Annals of Surgery. 2015;262(2):253-259.
Authors: Nathan R. Zilbert, MD et al
Objectives: The purpose of this study was to explore how risk is perceived and experienced by the surgeon and how risk is actively managed in individual practice.
Background: Risk in surgery has been examined from system-wide and personality perspectives. Although these are important, little is known about the perspective of the individual surgeon.
Methods: A constructivist grounded theory study was conducted to explore surgeons’ perspectives on risk in the context of their personal “Comfort Zones.” Semistructured, 60-minute interviews were conducted with 18 surgeons who were purposively sampled for sex and subspecialty with a snowballing strategy applied to sample for differences in reputation (conservative vs aggressive). Data were collected and analyzed in an iterative manner until thematic saturation was reached.
Results: Surgeons described cases that were inside or outside of their personal comfort zones. When considering cases at the boundary of their comfort zones, participants described a variety of factors that could make them feel more or less comfortable. Specific strategies used to modulate this border were also described. Two perspectives on risk taking became apparent: the procedure-centric perspective described how surgeons viewed their colleagues whereas the surgeon-centric perspective described how surgeons viewed themselves.
Conclusions: A framework for understanding surgeon’s unique assessment of risk was elaborated. Increased awareness of the factors and strategies identified in this study can foster critical self-reflection by surgeons of their own risk assessments and those of their colleagues, and provide avenues for more explicit educational strategies for surgical training.
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