Priyanka Patel, MSc; Nathan Zilbert, MD, MEd; Carween Mui; MA Tina Martimianakis, PhD; Simon Kitto, PhD;  Carol-anne Moulton, MBBS, PhD, MEd.

In a culture of Surgery that values certainty and confidence at all times, the pressure to portray an outer image of perfection conflicts with a surgeon’s internal feelings of uncertainty and stress. This internal conflict is evident for surgical residents who feel a need to manage their impressions. The purpose of this study is to look at how surgical residents engage in “impression management” as well as its perceived impact on their training experience and surgical judgment.

Using constructivist grounded theory methodology, 15 trainees from a General Surgery residency training program participated in the study. Results found that residents felt an ‘expectation’ to portray an ideal level of self confidence and certainty. They would use various strategies to maintain and manage their image. The reasons behind their need for “impression management” was to establish a perception of competence, and motivated by opportunities for learning, evaluation and future job prospects. Inadvertently, this behavior may have a negative impact on residents’ decision making, personal wellness and patient safety.

The findings from this study gives us a better understanding of the sociocultural context of surgical training. This helps us to address this aspect of surgical culture as it relates to trainee behavior. The knowledge gained from this can inform training curriculum and teaching practices to help trainees juggle the pressures without sacrificing surgical performance and learning.

Feature image by Douglas Buller