How Prevalent Are Hazardous Attitudes Among Orthopaedic Surgeons?

Abstract

Background So-called ''hazardous attitudes'' (macho, impulsive, antiauthority, resignation, invulnerable, and confident) were identified by the Federal Aviation Administration and the Canadian Air Transport Administration as contributing to road traffic incidents among college-aged drivers and felt to be useful for the prevention of aviation accidents. The concept of hazardous attitudes may also be useful in understanding adverse events in surgery, but it has not been widely studied. Questions/purposes We surveyed a cohort of orthopaedic surgeons to determine the following: (1) What is the prevalence of hazardous attitudes in a large cohort of orthopaedic surgeons? (2) Do practice setting and/or demographics influence variation in hazardous attitudes in our cohort of surgeons? (3) Do surgeons feel they work in a climate that promotes patient safety? Methods We asked the members of the Science of Variation Group-fully trained, practicing orthopaedic and trauma surgeons from around the world-to complete a questionnaire validated in college-aged drivers measuring six attitudes associated with a greater likelihood of collision and used by pilots to assess and teach aviation safety. We accepted this validation as applicable to surgeons and modified the questionnaire accordingly. We also asked them to complete the Modified Safety Climate Questionnaire, a questionnaire assessing the absence of a safety climate that is based on the patient safety cultures in healthcare organizations instrument. Three hundred sixtyfour orthopaedic surgeons participated, representing a 47% response rate of those with correct email addresses who were invited.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA. Electronic supplementary material123 Clin Orthop Relat Res (2015) 473:1582-1589 DOI 10.1007/s11999-014-3966-2 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®Results Thirty-eight percent (137 of 364 surgeons) had at least one score that would have been considered dangerously high in pilots ([ 20), including 102 with dangerous levels of macho (28%) and 41 with dangerous levels of self-confidence (11%). After accounting for possible confounding variables, the variables...

Early Implant Failures Related to Individual Surgeons: An Analysis Covering 11,074 Operations Performed during 28 Years

“…The surgeons may overestimate their ability to execute a complex or high‐risk procedure. Bruinsma et al . spoke to 364 orthopedic surgeons and found that 30% of them demonstrated attitudes that represented a potential danger for their patients.…”

Considering a Relationship Between Dysfunctional Coaching Styles in Youth Sports and the Development of Hazardous Attitudes in Players

“…Subsequent research has explored how surgeons also have problems with these psychological constructs: machoism, impulsivity, worry, low resilience or resignation, over-confidence, and resistance to authority (Bruinsma et al, 2015). The authors suggest that certain parenting and coaching styles are contributors to the unhealthy formation of these hazardous attitudes.…”

“…The so-called "hazardous attitudes" (machoism, impulsivity, invulnerability, antiauthority, resignation, and overconfidence) have received an increasing amount of attention for their impact on professional pilots in the United States and Canada, in addition to negative medical outcomes among surgeons who possess them (Bruinsma, Becker, Guitton, Kadzielski, & Ring, 2015). There is other evidence that these attitudes are generally problematic in societies, families, and working environments (Tyrer, Reed, & Crawford, 2015).…”

Editor's Spotlight/Take 5: Surgeons’ Attitudes Are Associated With Reoperation and Readmission Rates

“…The author certifies that he, or any member of his immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. that would be considered dangerously high in pilots [1].…”

“…A careful reader will identify shortcomings in these articles [1,2]; surgeons are not pilots, and the questionnaires the investigators used have not been validated in surgeons. If you like, consider these articles conversation starters rather than definitive efforts.…”