Plenary2-01: SOS! CALLING ATTENTION TO THE STATES OF STRESS IN SURGERY
Sydney A McQueen, BSc, MSc, Melanie Hammond Mobilio, MA, Carol-anne Moulton, MBBS, PhD, FRACS; University of Toronto

Background: Stress is a multidimensional phenomenon; previous attempts to study stress in surgery from either a physiologic or emotional perspective in isolation have been underwhelming. The present study sought to explore surgeons’ experiences with stress more broadly, considering its component parts, in order to develop a theoretical framework for understanding the relationship between surgeons and stress.

Methods: Using a constructivist grounded theory methodology, semi-structured interviews were conducted with 24 staff surgeons at the University of Toronto, purposively sampled for different experience levels and surgical practices. Data were coded and analyzed iteratively by three researchers until theoretical saturation was achieved. Questions explored the emotional, physiological, cognitive, cultural, and environmental dimensions of surgeon stress, and how these facets come together holistically to shape the stress experience.

Results: Although surgeons readily discussed stress as being a critical part of their practice, they lacked a vocabulary to describe these experiences. A theoretical framework was co-constructed with participants to identify different states of stress in surgery, with each state being multidimensional in nature. For example, the state of distress was associated with negative emotions including fear and anxiety, a physiologic stress response, and cognitive impacts such as a reduction in the ability to think clearly and make sound decisions. Engagement was described as having a lesser degree of physiologic activation, enhanced cognition, and being a positive emotional experience. Participants described how the environment and surgical culture could influence the experience and expression of different states. Some states, such as readiness to perform and flow, were described as desirable and actively sought after, while others, including burnout and disengagement, were identified as being hazardous to performance and wellness.

Conclusion: Providing a vocabulary for the states of stress in surgical practice may help surgeons recognize and become aware of these states. Future investigations should identify strategies that may help surgeons navigate between states. Ultimately, incorporating teaching on stress states and negotiation strategies into surgical education may help surgeons achieve optimal performance and enhanced wellness.