Exploring variation in surgical practice: does surgeon personality influence anastomotic decision-making?

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.

Influencing factors in surgical decision‐making: a qualitative analysis of colorectal surgeons' experiences of postoperative complications

“…The topic guide was developed from relevant literature on qualitative interview studies in healthcare [23,24] and findings from recent work on individual variation in practice [15]. All items in the topic guide were reviewed and agreed upon by the research team.…”

“…Purposive sampling was used [25]. Surgeons who had participated in earlier work on surgeon personality by this authorship group (the Plato Project) [15] were invited to participate. Other UK‐based surgeons who were certified surgeons (i.e.…”

“…For example, the clinician's gender has been associated with patient outcomes in both operative [12] and nonoperative settings [13,14]. Earlier work from this group indicated that the surgeon's personality influences variation in rectal anastomotic practice and stoma formation [11,15]. However, little is known about how postoperative outcomes, including anastomotic leakage, may intersect with surgeon-specific factors such as gender and impact later clinical decision-making.…”

Defunctioning loop ileostomies – making better decisions

“…One area of academic scrutiny that remains in its infancy is the influence of surgeon factors on decision making. Increasingly we are seeing a deeper understand of surgeon personality and how it impacts on what they decide to do, how complications impact them and how they interact with patients [6][7][8][9]. This nuanced approach will help patients with shared decision making in future.…”

Beyond high‐risk: analysis of the outcomes of extreme‐risk patients in the National Emergency Laparotomy Audit

“…In interviews, patients have expressed surprise that a risk of mortality of just 1 in 20 would be considered high risk [5]. Compounding this, each clinician has their own individual level of risk aversion, modified by personal experience and organisational factors [8,9].…”