Surgeon perceptions of personality as an influencing factor on anastomotic decision-making: a qualitative analysis

Aim
Surgeon personality is a factor influencing rectal anastomotic decision-making. However, it is unclear how or why this may be the case, or what aspects of personality are involved. The aim of this study was to investigate the views of colorectal surgeons on how their individual personality may influence variation in anastomotic decision-making.

Method
Purposive sampling was used to invite certified UK-based colorectal surgeons to participate, with individual interviews used for data collection. Participants were recruited until ongoing data review indicated no new codes were generated (i.e. data sufficiency). Data were analysed thematically following Braun and Clarke's six-step framework.

Results
Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes relating to personality and decision-making were identified: (1) surgeon development and training and (2) patient–surgeon interactions, each with relevant subthemes. Surgeons described how their personality may influence patients’ postoperative outcomes (e.g. decision-making, team working and communication) and potential mechanisms for how their personality may influence operative risk-taking. Following anastomotic leakage, surgeons described a disproportionate sense of guilt and responsibility. There appears to be a significant transition in responsibility from trainee to newly appointed consultant, which may be part of the ‘hidden curriculum’ of surgical training.

Conclusion
Colorectal surgeons have described their perceptions of how personality traits may impact variation in decision-making and patient outcomes for the first time. Early career surgeons felt ill-prepared for the level of guilt experienced when managing complications. Surgeons appear open to personality assessment if this was through an educational lens, with the aim of improving decision-making following complications and overall performance.