• Sonal Arora, Nick Sevdalis, Debra Nestel, Tanya Tierney, Maria Woloshynowych, and Roger Kneebone.
• Imperial College, London, England, UK. sonal.arora06@imperial.ac.uk
• Am. J. Surg. 2009 Apr 1; 197 (4): 537-43.

BackgroundCurrent surgical training provides little opportunity for surgeons to recognize and manage intraoperative stress before it affects performance and compromises patient safety. We explored the perceived need for structured stress training and propose an intervention design that may be acceptable and appropriate.MethodsFifteen semistructured interviews identified stressors in the operating room, characterized coping strategies, and explored surgeons' views about a training intervention. Interviews were analyzed using standard qualitative methods.ResultsStressors and coping strategies confirmed those identified in previous work. Key components of an intervention should include recognizing stress in oneself and in others; experiencing the impact of stress on performance; providing effective coping strategies; offering feedback; and providing opportunities to practice what has been taught in a safe, simulation-based environment.ConclusionsThere is a need for structured training in management of intraoperative stress. Surgeons would welcome a simulation-based intervention to enhance performance and patient safety.

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