Contingency in everyday surgical work

Pope, Catherine

doi:10.1111/1467-9566.00300

Cited by 60 publications

(62 citation statements)

References 39 publications

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“…[41][42][43] In such a circumstance, a variation that one surgeon considers a preference can become a principle for another. For example, although 2 surgeons may begin 1 step of a procedure by working down different planes, the first surgeon may insist that a resident perform the variation they prefer whereas the second may allow the resident to decide.…”

Section: Considering the Role Of Culturementioning

confidence: 99%

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

Apramian¹,

Cristancho²,

Watling³

et al. 2016

Journal of Surgical Education

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OBJECTIVE-Clinical research increasingly acknowledges the existence of significant procedural variation in surgical practice. This study explored surgeons' perspectives regarding the influence of intersurgeon procedural variation on the teaching and learning of surgical residents.DESIGN AND SETTING-This qualitative study used a grounded theory-based analysis of observational and interview data. Observational data were collected in 3 tertiary care teaching hospitals in Ontario, Canada. Semistructured interviews explored potential procedural variations arising during the observations and prompts from an iteratively refined guide. Ongoing data analysis refined the theoretical framework and informed data collection strategies, as prescribed by the iterative nature of grounded theory research. RESULTS-Surgeons endorsed the use of intersurgeon procedural variations to teach residents about adapting to the complexity of surgical practice and the norms of surgical culture. Surgeons suggested that residents' efforts to identify thresholds of principle and preference are crucial to professional development. Principles that emerged from the study included the following: (1) knowing what comes next, (2) choosing the right plane, (3) handling tissue appropriately, (4) recognizing the abnormal, and (5) making safe progress. Surgeons suggested that learning to follow these principles while maintaining key aspects of surgical culture, like autonomy and individuality, are important social processes in surgical education. PARTICIPANTS-OurCONCLUSIONS-Acknowledging intersurgeon variation has important implications for curriculum development and workplace-based assessment in surgical education. Adapting to intersurgeon procedural variations may foster versatility in surgical residents. However, the existence of procedural variations and their active use in surgeons' teaching raises questions about the lack of attention to this form of complexity in current workplace-based assessment strategies. CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptFailure to recognize the role of such variations may threaten the implementation of competencybased medical education in surgery.

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Section: Considering the Role Of Culturementioning

confidence: 99%

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

Apramian¹,

Cristancho²,

Watling³

et al. 2016

Journal of Surgical Education

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“…It has been recognised that these new developments have influenced and to some extent changed the traditional ways in which the members of the surgical team made up of various disciplines, engage in the performance of specialist tasks, communicate and co-ordinate their activities. Despite the long-standing interest in professional knowledge, inter-occupational work and interpersonal communication in the sociology of health and illness over the last few decades, very little research has been directed towards these issues with respect to the operating theatre, save the important exceptions of Fox (1994) and more recently Pope (2002) and Hindmarsh and Pilnick (2002).…”

Section: Operating Theatresmentioning

confidence: 99%

Technology and Medical Practice

Johnson¹,

Berner²

2016

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One of the most significant developments in healthcare over the past 25 years has been the widespread deployment of information and communication technologies. These technologies have had a wide-ranging impact on the organisation of healthcare, on professional practice and on patients' experience of illness and its management. In this paper we discuss the ways in which Sociology of Health and Illness has provided a forum for the analysis of these new technologies in healthcare. We review a range of relevant research published in the Journal; papers that address such issues as dehumanisation and emotional labour, professional practice and identity, and the social and institutional shaping of technology. Despite these important initiatives, we suggest that information and communication technologies in healthcare remain relatively under-explored within the Journal and, more generally, by the sociology of health and illness and point to developments in cognate areas which may have some bearing upon the analysis of technology in action.

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“…This is particularly salient in surgery. Pope has described the contingent nature of surgical work which includes factors specific to the patient (eg, previous surgeries, unique anatomy, comorbidities, or preferences), surgeon contingencies (eg, tactile ability, ease of product use, and good patient outcomes) and external contingencies (operating theater environment and level of support) [23]. This contingent nature of surgical practice highlights (1) the extent to which surgeon decision making may go beyond protocols and standardization as the physician focuses on clinical accountability; (2) that a clash may exist between clinical and cost accountability surrounding patient care; and (3) the idea of accountability via standardization may be an enduring aspiration.…”

Section: Background-autonomy and Accountabilitymentioning

confidence: 99%

“…Pope identified type of equipment and quality of assistance as key variables pertaining to surgical quality and outcomes [23]. Paradoxically, the strong relationships between individual orthopaedic surgeons and these kinds of variables have not been rigorously studied.…”

Section: The New Professionalism Of Shared Decision Making In Surgerymentioning

confidence: 99%

Professionalism in 21st Century Professional Practice: Autonomy and Accountability in Orthopaedic Surgery

Schneller

Wilson

2009

Clinical Orthopaedics &Amp; Related Research

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Orthopaedic surgical practice is becoming increasingly complex. The rapid change in pace associated with new information and technologies, the physiciansupplier relationship, the growing costs and growing gap between costs and reimbursements for orthopaedic surgical procedures, and the influences of advertising on the patient, challenge all involved in the delivery of orthopaedic care. This paper assesses the concepts of professionalism, autonomy, and accountability in the 21st century practice of orthopaedic surgery. These concepts are considered within the context of the complex value chain surrounding orthopaedic surgery and the changing forces influencing clinical decision making by the surgeon. A leading impetus for challenge to the autonomy of the orthopaedic surgeon has been cost. Mistrust and lack of understanding have characterized the physician-hospital relationship. Resource dependency has characterized the physician-supplier relationship. Accountability for the surgeon has increased. We suggest implant surgery involves shared decision making and ''coproduction'' between the orthopaedic surgeon and other stakeholders. The challenge for the profession is to redefine professionalism, accountability, and autonomy in the face of these changes and challenges.

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Contingency in everyday surgical work

Cited by 60 publications

References 39 publications

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

Technology and Medical Practice

Professionalism in 21st Century Professional Practice: Autonomy and Accountability in Orthopaedic Surgery

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