Table 4.

Full operating room ethogram

Behavioral category	Code/intensity	Example
Confrontational	c1	Interrupting or ignoring another who is talking. Acting curt, irritated, demanding, being dismayed, or raising one’s voice while talking to the other. Calling someone by their function, such as “Anesthesia” or “SOSI (Surgical Operating Services, Inc.)”
	c2	Grabbing equipment. Taking supplies from another when they are not offering them, or taking them from another in a hasty manner demonstrating impatience. Stomping
	c3	Cursing, yelling, name-calling, use of demeaning titles (e.g., “Dude,” “Miss”)
	c4	Making it clear that one does not want to work with others (e.g., asking for a mediator or superior). Storming out of the OR
Submissive	r1	No reaction to conflict-provoking behavior. Ignoring or acting as if unnoticed. Becoming quiet (conversation stops abruptly)
	r2	Using formal titles, being apologetic (“I’m sorry, sir”)
	r3	Cowering, moving away to create distance, slumping, or bowing in posture
Protesting	p1	Head shaking, eye-rolling, or other gestures of disagreement behind the back of the initiator of a confrontation, verbally stating disagreement with the initiator
	p2	Gestures of protest visible to the initiator, raising one’s voice while verbally disagreeing with the initiator
Playful	w1	Joking, making funny remarks, laughing with others. Lighthearted conversation
	w2	Singing, dancing, humming, whistling, shooting hoops (i.e. throwing garbage into trash from afar and celebrating if it goes in)
Mudslinging	m1	Bad-mouthing an absent non-team member to an ally (e.g., calling the blood bank technologists lazy), making fun of the anesthetized patient (e.g., “She’s gigantic. We’re going to need ten people to move her”)
	m2	Bad-mouthing an absent team member (e.g., the anesthesiologist complains about the surgeon’s tardiness)
	m3	Bad-mouthing a present team member to an ally
Friendly/solicitous	f1	Giving pleasantries (e.g., “Thank you!”), friendly greetings (e.g., “How are you?”). Polite conversation with interest in the other
	f2	Personal compliments (e.g., “Good work, doc!”). Prolonged non medical conversation that does not include joking or laughing (including innocuous gossip)
	f3	Patting on the back, hugging
Supportive/teambuilding	t1	Roll call, assembling
	t2	Teaching (e.g., telling medical student/fellow/etc. what to do to the patient, how the limbic system works, how to pass board exams)
	t3	Motivational talk, complimenting a team member or the team in general for their teamwork, debriefing (e.g., “Good job today, team”)
Disintegrating	d1	Remarks that suggest a team member does not want to be in the room. Discussing quitting, retirement (e.g., “I can’t wait until I’m 65. Just one more year of this place!”)
	d2	Quitting, calling in a mediator or supervisor
Courtship	x1	Flirting: behaving in a manner that increases the intimacy between two individuals one or both of whom seem to be sexually interested (e.g., a smiling/giggling technician teasing a nurse about his/her unflattering scrubs)
	x2	Telling jokes with sexual content, light touching
	x3	Prolonged or frequent touching, stroking of the other’s lower back, waist, thigh, up and down the arm, neck, shoulders. Using pet names (e.g., “Baby”)
Reaction	y1	Accepting, reciprocating, or favorably acknowledging (e.g., to Courtship smiling back)
	y2	Neutral (the flirtee neither reciprocates nor seems reluctant)
	y3	Rejecting the overtures by not reciprocating or smiling, reproaching the other, or moving away

Note: Each behavior and the subjects involved were recorded in real-time