Is the duration of surgical experience associated with a diverse range of individual personality traits?

Abstract

Background:

Surgery, a field marked by constant advancements in technique, calls for specific personality traits. The improvement of skills requires lifelong motivation, critical thinking and openness to new technologies. However, it remains unclear whether there is an association between the expression of personality traits such as motivation or critical thinking, and the duration of work experience.

Materials and methods:

We conducted telephone interviews with 40 experienced surgeons who had previously participated in proctoring sessions. The interviews were focused on their training experience and personality traits, especially critical faculties, achievement motivation and assertiveness, in relation to the duration of their work experience. Additionally, we interviewed 40 non-surgical physicians in order to explore potential fundamental differences between surgeons and non-surgeons.

Results:

Longer professional experience was significantly associated with a reduced ability to accept criticism (P = 0.046), lower performance motivation (P = 0.04), and greater assertiveness (P = 0.044). Surgeons, particularly chief physicians, demonstrated significantly higher levels of assertiveness and performance motivation compared to their non-surgical medical counterparts (P = 0.005 and P = 0.009, respectively).

Conclusion:

Understanding the personalities of surgeons, particularly chief physicians, who appear to demonstrate lower levels of critical faculties, may help in designing and adapting training programs for the implementation of new surgical methods.

Introduction

Many surgical disciplines are associated with the following characteristics: extraversion, unwillingness to compromise, assertiveness, and the inability to accept criticism^[1-5]. Generally, the acquisition of an expert’s degree or the appointment to a higher position in the hierarchy causes control mechanisms to disappear. A personality structure of this nature, coupled with prolonged work experience, makes it difficult to accept feedback and suggestions for improvement in general medical practice as well as specific surgical procedures. Proctoring becomes significant at this point. Surgical tutoring by an experienced external surgeon enables hospitals to train the surgical skills of their in-house surgeons, such as those in robot-assisted surgery, and thus improve the overall quality of surgical care^[6].

HIGHLIGHTS

• The improvement of skills in surgery requires lifelong motivation, critical thinking, openness to new technologies, flexibility, and the acquisition and transfer of new techniques.

• It remains unclear whether there is an association between the expression of personality traits such as motivation or critical thinking, and the duration of work experience.

• Understanding the personalities of surgeons, particularly chief physicians, who appear to demonstrate lower levels of critical faculties, may help in designing and adapting training programs for the implementation of new surgical methods.

The aim of the present study was to determine whether the personality traits of surgeons in regard of their faculties of criticism, performance motivation, and assertiveness, are associated with longer work experience. As regards personality traits, the question arises whether surgeons differ fundamentally from non-surgical medical professionals in that the former are probably less prone to criticism, more motivated, and more assertive than the latter.

Methods

In cooperation with the institute of clinical psychology, we conducted tandem telephone interviews with 40 medical professionals who attended the proctoring program; the interviews included general questions on the practice of proctoring, as well as psychological aspects (critical faculties, achievement motivation, and assertiveness; http://links.lww.com/JS9/E453)^[7]. These questions were derived from standard validated questionnaires including subscales relevant to the present study and were answered on a scale from 1 to 6, with 1 indicating that the statement was fully applicable and 6 indicating that it was not applicable at all. The interviews were conducted from September 2023 to March 2024.

Additionally we performed telephone interviews with 40 non-surgical physicians to determine fundamental differences, if any, between surgeons and non-surgeons. The questionnaires (surgical and non-surgical groups; http://links.lww.com/JS9/E452) are included in the supplemental data.

The ethics committee of the Medical Faculty approved the study (Vote no. D 548/23). Informed consent was obtained from all participants prior to their inclusion in the study.

The work has been reported in line with the STROCSS criteria^[8].

Statistical analysis

Gender, age, function, and academic qualification were examined as independent group variables with regard to their effect on the selected target variable using analyses of variance (ANOVAs). Quantitative values are presented as means and standard deviations. Pearson’s correlations were used to determine the association between the questionnaire items (critical faculties, performance motivation, and assertiveness) and work experience, as well as the duration of proctoring. The level of significance was set to P ≤ 0.05 and 2-sided tests were performed. The statistical software R, version 3.6.3, was used for calculation.

Results

In general, longer professional experience was associated with a lesser ability to accept general criticism among surgeons (P = 0.046, Figure 1a). A subgroup analysis concerning genders revealed no difference between men and women. The more professional experience the surgeons had, the less they justified themselves when criticized (P = 0.036), Figure 1b. The more professional experience the surgeons had, the less they rated the usefulness of criticism after an operation in terms of improving their performance (P = 0.069). However, this depended on gender and was more pronounced in women (P = 0.000), Figure 1c. Furthermore, surgeons who were less open to criticism were less motivated to perform (P = 0.04) and showed less effort to improve even after very good performance in case of longer professional experience (P = 0.029).

Figure 1.

Surgeons with longer professional experience were less able to take criticism overall, P = 0.046 (a), justified themselves less for criticism, P = 0.036 (b) and rated the criticism with regard to improving one’s own performance as less useful (P = 0.069)—however, this depended on gender and was driven by women (P = 0.000) (c).

In addition to the ability to accept criticism and the motivation to perform, a correlation was seen between assertiveness and the duration of professional experience. In decision-making situations, surgeons with longer professional experience appeared to be able to win others over to their side (P = 0.044, Figure 2).

Figure 2.

Surgeons with longer professional experience had more power to convince, P = 0.044.

Since surgeons appeared to constitute a specific group, we also conducted telephone interviews with 40 non-surgical physicians to determine differences if any. Table 1 provides an overview of the characteristics of surgeons and non-surgical physicians. The comparison revealed that surgeons, particularly chief physicians, had significantly better and stronger assertiveness and motivation to perform than non-surgeons (P = 0.005 and P = 0.009, respectively). A subgroup analysis of genders showed no difference.

Table 1.

Characteristics of surgical and non-surgical physicians

Characteristics	Surgeons	Non-surgeons
Age (years)
Mean (sd)	46.8 (7.9)	43.8 (8.9)
Gender (total/ percent)
Men	21 (52.5)	16 (40)
Women	19 (47.5)	24 (60)
Professional experience (years)
Mean (sd)	20.1 (7.8)	15.2 (8)
Title (total/percent)
No title	5 (12.5)	5 (12.5)
Doctor	22 (55)	29 (72.5)
Assistant professor	3 (7.5)	3 (7.5)
Professor	10 (25)	3 (7.5)
Function in the clinic (total/percent)
Specialist	1 (2.5)	14 (35)
Senior physician	22 (55)	14 (35)
Chief physician	17 (42.5)	2 (5)
Resident doctor, employed	0	5 (12.5)
Resident doctor, self-employed	0	5 (12.5)
Surgeon in the past (total/ percent)
Yes	x	15 (37.5)
No	x	25 (62.5)

Abbreviation: sd = standard deviation.

These data highlight the fact that surgeons constitute a special category of individuals in terms of personality: they are more assertive and driven by a greater motivation to perform.

Discussion

The present study revealed a significant association between character traits and increasing work experience: surgeons with longer professional experience showed greater assertiveness, lesser motivation to achieve, and were less able to accept criticism. Surgeons, especially chief surgeons, differ from non-surgeons in terms of better and stronger assertiveness, and their motivation to perform.

Mutabdzic et al investigated whether surgeons generally find it difficult to be trained, and whether they accept coaching for continued professional improvement^[9]. The interviewed surgeons expressed three main concerns about coaching: they questioned the value of technical improvement, were worried about appearing incompetent, and concerned about losing their autonomy^[9]. The study revealed that adherence to these firmly established values of competency and autonomy, as well as the lack of motivation to learn new techniques, actually limit the ways and extent to which surgeons can be taught and thus improve their skills^[9].

This is in strong contrast to other areas such as aviation: here it is routine practice to correct and coach a pilot even after several years of professional experience^[10]. Thoughts about possible incompetence or a loss of autonomy (as described above) do not arise here. A similar setup would be most desirable in medicine: regular coaching, supervision, and being corrected for the purpose of improving one’s skills^[7].

Conclusion

Understanding the personalities of surgeons with many years of professional experience, particularly chief surgeons, may help to align and adapt training concepts specifically to this group. Those concepts would differ from training during residency and fellowship, in order to respond sensitively to the characteristics of the senior surgeon and work out the best possible benefit for further surgical development. The aims should be daily questioning, reevaluating, motivating, and implementing the adjustment and reorientation of clinical practice to ethical values in medicine. From an ethical point of view alone, a poor ability to accept criticism and low motivation to perform constitute unacceptable weaknesses that should be overcome for the benefit of the patients. It is incumbent upon the respective institution, if not policy-makers, to work on this shortcoming and ensure ongoing progress in surgery as well as uphold a high standard of patient care.

Ethics approval

All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee, as well as the 1964 Helsinki Declaration and its later amendments, or comparable ethical standards.

Consent

Written informed consent was obtained from all patients for publication of this manuscript. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

Sources of funding

The authors receive financial support from the DFG as part of the funding program Open Access-Publikationskosten. IA is a proctor for Intuitive Surgery, and the department of obstetrics and gynecology at the University Hospitals in Kiel is a case observation center for robotic-assisted surgery.

Author contributions

I.A., V.G: project development, literature research, writing of manuscript, editing; L.A.: project development, editing; J.P., Z.R: literature research, editing; N.M., J.A.: literature research, project development; S.v.O.: literature research, data analysis; F.N.: project development, data analysis, writing of manuscript, editing. All authors have read and approved the manuscript.

Conflicts of interests disclosure

The authors Ibrahim Alkatout, Leila Allahqoli, Julian Pape, Nicolai Maass, Sören von Otte, Zino Ruchay, Johannes Ackermann, Frauke Nees and Veronika Günther declare that they have no conflict of interest.

Guarantor

Prof. Ibrahim Alkatout.

Research registration unique identifying number (UIN)

Not applicable.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Availability of data and materials

The datasets analyzed for the current review are available from the corresponding author on reasonable request.