Defining the Culture of Surgery

Abstract

INTRODUCTION: Surgical culture is often referenced but not well defined. Recent research and changing policies in graduate medical education have influenced the training paradigm and expectations of surgical trainees. It is unclear how these changes impact how surgeons understand surgical culture today and how those views impact surgical training. We sought to understand surgical culture and its impact on training from the perspective of a diverse group of surgeons with varied amounts of experience. METHODS: A series of semi-structured, qualitative interviews was conducted with 21 surgeons and trainees in an urban level 1 trauma center. Interviews were transcribed, coded and analyzed using grounded theory. RESULTS: We identified seven major categories that impact surgical culture. We found surgeons who had been promoted to at least associate professor (experienced) and assistant professors, fellows, residents, and students (early career) emphasized patient-centered care, hierarchy, high standards, and meaningful work similarly. Experienced and early career surgeons highlighted sub-themes at different rates (Table). Codes for gender inequality were disproportionately represented with female interviewees at 72.3% of codes. Table. - Variation of Themes Between Cohorts Categories Themes Experienced % (n) Early career % (n) Bias and discrimination Gender inequality 62.3 (69) 37.7 (24) Changing aspects of surgery Training requirements and culture change 30.6 (9) 69.4 (22) Emotional intelligence Work-life balance 24.4 (5) 75.6 (17) Generation difference Old surgical culture 74.6 (26) 25.4 (9) Job requirements Accountability 74.3 (23) 25.7 (8) Challenges 75.5 (15) 24.5 (5) Surgery personality Self-sacrificing 14.8 (7) 85.2 (38) Leading by example 64.4 (31) 35.6 (17) Surgical training Teaching/education 26.8 (17) 73.2 (18) CONCLUSION: Experienced and early career surgeons both emphasize that a patient-centered care is core to surgical culture. Early career surgeons expressed more about themes related to personal wellbeing, while experienced surgeons emphasized theme related to professional accomplishment. These different perceptions highlight potential for misaligned expectations and can lead to miscommunication and difficult interpersonal interactions, especially between trainees and senior faculty. Training and practice approaches must respond to changing values and view of culture in surgery.