非技术属性和手术经验：一项比较外科医护人员、学员和申请人沟通风格和态度的横断面研究。

Non-technical attributes and surgical experience: A cross-sectional study comparing communication styles and attitudes in surgical staff, trainees and applicants.

机构信息

Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.

Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium.

出版信息

Int J Surg. 2019 Mar;63:83-89. doi: 10.1016/j.ijsu.2019.02.002. Epub 2019 Feb 12.

DOI:10.1016/j.ijsu.2019.02.002

PMID:30769216

Abstract

BACKGROUND

This monocentric study aimed to explore whether key non-technical attributes can be reliably measured in a mixed population of candidates applying for surgical training, surgical trainees and staff and to identify any differences between these groups.

MATERIALS & METHODS: Candidates applying for surgical training, surgical trainees and staff from four surgical specialties (general surgery, orthopedics, plastic surgery or urology) at a tertiary academic teaching hospital were all sent an online self-report questionnaire. The Communication Styles Inventory (CSI, 96 items) was used to assess a six-dimensional behavioral model of participant communication styles (expressiveness, preciseness, verbal aggressiveness, questioningness, emotionality and impression manipulativeness). Attitudes toward uncertainty and risks were assessed with the Physicians' Reaction toward Uncertainty (PRU, 15 items) and Physician Risk Attitudes (PRA, 6 items) scales respectively. Data was encoded and analyzed using parametric testing.

RESULTS

The questionnaire was completed by 177 participants (110 candidates; 42 trainees; 25 staff). All scales had very good internal consistency (Cronbach's alpha >0.80). After controlling for gender-based differences, surgical candidates scored significantly higher on 'expressiveness' (P = 0.012) and were significantly less risk-averse (P = 0.006) than trainees and staff. Surgical trainees scored lowest on the CSI 'questioningness' subscale (P = 0.019) and had significantly more difficulties dealing with uncertainty, characterized by their highest scores on the 'concern about bad outcome' (P = 0.021) and reluctance to disclose uncertainty to patients' (P = 0.05) subscales. Multiple subscales revealed gender-based differences in candidate and trainee groups, which were not noted for surgical staff.

CONCLUSIONS

Meaningful differences in non-technical attributes of surgical staff, trainees and candidates have been identified, which may be explained by differences in clinical experience and learning and may suggest that these develop over time. Further research on assessment of non-technical attributes during surgical selections and the role of both technical and non-technical attributes in surgery at large is needed.

摘要

背景

本单中心研究旨在探索关键非技术属性是否可以在申请外科培训的候选人群、外科受训者和外科工作人员的混合人群中可靠地测量，并确定这些人群之间的任何差异。

材料和方法

来自一家三级学术教学医院四个外科专业（普通外科、骨科、整形外科学或泌尿科）的候选申请人、外科受训者和工作人员均被发送在线自我报告问卷。采用沟通风格量表（CSI，96 项）评估参与者沟通风格的六维行为模型（表达性、精确性、言语攻击性、提问性、情感性和印象操纵性）。使用医师对不确定性的反应（PRU，15 项）和医师风险态度（PRA，6 项）量表分别评估对不确定性和风险的态度。数据使用参数测试进行编码和分析。

结果

177 名参与者（110 名候选申请人；42 名受训者；25 名工作人员）完成了问卷。所有量表的内部一致性均非常好（Cronbach's alpha >0.80）。在控制基于性别的差异后，手术候选申请人在“表达性”方面的得分显著更高（P=0.012），并且比受训者和工作人员的风险规避程度显著更低（P=0.006）。外科受训者在 CSI“提问性”分量表上的得分最低（P=0.019），并且在处理不确定性方面存在明显的困难，这表现在他们在“对不良结果的担忧”（P=0.021）和不愿意向患者透露不确定性的（P=0.05）分量表上的得分最高。在候选人和受训者群体中，多个分量表显示出基于性别的差异，而在外科工作人员中则没有注意到这些差异。