase reflexive thematic analysis.

RESULTS

Respondents did not differ substantively from non-respondents by age, nationality, or ethnicity, and year of entering medical school, however, they were slightly more female dominant. The number of hours of hands-on participation in dissection showed no significant relationship (r2 = 0.010; p = 0.424) with professional identity formation measured by the MacLeod-Clark Professional Identity Scale. Despite the survey results, semi-structured interviews revealed rich and nuanced findings suggesting the influence of dissection in participants' professional identity formation through deepening students' appreciation of humanistic values and enhancing their notions of patients' personhood. Notably, students without dissection experience did not express these sentiments and were orientated towards knowledge acquisition.

CONCLUSION

While our findings do not suggest that dissection strongly impacts students' professional identity formation, students shared thought-provoking experiences which suggest some level of its contribution. Careful consideration of this phenomenon should be exercised prior to removing dissection in favour of technological alternatives.

The good, the bad, and the ugly: Operative staff perspectives of surgeon coping with intraoperative errors

BACKGROUND

Intraoperative errors are inevitable, and how surgeons respond impacts patient outcomes. Although previous research has queried surgeons on their responses to errors, no research to our knowledge has considered how surgeons respond to operative errors from a contemporary first-hand source: the operating room staff. This study evaluated how surgeons react to intraoperative errors and the effectiveness of employed strategies as witnessed by operating room staff.

METHODS

A survey was distributed to operating room staff at 4 academic hospitals. Items included multiple-choice and open-ended questions assessing surgeon behaviors observed after intraoperative error. Participants reported the perceived effectiveness of the surgeon's actions.

RESULTS

Of 294 respondents, 234 (79.6%) reported being in the operating room when an error or adverse event occurred. Strategies positively associated with effective surgeon coping included the surgeon telling the team about the event and announcing a plan. Themes emerged regarding the importance of the surgeon remaining calm, communicating, and not blaming others for the error. Evidence of poor coping also emerged: "Yelling, feet stomping and throwing objects onto the field. [The surgeon] cannot articulate needs well because of anger."

CONCLUSION

These data from operating room staff corroborates previous research presenting a framework for effective coping while shedding light on new, often poor, behaviors that have not emerged in prior research. Surgical trainees will benefit from the now-enhanced empirical foundation on which coping curricula and interventions can be built.