Surgeon Fear in the Operating Room and Its Link to Identity; A Constructivist Grounded Theory Study

Objective: We aimed to gain a deeper understanding of the underpinnings of surgeon fear in the operating room (OR). Summary Background Data: Fear can affect judgement, risk-tolerance, and decision-making, all of which may impact surgeon performance, yet there is little research on surgeon fear in the OR. Methods: Using constructivist grounded theory, we conducted semi-structured interviews with 18 attending surgeons from 14 surgical subspecialties affiliated with the same large, urban, academic institution. Snowball and purposive sampling were used to achieve diversity in sampling. Data collection and analysis were iterative and guided by theoretical sampling. A conceptual framework was generated from the data. Surgeons ranged from 1-40+ years in practice. Results: Most surgeons in this study experienced fear in the OR. Themes related to identity, identity enmeshment, and identity resilience were identified during coding; data were reanalyzed deductively using these categories, and findings suggested that surgeons who more intensely experienced fear in the OR potentially had lower identity resilience and were experiencing the fearful stimuli as identity threat. While this impacted the surgeon’s experience inside the OR, surgeons with identity enmeshment were impacted beyond the OR: events, good or bad, that occurred in the OR seeped into the surgeon’s personal life, thereby extending the experience of the event. Conclusion: Most surgeons in this study experience fear in the OR. This study offers a glimpse into the rarely explored experience of surgeon fear in the OR, highlighting the importance of identity management and emotion regulation in surgical education and practice.