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Bisset CN, Moug SJ, Oliphant R, Dames N, Cleland J. Surgeon perceptions of personality as an influencing factor on anastomotic decision-making: A qualitative analysis. Colorectal Dis 2024; 26:1608-1616. [PMID: 39162024 DOI: 10.1111/codi.17078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/27/2024] [Accepted: 06/01/2024] [Indexed: 08/21/2024]
Abstract
AIM Surgeon personality is a factor influencing rectal anastomotic decision-making. However, it is unclear how or why this may be the case, or what aspects of personality are involved. The aim of this study was to investigate the views of colorectal surgeons on how their individual personality may influence variation in anastomotic decision-making. METHOD Purposive sampling was used to invite certified UK-based colorectal surgeons to participate, with individual interviews used for data collection. Participants were recruited until ongoing data review indicated no new codes were generated (i.e. data sufficiency). Data were analysed thematically following Braun and Clarke's six-step framework. RESULTS Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes relating to personality and decision-making were identified: (1) surgeon development and training and (2) patient-surgeon interactions, each with relevant subthemes. Surgeons described how their personality may influence patients' postoperative outcomes (e.g. decision-making, team working and communication) and potential mechanisms for how their personality may influence operative risk-taking. Following anastomotic leakage, surgeons described a disproportionate sense of guilt and responsibility. There appears to be a significant transition in responsibility from trainee to newly appointed consultant, which may be part of the 'hidden curriculum' of surgical training. CONCLUSION Colorectal surgeons have described their perceptions of how personality traits may impact variation in decision-making and patient outcomes for the first time. Early career surgeons felt ill-prepared for the level of guilt experienced when managing complications. Surgeons appear open to personality assessment if this was through an educational lens, with the aim of improving decision-making following complications and overall performance.
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Affiliation(s)
- Carly N Bisset
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Susan J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
- Department of General Surgery, Golden Jubilee University National Hospital, Clydebank, UK
- University of Glasgow, Glasgow, UK
| | - Raymond Oliphant
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - Nicola Dames
- Association of Coloproctology of Great Britain and Ireland Patient Liaison Group, Glasgow, UK
| | - Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Debono B, Lonjon G, Guillain A, Moncany AH, Hamel O, Challier V, Diebo B. Spine surgeons facing second opinions: a qualitative study. Spine J 2024; 24:1485-1494. [PMID: 38556219 DOI: 10.1016/j.spinee.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/04/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND CONTEXT The social and technological mutation of our contemporary period disrupts the traditional dyad that prevails in the relationship between physicians and patients. PURPOSE The solicitation of a second opinion by the patient may potentially alter this dyad and degrade the mutual trust between the stakeholders concerned. The doctor-patient relationship has often been studied from the patient's perspective, but data are scarce from the spine surgeon's point of view. STUDY DESIGN/SETTING This qualitative study used the grounded theory approach, an inductive methodology emphasizing field data and rejecting predetermined assumptions. PATIENT SAMPLE We interviewed spine surgeons of different ages, experiences, and practice locations. We initially contacted 30 practitioners, but the final number (24 interviews; 11 orthopedists and 13 neurosurgeons) was determined by data saturation (the point at which no new topics appeared). OUTCOME MEASURES Themes and subthemes were analyzed using semistructured interviews until saturation was reached. METHODS Data were collected through individual interviews, independently analyzed thematically using specialized software, and triangulated by three researchers (an anthropologist, psychiatrist, and neurosurgeon). RESULTS Index surgeons were defined when their patients went for a second opinion and recourse surgeons were defined as surgeons who were asked for a second opinion. Data analysis identified five overarching themes based on recurring elements in the interviews: (1) analysis of the patient's motivations for seeking a second opinion; (2) impaired trust and disloyalty; (3) ego, authority, and surgeon image; (4) management of a consultation recourse (measurement and ethics); and (5) the second opinion as an avoidance strategy. Despite the inherent asymmetry in the doctor-patient relationship, surgeons and patients share two symmetrical continua according to their perspective (professional or consumerist), involving power and control on the one hand and loyalty and autonomy on the other. These shared elements can be found in index consultations (seeking high-level care/respecting trust/closing the loyalty gap/managing disengagement) and referral consultations (objective and independent advice/trusting of the index advice/avoiding negative and anxiety-provoking situations). CONCLUSIONS The second opinion often has a negative connotation with spine surgeons, who see it as a breach of loyalty and trust, without neglecting ego injury in their relationship with the patient. A paradigm shift would allow the second opinion to be perceived as a valuable resource that broadens the physician-patient relationship and optimizes the shared surgical decision-making process.
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Affiliation(s)
- Bertrand Debono
- Paris-Versailles Spine Center (Centre Francilien du Dos), Paris, France; Ramsay Santé-Hôpital Privé de Versailles, Versailles, France.
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean- Sud de France, Santecite Group. St Jean de Vedas, Montpellier Metropole, France
| | - Antoine Guillain
- AMADES (Medical Anthropology, Development and Health), Centre de la Vieille Charité, Marseille, France
| | - Anne-Hélène Moncany
- Department of Psychiatry and Addictive Behaviour, Gerard Marchant Hospital Center, Toulouse, France
| | - Olivier Hamel
- Department of Neurosurgery, Ramsay Santé-Clinique des Cèdres, Cornebarrieu, France
| | - Vincent Challier
- Department of Orthopedic Surgery, Hôpital privé du dos Francheville, Périgueux, France
| | - Bassel Diebo
- Department of Orthopedic surgery, Brown University Warren Alpert Medical School, East Providence, RI, USA
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Sier VQ, Bisset CN, Tesselaar DAJ, Schmitz RF, Schepers A, Moug SJ, van der Vorst JR. Dissecting the surgeon's personality: cross-cultural comparisons in Western Europe. Colorectal Dis 2024; 26:1239-1249. [PMID: 38687763 DOI: 10.1111/codi.16993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/16/2024] [Accepted: 03/06/2024] [Indexed: 05/02/2024]
Abstract
AIM The surgeon's personality contributes to variation in surgical decision-making. Previous work on surgeon personality has largely been reserved to Anglo-Saxon studies, with limited international comparisons. In this work we built upon recent work on gastrointestinal surgeon personality and aimed to detect international variations. METHOD Gastrointestinal surgeons from the UK and the Netherlands were invited to participate in validated personality assessments (44-item, 60-item Big Five Inventory; BFI). These encompass personality using five domains (open-mindedness, conscientiousness, extraversion, agreeableness and negative emotionality) with three subtraits each. Mean differences in domain factors were calculated between surgeon and nonsurgeon populations from normative data using independent-samples t-tests, adjusted for multiple testing. The items from the 44-item and 60-item BFI were compared between UK and Dutch surgeons and classified accordingly: identical (n = 16), analogous (n = 3), comparable (n = 12). RESULTS UK (n = 78, 61.5% male) and Dutch (n = 280, 65% male) gastrointestinal surgeons had marked differences in the domains of open-mindedness, extraversion and agreeableness compared with national normative datasets. Moreover, although surgeons had similar levels of emotional stability, country of work influenced differences in specific BFI items. For example, Netherlands-based surgeons scored highly on questions related to sociability and organization versus UK-based surgeons who scored highly on creative imagination (p < 0.0001). CONCLUSION In a first cross-cultural setting, we identified country-specific personality differences in gastrointestinal surgeon cohorts across domain and facet levels. Given the variation between Dutch and UK surgeons, understanding country-specific data could be useful in guiding personality research in healthcare. Furthermore, we advocate that future work adopts consensus usage of the five factor model.
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Affiliation(s)
- V Q Sier
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - C N Bisset
- Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland
- University of Aberdeen, Aberdeen, Scotland
| | - D A J Tesselaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - R F Schmitz
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
| | - A Schepers
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - S J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, Scotland
- Department of Colorectal Surgery, Golden Jubilee National Hospital, Clydebank, Scotland
- University of Glasgow, Glasgow, Scotland
| | - J R van der Vorst
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Smart N. Defunctioning loop ileostomies - making better decisions. Colorectal Dis 2024; 26:835-836. [PMID: 38790150 DOI: 10.1111/codi.17041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Affiliation(s)
- Neil Smart
- Royal Devon & Exeter Hospital, Exeter, UK
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Bisset CN, Moug SJ, Oliphant R, Dames N, Parson S, Cleland J. Influencing factors in surgical decision-making: a qualitative analysis of colorectal surgeons' experiences of postoperative complications. Colorectal Dis 2024; 26:987-993. [PMID: 38485203 DOI: 10.1111/codi.16943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/25/2024] [Accepted: 02/21/2024] [Indexed: 05/26/2024]
Abstract
AIM When making anastomotic decisions in rectal cancer surgery, surgeons must consider the risk of anastomotic leakage, which bears implications for the patient's quality of life, cancer recurrence and, potentially, death. The aim of this study was to investigate the views of colorectal surgeons on how their individual attributes (e.g. experience, personality traits) may influence their decision-making and experience of complications. METHOD This qualitative study used individual interviews for data collection. Purposive sampling was used to invite certified UK-based colorectal surgeons to participate. Participants were recruited until ongoing data review indicated no new codes were generated, suggesting data sufficiency. Data were analysed thematically following Braun and Clarke's six-step framework. RESULTS Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes with relevant subthemes were identified: (1) personal attributes influencing variation in decision-making (e.g. demographics, personality) and (2) the influence of complications on decision-making. Surgeons described variation in the management of complications based upon their personal attributes, which included factors such as gender, experience and subspeciality interests. Surgeons described the detrimental impact of anastomotic leakage on their mental and physical health. Experience of anastomotic leakage influences future decision-making and is associated with changes in practice even when a technical error is not identified. CONCLUSION Colorectal surgeons consider anastomotic leaks to be personal 'failures', which has a negative impact on surgeon welfare. Better understanding of how surgeons make difficult decisions, and how surgeons respond to and learn from complications, is necessary to identify 'personalized' methods of supporting surgeons at all career stages, which may improve patient outcomes.
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Affiliation(s)
- Carly N Bisset
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
- University of Aberdeen, Aberdeen, UK
| | - Susan J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
- Department of General Surgery, Golden Jubilee University National Hospital, Clydebank, UK
- University of Glasgow, Glasgow, UK
| | - Raymond Oliphant
- University of Aberdeen, Aberdeen, UK
- Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - Nicola Dames
- Association of Coloproctology of Great Britain & Ireland Patient Liaison Group, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Hammoud S, Alsabek L, Rogers L, McAuliffe E. Systematic review on the frequency and quality of reporting patient and public involvement in patient safety research. BMC Health Serv Res 2024; 24:532. [PMID: 38671476 PMCID: PMC11046929 DOI: 10.1186/s12913-024-11021-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND In recent years, patient and public involvement (PPI) in research has significantly increased; however, the reporting of PPI remains poor. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was developed to enhance the quality and consistency of PPI reporting. The objective of this systematic review is to identify the frequency and quality of PPI reporting in patient safety (PS) research using the GRIPP2 checklist. METHODS Searches were performed in Ovid MEDLINE, EMBASE, PsycINFO, and CINAHL from 2018 to December, 2023. Studies on PPI in PS research were included. We included empirical qualitative, quantitative, mixed methods, and case studies. Only articles published in peer-reviewed journals in English were included. The quality of PPI reporting was assessed using the short form of the (GRIPP2-SF) checklist. RESULTS A total of 8561 studies were retrieved from database searches, updates, and reference checks, of which 82 met the eligibility criteria and were included in this review. Major PS topics were related to medication safety, general PS, and fall prevention. Patient representatives, advocates, patient advisory groups, patients, service users, and health consumers were the most involved. The main involvement across the studies was in commenting on or developing research materials. Only 6.1% (n = 5) of the studies reported PPI as per the GRIPP2 checklist. Regarding the quality of reporting following the GRIPP2-SF criteria, our findings show sub-optimal reporting mainly due to failures in: critically reflecting on PPI in the study; reporting the aim of PPI in the study; and reporting the extent to which PPI influenced the study overall. CONCLUSIONS Our review shows a low frequency of PPI reporting in PS research using the GRIPP2 checklist. Furthermore, it reveals a sub-optimal quality in PPI reporting following GRIPP2-SF items. Researchers, funders, publishers, and journals need to promote consistent and transparent PPI reporting following internationally developed reporting guidelines such as the GRIPP2. Evidence-based guidelines for reporting PPI should be encouraged and supported as it helps future researchers to plan and report PPI more effectively. TRIAL REGISTRATION The review protocol is registered with PROSPERO (CRD42023450715).
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Affiliation(s)
- Sahar Hammoud
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland.
| | - Laith Alsabek
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
- Department of Oral and Maxillofacial Surgery, University Hospital Galway, Galway, Ireland
| | - Lisa Rogers
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
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7
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Ostroff C. Shared decision-making and social science: A patient perspective. Colorectal Dis 2024; 26:197-202. [PMID: 38235925 DOI: 10.1111/codi.16857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024]
Abstract
Shared decision making (SDM) between doctors and patients has been deemed important when providing care. Yet, it can be difficult to achieve. Specific examples from a patient perspective are integrated with the social science literature to provide an overview of components of SDM including the role of fit, trust, information asymmetry, cognitive decision frames and balancing medical and patient outcomes. Consideration of these issues should facilitate higher quality SDM conversations.
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Ludwiczak A, Stephens TJ, Prowle J, Pearse R, Osman M. Supporting effective shared decision-making in surgical context: Why framing of choices matters for high-risk patients and clinicians. Colorectal Dis 2024; 26:110-119. [PMID: 38009965 DOI: 10.1111/codi.16805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/25/2023] [Accepted: 09/17/2023] [Indexed: 11/29/2023]
Abstract
AIM In the context of high-risk surgery, shared decision-making (SDM) is important. However, the effectiveness of SDM can be hindered by misalignment between patients and clinicians in their expectations of postoperative outcomes. This study investigated the extent and the effects of this misalignment, as well as its amenability to interventions that encourage perspective-taking. METHOD Lay participants with a Charlson Comorbidity Index of ≥4 (representing patients) and surgeons and anaesthetists (representing doctors) were recruited. During an online experiment, subjects in both groups forecast their expectations regarding short-term (0, 1 and 3 months after treatment) and long-term (6, 9 and 12 months after treatment) outcomes of different treatment options for one of three hypothetical clinical scenarios - ischaemic heart disease, colorectal cancer or osteoarthritis of the hip - and then chose between surgical or non-surgical treatment. Subjects in both groups were asked to consider the scenarios from their own perspective (Estimation task), and then to adopt the perspective of subjects in the other study group (Perspective task). The decisions of all participants (surgery vs. non-surgical alternative) were analysed using binomial generalized linear mixed models. RESULTS In total, 55 lay participants and 54 doctors completed the online experiment. Systematic misalignment in expectations between high-risk patients and doctors was observed, with patients expecting better surgical outcomes than clinicians. Patients forecast a significantly higher likelihood of engaging in normal activities in the long term (β = -1.09, standard error [SE] = 0.20, t = -5.38, p < 0.001), a lower likelihood of experiencing complications in the long term (β = 0.92, SE = 0.21, t = 4.45, p < 0.001) and a lower likelihood of experiencing depression in both the short term and the long term (β = 1.01, SE = 0.19, t = 5.38, p < 0.001), than did doctors. Compared with doctors, patients forecast higher estimates of experiencing complications in the short term when a non-surgical alternative was selected (β = -0.91, SE = 0.26, t = -3.50, p = 0.003). Despite this misalignment, in both groups surgical treatment was strongly preferred (estimation task: 88.7% of doctors and 80% of patients; perspective task: 82.2% of doctors and 90.1% of patients). CONCLUSION When high-risk surgery is discussed, a non-surgical option may be viewed as 'doing nothing', hence reducing the sense of agency and control. This biases the decision-making process, regardless of the expectations that doctors and patients might have about the outcomes of surgery. Therefore, to improve SDM and to increase the agency and control of patients regarding decisions about their care, we advocate framing the non-surgical treatment options in a way that emphasizes action, agency and change.
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Affiliation(s)
- Agata Ludwiczak
- Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
- Psychology and Counselling, School of Human Sciences, University of Greenwich, Old Royal Naval College, London, UK
| | - Timothy J Stephens
- Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John Prowle
- Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rupert Pearse
- Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Magda Osman
- Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
- Centre for Science and Policy, University of Cambridge, Cambridge, UK
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Bisset CN, Ferguson E, MacDermid E, Stein SL, Yassin N, Dames N, Keller DS, Oliphant R, Parson SH, Cleland J, Moug SJ. Exploring variation in surgical practice: does surgeon personality influence anastomotic decision-making? Br J Surg 2022; 109:1156-1163. [PMID: 35851801 PMCID: PMC10364753 DOI: 10.1093/bjs/znac200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/09/2022] [Accepted: 05/14/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Decision-making under uncertainty may be influenced by an individual's personality. The primary aim was to explore associations between surgeon personality traits and colorectal anastomotic decision-making. METHODS Colorectal surgeons worldwide participated in a two-part online survey. Part 1 evaluated surgeon characteristics using the Big Five Inventory to measure personality (five domains: agreeableness; conscientiousness; extraversion; emotional stability; openness) in response to scenarios presented in Part 2 involving anastomotic decisions (i.e. rejoining the bowel with/without temporary stomas, or permanent diversion with end colostomy). Anastomotic decisions were compared using repeated-measure ANOVA. Mean scores of traits domains were compared with normative data using two-tailed t tests. RESULTS In total, 186 surgeons participated, with 127 surgeons completing both parts of the survey (68.3 per cent). One hundred and thirty-one surgeons were male (70.4 per cent) and 144 were based in Europe (77.4 per cent). Forty-one per cent (77 surgeons) had begun independent practice within the last 5 years. Surgeon personality differed from the general population, with statistically significantly higher levels of emotional stability (3.25 versus 2.97 respectively), lower levels of agreeableness (3.03 versus 3.74), extraversion (2.81 versus 3.38) and openness (3.19 versus 3.67), and similar levels of conscientiousness (3.42 versus 3.40 (all P <0.001)). Female surgeons had significantly lower levels of openness (P <0.001) than males (3.06 versus 3.25). Personality was associated with anastomotic decision-making in specific scenarios. CONCLUSION Colorectal surgeons have different personality traits from the general population. Certain traits seem to be associated with anastomotic decision-making but only in specific scenarios. Further exploration of the association of personality, risk-taking, and decision-making in surgery is necessary.
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Affiliation(s)
- Carly N Bisset
- Correspondence to: Carly N. Bisset, Department of General Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK (e-mail: )
| | - Eamonn Ferguson
- Department of Psychology, University of Nottingham, Nottingham, UK
| | - Ewan MacDermid
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Colorectal Surgery, Bankstown-Lidcombe Hospital, Australia University of Sydney, Sydney, NSW, Australia
| | - Sharon L Stein
- UHRISES: Research in Surgical Outcomes and Effectiveness, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Nuha Yassin
- Department of Colorectal Surgery, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Nicola Dames
- Association of Coloproctology of Great Britain & Ireland Patient Liaison Group, UK
| | - Deborah S Keller
- Department of Colorectal Surgery, University of California Davis, Sacramento, CA, USA
| | - Raymond Oliphant
- Department of Medical Education, University of Aberdeen, Aberdeen, UK
- Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - Simon H Parson
- Department of Medical Education, University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Sier VQ, Schmitz RF, Putter H, Schepers A, van der Vorst JR. The big five: Studying the surgical personality. Surgery 2022; 172:1358-1363. [PMID: 36064500 DOI: 10.1016/j.surg.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/22/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The challenging nature of performing surgery on a personal and professional level demands specific characteristics. Personality traits play an important role in the nature and behavior of humans, which are studied using the five-factor model. Therefore, we investigated the personality of 3 surgical generations. METHODS Three distinct surgical populations were approached. The Dutch Big Five Inventory-2 was sent out online to 126 surgical residents (response: n = 69) and 104 surgeons (response: n = 60) in a teaching region in the Netherlands. Moreover, medical students interested in surgery were approached via the students' surgical society (response: n = 54). To obtain a normative Dutch population sample, the Longitudinal Internet studies for the Social Sciences panel was used, creating groups of the following age categories: 18 to 25 (n = 84), 26 to 35 (n = 101), 36 to 67 (n = 432). One-way analysis of variance with Bonferroni correction was used to assess differences in personality scores. RESULTS Individuals interested in surgery (ie, surgically-oriented medical students, surgical residents, and surgeons) generally scored significantly higher on extraversion, conscientiousness, agreeableness, open-mindedness, and lower on negative emotionality compared with the normative population sample. Across the surgical generations, surgical residents scored significantly lower on open-mindedness (3.60) compared with surgeons (3.92) and surgically-oriented medical students (3.82). Surgically-oriented medical students scored significantly higher in negative emotionality (2.44) compared with surgical residents (2.12) and surgeons (2.07). CONCLUSION Being a surgeon demands particular levels of determination and emotional stability. The surgical population shows a distinct personality pattern compared with the normative population, and more modest differences exist between persons in different stages of their surgical career.
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Affiliation(s)
- Vincent Q Sier
- Department of Surgery, Leiden University Medical Center, Netherlands
| | | | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Netherlands. https://twitter.com/hein_putter
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Netherlands
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Mackay I, Clark DA, Nicholson J, Edmundson A, Steffens D, Solomon M. Risk taking propensity: Nurse, surgeon and patient preferences for diverting ileostomy. Colorectal Dis 2022; 24:1073-1079. [PMID: 35426482 PMCID: PMC9790330 DOI: 10.1111/codi.16149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/18/2022] [Accepted: 04/07/2022] [Indexed: 12/30/2022]
Abstract
AIM The decision-making process to defunction a pelvic colorectal anastomosis involves complex heuristics and is framed by surgeon personality factors. Risk taking propensity may be an important factor in these decisions and patient preferences have not been evaluated alongside surgeons and nurses. METHODS A prospective cross-sectional study involving a one-off interview and questionnaire assessing how risk taking propensity affects nurse, surgeon and patient preferences for a temporary defunctioning ileostomy (TDI) was performed. The risk taking index (RTI) was employed to evaluate risk taking propensity and the validated prospective measures of preference instruments to evaluate preferences for stoma avoidance in several scenarios by asking the individual to consider trading or gambling years of remaining life expectancy. RESULTS One hundred and fifty participants met the inclusion criteria, which included 30 (20.0%) surgical nurses, 20 (13.3%) colorectal surgeons and 100 (66.7%) patients. Surgeons had a significantly higher RTI (mean ± SD: 26.8 ± 6.7) than patients (mean ± SD: 20.0 ± 9.8) and nurses (mean ± SD: 23.0 ± 6.6) p = 0.002. Surgeons would consider that it would be in a patient's best interest to have a TDI at an AL rate of 15% or greater, whereas nurses and patients would do so at 28% and 25%, respectively (p = 0.007). CONCLUSION Surgeons were shown to have a higher risk taking propensity than patients and nurses but a significantly lower threshold of AL where they would consider a TDI is in the best interest of the patient.
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Affiliation(s)
- Ian Mackay
- Royal Brisbane and Women's HospitalBrisbaneQldAustralia
| | - David A. Clark
- Royal Brisbane and Women's HospitalBrisbaneQldAustralia,Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyNSWAustralia,Surgical Outcomes Research Centre (SOuRCe) Royal Prince Alfred HospitalSydneyNSWAustralia,University of QldBrisbaneQldAustralia,St Vincent's Private Hospital NorthsideBrisbaneQldAustralia
| | - James Nicholson
- Salford Royal NHS Foundation TrustUniversity Teaching HospitalSalfordUK
| | - Aleks Edmundson
- Royal Brisbane and Women's HospitalBrisbaneQldAustralia,University of QldBrisbaneQldAustralia
| | - Daniel Steffens
- Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyNSWAustralia,Surgical Outcomes Research Centre (SOuRCe) Royal Prince Alfred HospitalSydneyNSWAustralia
| | - Michael Solomon
- Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyNSWAustralia,Surgical Outcomes Research Centre (SOuRCe) Royal Prince Alfred HospitalSydneyNSWAustralia
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Merali K, Karimuddin A, Crump T, Brown C, Phang T, Raval M, Liu G, Sutherland JM. The relationship between perceptions of shared decision-making and patient-reported outcomes in a cross-sectional cohort of haemorrhoidectomy patients. Colorectal Dis 2022; 24:504-510. [PMID: 34985826 DOI: 10.1111/codi.16039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
AIM Shared decision-making between patients and clinicians is important to surgical practice and patients' perceptions of their healthcare experience. This study aims to measure associations between patients' perceptions of their shared decision-making (SDM) process and health-related quality of life among a cohort of patients choosing surgical management of an elective surgical procedure, haemorrhoidectomy. METHODS This study is a single-site study based in Vancouver, Canada. Consecutive patients of five colorectal surgeons registered for elective haemorrhoidectomy between September 2016 and June 2020 were eligible to participate. Participants completed the CollaboRATE instrument which measures patients' perceptions of their SDM after the surgical consultation, along with a number of other patient-reported outcomes. RESULTS The participation rate was 45.3%, with 157 patients scheduled for haemorrhoidectomy providing complete information. Unadjusted results found that participants having the most comorbidities reported better communication with their surgeon. The adjusted results show that socioeconomic status and depression were associated with lower CollaboRATE scores. There was no effect of sex, pain interference, anxiety or perceived health status on participants' CollaboRATE scores. CONCLUSION This study found evidence that participants with lower economic status or those reporting depressive symptoms had worse perceptions of their SDM process with their surgeon. These findings suggest that special attention should be paid to the surgical decision-making process for these patient populations.
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Affiliation(s)
- Khalil Merali
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ahmer Karimuddin
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trafford Crump
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Carl Brown
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Phang
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manoj Raval
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Guiping Liu
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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A Systematic Review of the Abdominal Surgeon's Personality: Exploring Common Traits in Western Populations. Behav Sci (Basel) 2020; 11:bs11010002. [PMID: 33375271 PMCID: PMC7823302 DOI: 10.3390/bs11010002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 12/21/2022] Open
Abstract
The personality traits commonly seen in abdominal surgeons remains undefined, and its potential influence on decision-making and patient outcomes underexplored. This systematic review identified studies on abdominal surgeons who had undergone validated personality testing, with assessment of decision-making and post-operative patient outcomes. The study protocol was registered on PROSPERO (University of York, UK (CRD42019151375)). MEDLINE, Embase, PsycInfo and Cochrane Library databases were searched using the keywords: surgeon; surgeon personality; outcomes. All study designs were accepted including adult visceral surgeons published in English. Five articles from 3056 abstracts met our inclusion criteria and one article was identified from hand searches with two reviewers screening studies. Bias was assessed using the Newcastle-Ottawa scale. Six studies included 386 surgeons. Studies assessing personality using the Five Factor Model (four studies, 329 surgeons) demonstrated higher levels of conscientiousness (self-discipline, thoughtfulness), extraversion (sociability, emotional expression) and openness (creative, conventional) in surgeons versus population norms. Surgeon characterisation of agreeableness and emotional stability was less clear, with studies reporting mixed results. Post-operative outcomes were reported by only one study. Further exploration of the influence of surgeon personality and its influence on decision-making is necessary to deliver patient-centred care and targeted non-technical skills training for surgeons.
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