Carween Mui; MA Tina Martimianakis, PhD; Sherry Espin, RN, BScN, MEd, PhD; Lisa Robinson, RN, BScN, MN; Gianni R Lorello, BSc, MD, MSc, CI, FRCPC;  Priyanka Patel, Msc; Carol-anne Moulton, MBBS, PhD, MEd.

In compliance with the typical surgical traits, surgeon is often expected to demonstrate technical competence, certainty and confidence to others. However, as surgeons are embedded within the bigger OR environment, there are also other sets of expectations and rules different from those within the surgical culture. Concern to meet these various expectations may influence how surgeons impression manage in front of others. This study explored whether and how surgeons perceive that they are judged, how OR team members judge them, and to what degree and in what contexts surgeons care.

Using a constructivist grounded theory approach sensitized by Goffman’s Impression Management theory, we conducted semi-structured interviews with surgeons, OR nurses, and anaesthetists. OR team observations and brief peri-operative interviews refined the framework to saturation.

We found that surgeons are expected to perform an image of competence in front of their surgical colleagues, which was aligned with the traits of confidence, technical prowess, and boldness perpetuated by the surgical culture.  In contrast, other OR team members emphasized the importance of surgeons portraying an image of cordiality and professionalism instead. Nevertheless, all team members agree on the importance of an in-control surgeon during times of high acuity.

We also found that some surgeons valued these images to different degrees, which at times created frustration as they try to negotiate their image in response to the demands of the different audiences. Further understanding of how the surgical image is negotiated and the impact of this negotiation on individual and team performance has implications for education and interprofessional communication.

Cover image by Douglas Buller