• Annals of surgery · Aug 2015

    Taking a Chance or Playing It Safe: Reframing Risk Assessment Within the Surgeon's Comfort Zone.

    • Nathan R Zilbert, M Lucas Murnaghan, Steven Gallinger, Glenn Regehr, and Carol-Anne Moulton.
    • *Department of Surgery and †The Wilson Centre, University of Toronto, Toronto, Ontario, Canada ‡Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada.
    • Ann. Surg. 2015 Aug 1;262(2):253-9.

    ObjectivesThe purpose of this study was to explore how risk is perceived and experienced by the surgeon and how risk is actively managed in individual practice.BackgroundRisk in surgery has been examined from system-wide and personality perspectives. Although these are important, little is known about the perspective of the individual surgeon.MethodsA constructivist grounded theory study was conducted to explore surgeons' perspectives on risk in the context of their personal "Comfort Zones." Semistructured, 60-minute interviews were conducted with 18 surgeons who were purposively sampled for sex and subspecialty with a snowballing strategy applied to sample for differences in reputation (conservative vs aggressive). Data were collected and analyzed in an iterative manner until thematic saturation was reached.ResultsSurgeons described cases that were inside or outside of their personal comfort zones. When considering cases at the boundary of their comfort zones, participants described a variety of factors that could make them feel more or less comfortable. Specific strategies used to modulate this border were also described. Two perspectives on risk taking became apparent: the procedure-centric perspective described how surgeons viewed their colleagues whereas the surgeon-centric perspective described how surgeons viewed themselves.ConclusionsA framework for understanding surgeon's unique assessment of risk was elaborated. Increased awareness of the factors and strategies identified in this study can foster critical self-reflection by surgeons of their own risk assessments and those of their colleagues, and provide avenues for more explicit educational strategies for surgical training.

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