SlideShare a Scribd company logo
Shelly Luu, Annie Leung, Jenny Jin,
Steven Gallinger, Carol-anne
Moulton
Sorry for this late reply - been out of town
for OMSW conference this weekend.
Junior Senior
General
Surgeons
Other
Surgeons
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error
Exploring Surgeons' Reactions to Error

More Related Content

Viewers also liked

Svadba 2012
Svadba 2012Svadba 2012
Svadba 2012
Elegance catering
 
Staffan Laestadius - Omställning till grön ekonomi 28/10
Staffan Laestadius - Omställning till grön ekonomi 28/10Staffan Laestadius - Omställning till grön ekonomi 28/10
Staffan Laestadius - Omställning till grön ekonomi 28/10
Global Utmaning
 
คณิต 50
คณิต 50คณิต 50
คณิต 50chugafull
 
Indicadores de medición
Indicadores de mediciónIndicadores de medición
Indicadores de mediciónAndres Martin
 
Pre installation debrief with club japan
Pre installation debrief with club   japanPre installation debrief with club   japan
Pre installation debrief with club japan
itjudn
 
건강보험 하나로 심층_학습(건강보험이해)
건강보험 하나로 심층_학습(건강보험이해)건강보험 하나로 심층_학습(건강보험이해)
건강보험 하나로 심층_학습(건강보험이해)
New Progressive Party of Korea
 

Viewers also liked (7)

Svadba 2012
Svadba 2012Svadba 2012
Svadba 2012
 
Staffan Laestadius - Omställning till grön ekonomi 28/10
Staffan Laestadius - Omställning till grön ekonomi 28/10Staffan Laestadius - Omställning till grön ekonomi 28/10
Staffan Laestadius - Omställning till grön ekonomi 28/10
 
คณิต 50
คณิต 50คณิต 50
คณิต 50
 
Indicadores de medición
Indicadores de mediciónIndicadores de medición
Indicadores de medición
 
Pre installation debrief with club japan
Pre installation debrief with club   japanPre installation debrief with club   japan
Pre installation debrief with club japan
 
102schoolday
102schoolday102schoolday
102schoolday
 
건강보험 하나로 심층_학습(건강보험이해)
건강보험 하나로 심층_학습(건강보험이해)건강보험 하나로 심층_학습(건강보험이해)
건강보험 하나로 심층_학습(건강보험이해)
 

Recently uploaded

Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
MedicoseAcademics
 
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdfARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
Anujkumaranit
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
Little Cross Family Clinic
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
KafrELShiekh University
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
VarunMahajani
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
touseefaziz1
 
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Savita Shen $i11
 
Antiulcer drugs Advance Pharmacology .pptx
Antiulcer drugs Advance Pharmacology .pptxAntiulcer drugs Advance Pharmacology .pptx
Antiulcer drugs Advance Pharmacology .pptx
Rohit chaurpagar
 
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #GirlsFor Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
Savita Shen $i11
 
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
i3 Health
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
LanceCatedral
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
MedicoseAcademics
 
Charaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
Charaka Samhita Sutra sthana Chapter 15 UpakalpaniyaadhyayaCharaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
Charaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
Dr KHALID B.M
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
Levi Shapiro
 
Physiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdfPhysiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdf
MedicoseAcademics
 
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
Catherine Liao
 
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
GL Anaacs
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
kevinkariuki227
 

Recently uploaded (20)

Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
 
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdfARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
 
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
 
Antiulcer drugs Advance Pharmacology .pptx
Antiulcer drugs Advance Pharmacology .pptxAntiulcer drugs Advance Pharmacology .pptx
Antiulcer drugs Advance Pharmacology .pptx
 
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #GirlsFor Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
 
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
 
Charaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
Charaka Samhita Sutra sthana Chapter 15 UpakalpaniyaadhyayaCharaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
Charaka Samhita Sutra sthana Chapter 15 Upakalpaniyaadhyaya
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
 
Physiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdfPhysiology of Chemical Sensation of smell.pdf
Physiology of Chemical Sensation of smell.pdf
 
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
 
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
 

Exploring Surgeons' Reactions to Error

Editor's Notes

  1. Hi everyone. My name is Shelly, and I am a second year medical student working with Dr Carol-anne Moulton on a research project that studies surgeons’ reactions to their errors. Yes, surgeons are people too. Yes, they can react to things other than themselves. Or that’s what we thought.
  2. In previous literatures, physicians, when faced with major adverse events and errors, have been found to experience profound reaction. These reactions have been are shame, self-disappointment, fear of litigation, guilt, and fear of stigmatization. Why are there such profound reactions?
  3. Reactions are not surprising given the stereotypical surgical culture. Surgeons are stereotyped to be rapid and confident decision makers.
  4. Surgical residents are taught the basic tenet of “do no harm”. Medicine is wrought with uncertainty, yet error is unacceptable. Residents can then be caught between these two conflicting thoughts.
  5. The workplace can be problematic as well. The workplace is often not conducive to personal disclosure of errors. Counseling and debriefing opportunities are often rare.
  6. Lastly, a surgeons’ work deals with human life. There is inherent uncertainty and fragility in their line of work. Problems can happen unexpectedly.
  7. In a previous study, a phenomenon called ‘slowing down when you should’ was identified. Significant patient outcomes was found to be associated with profound reactions. These reactions have been briefly described before in other literatures. So why dig it up again? Other than getting a bigger understanding of the issue, understanding reactions… -enables disclosure on a medical/legal level -enables surgeons to put it in perspective in their discussion with others -enables surgeons to achieve expertise in their work - incorporation of coping strategies and reflexive practice in the surgical curriculum.
  8. (Just read slide)
  9. First we started with a psychology literature review. We identified theories that described reactions to loss, uncertainty, error or complication. Principles from the psychology literature were drawn as needed to aid in the interpretation of the results.
  10. An example of the psychology literature that we have reviewed is the theory of self. This theory explains why individuals will react in the way they react when faced with cognitive dissonance. The goal of the individual is to protect their self-integrity, and will self-affirm in whatever way necessary in order to do it. This theory carries relevance in our attempt to understand how surgeons protect themselves.
  11. Currently our study is in Phase I, so today I will be presenting preliminary results. We are using a grounded theory constructivist approach. In phase I, we have conducted semi-structured interviews with 9 surgeons regarding their reactions to adverse events. Preliminary data analysis occurred in conjunction with data collection in an iterative and constant comparative process.
  12. Purposive sampling was used to include both male and female surgeons, across different specialties, and experience levels. We have interviewed 3 female surgeons and 6 males. 2 were junior, and 7 were senior surgeons. 2 were from outside general surgery. Theoretical sampling is being used to explore emergent themes.
  13. In Phase II, we will conduct brief interviews with them shortly after an event. We will conduct brief interviews with surgeons to capture their experiences with events in real-time. We included this phase because we believe that reactions are temporally affected. That is, similar to Kubler’s stages of grief, reactions may change over time from the event. Surgeons may also be able to better describe it when it is closer to the event itself.
  14. So what have we found thus far? We have found that surgeons are more consistent in the depth and pattern of their reaction to adverse events. More consistent than they realize Here, I will describe the surgeon’s preliminary four-phase reaction to error. These phases are not set in stone and the timeframe has not been examined. These are just commonalities that we have noticed in our data.
  15. Surgeons have described wanting to be alone, want to jump off the roof of a building, and likened it to flight or fright. It is a profound, visceral stress. The surgeon almost feels nauseated, as their gut drops. Almost like a physical blow. Cognitively, it is self-doubt, am I good enough to be wearing my scrubs? You can then imagine how difficult it is to negotiate disclosure and to have clear discussions when you are thinking about things clearly.
  16. This is what our surgeons have said. (Just read slide)
  17. In this second phase, we found that surgeons were information gathering to determine: what was role? How guilty am I? how stupid was I? Did I cause this? Can this happen to anyone? Emotionally, the surgeon is often in disbelief. They zone out from other aspects of their work and home life.
  18. A PE is a pulmonary embolism – something that surgeons usually attribute to an operative cause. Not due to the surgeon. (Read slide) However, you can see how if the surgeon feels that they didn’t do everything they could, they would still feel terrible.
  19. Surgeons will actively do things to prevent situations that can allow them to link the event to themselves.
  20. The third phase we noticed was a recovery. It is characterized by a surgeon using coping strategies and thoughts in order to feel better about themselves. It seems like various strategies are being used by surgeons to recover from the initial blow are: information gathering, talking to everyone about it, and minimisation. Surgeons have said that they think there are various factors that will affect how they recover: Male vs female Senior vs junior Elective vs emergency
  21. From what we’ve heard so far, we think that, over time, surgeons will reconcile their reactions into their identity. The recovery process may determine how the error affects the surgeon. We are wondering whether these reactions can affect their career paths? How people choose various surgical paths or drop out This is something that are we thinking about and doing more sampling to flesh this out.
  22. On the two ends of the spectrum, we speculate that there are two ways in which the surgeon can incorporate their reactions to their identity. Some do that very well and incorporate it into their practice. Some have changed their direction in surgery completely. There are probably two types: Cowboy surgeon who says “I’m going to be doing big things, I can deal with big things.” They incorproate the event into them and move on. They seem to bounce back from each event easily. The ‘tired cowboy’ who’s tired of each reaction. Who doesn’t recover completely each time, and who thinks that they may be in the wrong career for this. They aren’t up to dealing with everything. These are obviously two extremes of the spectrum with loosely given names, and most surgeons probably fall somewhere in between.
  23. Surgeons are more consistent in the depth and pattern of their reactions to adverse events than they imagine as they try to work through these experiences alone. The development of a framework that describes surgeon’s reactions to adverse events will help surgeons understand their emotional and cognitive reactions during these times. And how it ultimately becomes understood by the surgeon in terms of their identity as a surgeon. How they ultimately cope with it or not. This might enable surgeons to more effectively manage these experiences and appropriately focus on their role in the event. This, in turn, could provide better opportunities for learning from these events. Incorporating this framework into the training curricula has obvious educational benefit.