317expectation [ 53 ]. Moments of uncertainty can be thought to reveal an underlying
lack of expertise, while surgical error can be viewed as incompetence. Surgeons,
broadly, are a competitive group who have each achieved a number of successes
during their training and practice. Being a member within surgical culture involves
comparing oneself to others and often involves judging other surgeons’ competency
[ 54 ] in areas such as peer-reviewed research, academic promotion, or clinical per-
formance. As surgeons typically do not operate together, informal sources of infor-
mation, including gossip, may be used to compare surgeon performance [ 55 ].
Surgeons may solicit information from other members of the interprofessional
team, such as nurses, in an effort to obtain insights about the performance of other
surgeons, possibly with the aim to be viewed as “the best” in the eyes of their col-
leagues. Some surgeons are awarded desired reputations (such as the exemplary
surgeon, the “go-to” guy, the “surgeons’ surgeon”), while others are labeled nega-
tively (the hesitant surgeon, the hack, the incompetent buffoon) [ 55 ]. These types of
social labels carry with them a great deal of cultural capital and are powerful moti-
vators in moving individuals toward particular behaviors and away from others.
Recent studies of surgical complications and errors have suggested that individ-
ual surgeon improvement would lead to better surgical quality of care and that this
might be achieved through surgeon-to-surgeon coaching for technical performance
[ 56 – 59 ]. However, if coaching is to be a successful strategy for bettering perfor-
mance, it will need to be accepted by surgeons. Mutabdzic et al. qualitatively
explored surgeons’ responses to the idea of having a coach paired with them in the
OR [ 60 ]. Study results indicate that, while participants did recognize the theoretical
benefits that having a coach could bring to their practice, they were more concerned
with how having a coach might make them appear to their colleagues. Ultimately,
fears around appearing incompetent and losing autonomy (i.e., being paired with a
coach that the learner surgeon had not chosen) outweighed the potential of a paired
learning experience for the surgeons in the study. These findings align with earlier
studies [ 61 , 62 ], where physicians have been seen to be reluctant to ask for and learn
from feedback, due to a perceived pressure to appear “competent” in learning. It
may be worth considering that medical culture itself has a significant role to play in
the aversion to feedback as such hesitance is not seen in other disciplines. In par-
ticular, Watling highlights the discrepancy between the learning culture in music,
where the emphasis is on improvement, and medicine, where the focus is on the
performance of competence. Mutabdzic et al. come to a similar conclusion in their
work, concluding the study by noting, “it might be considered ironic that a sur-
geon’s culturally embedded value of performing competence may be the very thing
that prevents further development of competence” [ 60 ].
Management of Emotions After Adverse Events
How do healthcare providers manage their own emotions that are linked to their
patient’s adverse events?
Most healthcare providers believe that talking about the incident with someone else
is beneficial, typically a trusted senior colleague or significant other [ 23 , 24 , 63 , 64 ].
18 Surgeons’ Reactions to Error