Natashia Seeman, MD, MSc; Vicki LeBlanc, MSc, PhD; Carol-anne Moulton, MBBS, PhD, MEd; Kyle Tsang, MHSc; Dorotea Mutabdzic, MD, MEd; Tamara Gimon, MD.

Although chronic stress and burnout have been extensively studied in medicine, acute stress remains a relatively recent area of research. The implications of acute stress on a physician’s performance during a critical task, and subsequent patient outcomes, are important to understand. The majority of existing studies of stress in surgeons, had either focused on aspects of chronic stress, such as burnout, or had been carried out in a simulation environment. Therefore, the primary aim of this study was to capture the experience of acute stress, and stress as a whole by collecting data from four components: physiology, cognition, emotion and culture. A secondary objective of the pilot study was to look at the relationship between the perceived and physiologic stress experienced by surgeons in the OR.

To capture the experience of stress in the operating room, seven surgeons were studied over several operations. Physiologic data included real-time ECG monitoring and cortisol measurements. Affective, cognitive and sociocultural data was captured through StateTrait Anxiety Inventories (STAI), pre- and post-op interviews, and intraoperative observer notes. Perceived stress was defined by the surgeon indicating stress verbally, discretely compressing a foot-pedal during the operation or indicating so in the post-operative interview. Data triangulation was used for analysis, focusing on the noted moments of perceived stress and physiologic stress.

This study refined a methodology that more completely captures surgeon stress in a real operating room environment. Heart rate and heart rate variability proved to be the most reliable, sensitive and specific measure of physiologic stress. However, without the context of perceived stress data, physiologic data would offer only a limited understanding. The relationship between perceived and physiologic stress is complex. Surgeons’ perceived stress can be present without measurable indication of physiologic stress. Likewise, physiologically defined stress does not necessarily correlate with perceived stress. The components of acute stress cannot be studied in isolation. A multifaceted methodology is necessary to understanding the surgeon stress experience and warrants further study to continue exploring this complex relationship.