The Surgical Hazardous Attitudes Reflection Profile (SHARP) Instrument – A Prototype Study

Abstract

There is growing recognition that surgeons' non-technical skills are crucial in guaranteeing optimal quality and safety of patient care. However, insight in relevant attitudes underlying these behavioral skills is lacking. Hazardous attitudes potentially cause risky behavior, which can result in medical errors and adverse events. A questionnaire offering surgeons insight in their attitudinal profile is still missing and would be instrumental in risk reduction. Therefore, the aim of this study is to develop a prototype of a reliable and valid instrument to measure hazardous attitudes among surgeons. DESIGN To measure hazardous attitudes, a prototype of the Surgical Hazardous Attitudes Reflection Profile (SHARP) tool was designed using a mixed methods approach, consisting of (1) two focus group discussions, (2) a modified Delphi analysis and (3) a survey followed by (4) statistical analysis of the psychometric properties. Statistical analysis included exploratory factor analysis with varimax rotation, calculation of internal consistency reliability coefficients and inter-scale correlations. SETTING 14 hospitals across the Netherlands were recruited to guarantee demographic variety and the inclusion of academic, tertiary and general hospitals.PARTICIPANTS Nineteen experts participated in the two focus groups, and 19 in the modified Delphi study. In total, 302 surgeons (54.1%) completed the SHARP. RESULTSIn total, 302 surgeons (54.1%) completed the SHARP. Exploratory factor analysis resulted in six subscales measuring attitude towards (1) authority (α=0,78), (2) selfperformance (α=0,69), (3) performance feedback (α=0,61), (4) own fitness to perform (α=0,54), ( 5) uncertainty (α=0,51), and (6) planned procedures (α=0,48).CONCLUSIONS This study resulted in a prototype instrument identifying six potential hazardous attitudes in surgeons. Attitudes towards "authority" and "self-performance" can now be validly and reliably measured. Further research is required to optimize the prototype version of the instrument and could usefully explore the plausible relations between hazardous attitudes and clinical outcomes.

Different approaches to selection of surgical trainees in the European Union

“…Most selection systems are oriented towards finding the top candidates, but an important consideration when selecting to training positions is also to identify unsuitable candidates to mitigate the multiple detrimental effects of enrolling a potentially problematic trainee and future colleague [ 13 , 27 ]. Trainees that need remediation will inevitably affect patient safety, work climate, and are costly for the department [ 28 – 31 ].…”

“…Trainees that need remediation will inevitably affect patient safety, work climate, and are costly for the department [ 28 – 31 ]. On the one hand, local selection processes are particularly susceptible in that they de facto narrow the candidate field with an increased risk for selecting a person with a slow or dysfunctional learning curve or hazardous traits [ 13 , 27 ]. On the other hand, prolonged exposure of a candidate to multiple senior colleagues and members of other professions in a variety of settings would result in deeper familiarity and offer greater opportunities to detect both unsuitability and fitness for the job [ 13 , 32 ].…”

Different Approaches to Selection of Surgical Trainees in the European Union 

“…Most selection systems are oriented towards nding the top candidates, but an important consideration when selecting to training positions is also to identify unsuitable candidates to mitigate the multiple detrimental effects of enrolling a potentially problematic trainee and future colleague (13,27). Trainees that need remediation will inevitably affect patient safety, work climate, and are costly for the department (28)(29)(30)(31).…”

“…Trainees that need remediation will inevitably affect patient safety, work climate, and are costly for the department (28)(29)(30)(31). On the one hand, local selection processes are particularly susceptible in that they de facto narrow the candidate eld with an increased risk for selecting a person with a slow or dysfunctional learning curve or hazardous traits (13,27). On the other hand, prolonged exposure of a candidate to multiple senior colleagues and members of other professions in a variety of settings would result in deeper familiarity and offer greater opportunities to detect both unsuitability and tness for the job (13,32).…”

“…On the other hand, prolonged exposure of a candidate to multiple senior colleagues and members of other professions in a variety of settings would result in deeper familiarity and offer greater opportunities to detect both unsuitability and tness for the job (13,32). Hazardous traits may be detected through validated tools or clinical job performance if appropriate attention is paid, albeit currently not performed to the best of the authors knowledge (13,27,33,34).…”