How Surgical Trainees Handle Catastrophic Errors: A Qualitative Study

Balogun, James A.; Bramall, Alexa N.; Bernstein, Mark

doi:10.1016/j.jsurg.2015.05.003

Cited by 23 publications

(86 citation statements)

References 24 publications

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“…Of these, 11 studies used quantitative methods, seven qualitative methods, and one mixed methods. The number of individuals who participated in the included qualitative studies ranged from 11 to 31 , , . The included studies were assessed for the use of methodological triangulation (use of 2 or more methods), which has been advocated as a way of safeguarding the ‘validity’ of qualitative studies.…”

Section: Resultsmentioning

confidence: 99%

“…That's quickly replaced by some sort of sadness and depression to some extent … this patient trusted me and my team to do something and we betrayed that trust. So I think for me that's the path of emotions that I follow: initial shock and horror followed by sadness and depression followed by a component of guilt and then self‐doubt’. Other surgeons felt distraught and described how it impacted their ability to perform more mundane tasks: ‘I honestly think I almost crashed into four parked cars before I got out of the parking garage that day.…”

Section: Resultsmentioning

confidence: 99%

“…Another vascular surgical trainee anticipated the impact would be enduring: ‘I'm sure in 20 years’ time I'll still be able to remember this case and what it taught me …'. Junior surgeons appeared to experience more extreme emotions than their senior colleagues , , , feeling insecure, isolated, and concerned about their reputation and what others might think: ‘… is this an error that I've made that's unforgivable and is it going to affect people's professional opinion of me …’. Some felt that senior colleagues had tried to place the blame on them: ‘he basically pinned the whole thing on us … I don't like it when people finger point and that happens a lot…’.…”

Section: Resultsmentioning

confidence: 99%

“…One vascular surgeon explained ‘… repairing someone's aneurysm, giving them a stroke and then rendering them paraplegic, it would be a terrible outcome … Death, limb loss, paralysis, they're huge and probably affect the impact of complication on your emotions…’. Surgical incidents that occurred during elective procedures also appeared to have more of an impact on operating staff than those that occurred during emergency surgery, perhaps because they considered an unanticipated event less likely , .…”

Section: Resultsmentioning

confidence: 99%

“…Health professionals used different coping strategies in the aftermath of a surgical incident: seeking peer support or counselling, openly discussing the incident with patients and families, reflecting on the incident privately, and implementing changes to their practice. Health professionals often sought the support of their peers or, in some cases, independent counsellors following a surgical incident , , . Most surgeons and anaesthetists discussed the event with senior colleagues within their own specialty: ‘the best ‘counselling’ is by talking to a skilled trusted senior anaesthesiologist to put the case into perspective as they can much more understand the context and situation than a counsellor’.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of psychological, emotional and behavioural impacts of surgical incidents on operating theatre staff

et al. 2017

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BackgroundAdverse surgical incidents affect both patients and health professionals. This study sought to explore the effect of surgical incidents on operating theatre staff and their subsequent behaviours.MethodsEligible studies were primary research or reviews that focused on the effect of incidents on operating theatre staff in primary, secondary or tertiary care settings. MEDLINE, Embase, CINALH and PsycINFO were searched. A data extraction form was used to capture pertinent information from included studies and the Critical Appraisal Skills Programme (CASP) tool to appraise their quality. PRISMA‐P reporting guidelines were followed and the review is registered with PROSPERO.ResultsA total of 3918 articles were identified, with 667 duplicates removed and 3230 excluded at the title, abstract and full‐text stages. Of 21 included articles, eight focused on the impact of surgical incidents on surgeons and anaesthetists. Only two involved theatre nurses and theatre technicians. Five key themes emerged: the emotional impact on health professionals, organization culture and support, individual coping strategies, learning from surgical complications and recommended changes to practice.ConclusionHealth professionals suffered emotional distress and often changed their behaviour following a surgical incident. Both organizations and individual clinicians can do a great deal to support staff in the aftermath of serious incidents.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systematic review of psychological, emotional and behavioural impacts of surgical incidents on operating theatre staff

et al. 2017

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Surgeon and Surgical Trainee Experiences After Adverse Patient Events

Ginzberg,

Gasior,

Passman

et al. 2024

JAMA Netw Open

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ImportanceAdverse patient events are inevitable in surgical practice.ObjectivesTo characterize the impact of adverse patient events on surgeons and trainees, identify coping mechanisms, and assess whether current forms of support are sufficient.Design, Setting, and ParticipantsIn this mixed-methods study, a validated survey instrument was adapted and distributed to surgical trainees from 7 programs, and qualitative interviews were conducted with faculty from 4 surgical departments in an urban academic health system.Main Outcomes and MeasuresThe personal impact of adverse patient events, current coping mechanisms, and desired forms of support.ResultsOf 216 invited trainees, 93 (43.1%) completed the survey (49 [52.7%] male; 60 [64.5%] in third postgraduate year or higher; 23 [24.7%] Asian or Pacific Islander, 6 [6.5%] Black, 51 [54.8%] White, and 8 [8.6%] other race; 13 [14.0%] Hispanic or Latinx ethnicity). Twenty-three of 29 (79.3%) invited faculty completed interviews (13 [56.5%] male; median [IQR] years in practice, 11.0 [7.5-20.0]). Of the trainees, 77 (82.8%) endorsed involvement in at least 1 recent adverse event. Most reported embarrassment (67 of 79 trainees [84.8%]), rumination (64 of 78 trainees [82.1%]), and fear of attempting future procedures (51 of 78 trainees [65.4%]); 28 of 78 trainees (35.9%) had considered quitting. Female trainees and trainees who identified as having a race and/or ethnicity other than non-Hispanic White consistently reported more negative consequences compared with male and White trainees. The most desired form of support was the opportunity to discuss the incident with an attending physician (76 of 78 respondents [97.4%]). Similarly, faculty described feelings of guilt and shame, loss of confidence, and distraction after adverse events. Most described the utility of confiding in peers and senior colleagues, although some expressed unwillingness to reach out. Several suggested designating a departmental point person for event debriefing.Conclusions and RelevanceIn this mixed-methods study of the personal impact of adverse events on surgeons and trainees, these events were nearly universally experienced and caused significant distress. Providing formal support mechanisms for both surgical trainees and faculty may decrease stigma and restore confidence, particularly for underrepresented groups.

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Potential Consequences of Patient Complications for Surgeon Well-being

2019

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IMPORTANCE Patient complications occur in all areas of surgery, and managing them is an important part of surgical practice. Several investigations have examined whether surgeon health affects patient outcomes; however, to date, whether adverse patient outcomes affect surgeon well-being has not been comprehensively examined.OBJECTIVE To examine how surgical complications in their patients affect the health of surgeons, in particular emotional outcomes, coping strategies, and support mechanisms.EVIDENCE REVIEW A systematic literature review was conducted to identify studies evaluating how patient complications affect surgeons with the aim of determining emotional outcomes, coping strategies, and support mechanisms. Studies pertaining to burnout alone or not conducted in surgeons were excluded. The databases searched included MEDLINE, Embase, PubMed, Web of Science, and Google Scholar, with all literature available on these data sets until the search date of May 1, 2018; collected data were analyzed between May 2 and June 1, 2018. The reference lists of all included studies, as well as related review articles, were manually searched to identify further relevant studies. An inductive approach was used to identify common themes.FINDINGS Nine case series or cross-sectional studies from the United Kingdom or North America were found (8518 unique participants), with 1 study in surgical trainees. Across all studies, surgeons were affected emotionally after complications, with adverse consequences in their professional and personal lives. Four themes were identified within the literature: the adverse emotional influence of complications (anxiety, guilt, sadness, shame, interference with professional and leisure activities) after intraoperative adverse events; coping mechanisms used by surgeons and trainees (limited discussion with colleagues, exercise, artistic or creative outlets, alcohol and substance abuse); institutional support mechanisms and barriers to support (clinical conferences, discussion with mentors, a perception that emotional distress would be perceived as a constitutional weakness); and the consequences of complications in future clinical practice (changes in practice, introduction of protocols, education of staff members, and participating in root-cause analysis).CONCLUSIONS AND RELEVANCE This study's findings suggest that complications affect surgeons adversely across multiple domains. Further efforts are required at a personal, departmental, institutional, and organizational level to provide effective support. This review highlights that the psychological consequences of patient complications seem to be an important occupational health issue for surgeons.

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How Surgical Trainees Handle Catastrophic Errors: A Qualitative Study

Cited by 23 publications

References 24 publications

Systematic review of psychological, emotional and behavioural impacts of surgical incidents on operating theatre staff

Systematic review of psychological, emotional and behavioural impacts of surgical incidents on operating theatre staff

Surgeon and Surgical Trainee Experiences After Adverse Patient Events

Potential Consequences of Patient Complications for Surgeon Well-being

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