McCulloch P, Kaul A, Wagstaff G F, Wheatcroft J
Academic Unit of Surgery, University of Liverpool, Liverpool, UK.
Br J Surg. 2005 Oct;92(10):1293-7. doi: 10.1002/bjs.4930.
Surgeons have a reputation for decisiveness and self-confidence, which suggests that they may tolerate uncertainty poorly and therefore be less capable than other doctors of experiencing clinical equipoise. Their 'typical' behaviour is characteristic of the stable extrovert personality and so they may prefer spontaneous clinical judgement over randomized trials. The aim of this study was to compare personality dimensions and tolerance of uncertainty among surgeons and hospital physicians, to determine whether differences in either property might help to explain the apparently poor performance of surgeons in conducting randomized controlled trials.
This was a postal questionnaire study of 1000 consultant general surgeons and 1000 consultant physicians. Respondents completed a short self-assessment of Eysenck personality dimensions, Budner's Intolerance of Ambiguity scale and a short questionnaire about attitudes to randomized trials. Correlation and multiple regression analyses were performed.
The response rate was 36.5 per cent. Physicians were more likely to be women (P < 0.001) and had spent 1 more year in academic posts than surgeons (P < 0.030). Surgeons were significantly more extrovert (P < 0.001) and less neurotic (P < 0.001) than physicians. Surgeons were significantly more intolerant of uncertainty than physicians (P = 0.007). Multivariate analysis identified age (P < 0.030) and sex (P = 0.015) as independent predictors of intolerance of uncertainty. The attitudes of surgeons and physicians to randomized trials were no different.
Surgeons are not prejudiced against randomized trials, but their intolerance of uncertainty may inhibit them from deciding that an individual patient is suitable for trial entry. If more surgeons were female, this difference between surgeons and physicians might disappear.
外科医生以果断和自信著称，这表明他们可能难以容忍不确定性，因此在体验临床 equipoise 方面可能不如其他医生。他们“典型”的行为是稳定外向型人格的特征，所以他们可能更喜欢自发的临床判断而非随机试验。本研究的目的是比较外科医生和医院内科医生的人格维度及对不确定性的耐受性，以确定这两种特质的差异是否有助于解释外科医生在进行随机对照试验时表现明显不佳的原因。
这是一项对 1000 名普通外科顾问医生和 1000 名内科顾问医生进行的邮寄问卷调查研究。受访者完成了艾森克人格维度的简短自我评估、布德纳的不确定性不耐受量表以及一份关于对随机试验态度的简短问卷。进行了相关性和多元回归分析。
回复率为 36.5%。内科医生女性比例更高（P < 0.001），且在学术岗位上的工作时间比外科医生多 1 年（P < 0.030）。外科医生比内科医生明显更外向（P < 0.001）且神经质程度更低（P < 0.001）。外科医生对不确定性的不耐受程度明显高于内科医生（P = 0.007）。多变量分析确定年龄（P < 0.030）和性别（P = 0.015）是不确定性不耐受的独立预测因素。外科医生和内科医生对随机试验的态度没有差异。
外科医生并不排斥随机试验，但他们对不确定性的不耐受可能会阻碍他们判定个别患者是否适合纳入试验。如果更多外科医生是女性，外科医生和内科医生之间的这种差异可能会消失。
