• Cordula M Wetzel, Roger L Kneebone, Maria Woloshynowych, Debra Nestel, Krishna Moorthy, Jane Kidd, and Ara Darzi.
• Department of Biosurgery and Surgical Technology, Imperial College, London, UK. c.wetzel@imperial.ac.uk
• Am. J. Surg. 2006 Jan 1;191(1):5-10.

BackgroundAlthough the general literature on stress and performance is extensive, little is known about specific effects of stress in surgical practice. This qualitative study explored key surgical stressors, their impact on performance, and coping strategies used by surgeons.MethodsIndividual in-depth semistructured interviews with surgeons were analyzed by 2 researchers independently. Key themes were discussed within the research team.ResultsSixteen interviews were performed, including interviews with consultants (n = 9) and surgeons in training (n = 7). A wide range of intraoperative stressors was identified. Although stress had both positive and negative effects, undue levels of stress impaired judgment, decision making, and communication. Although junior surgeons showed uncertainty about their ability to cope, senior surgeons had developed sophisticated strategies for controlling each situation.ConclusionsAlthough stress poses significant risks, coping strategies are not taught explicitly during surgical training. This article presents a framework for categorizing surgical stress and suggests key elements for effective coping strategies.

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