Facing Fear in the Operating Room: A Qualitative Investigation Into the Causes of and Management Strategies for Surgeon Fear in the Operating Room.

Aim: We aimed to identify causes of surgeon fear in the operating room (OR) and to understand how surgeons manage that fear. Background: Emotions like fear can impact attention, memory, risk-tolerance, judgement, and decision-making. Yet, few studies have sought to elucidate what causes surgeon fear in the OR. Further, management strategies for surgeon fear also remain poorly described. Methods: This was a nested, descriptive analysis from a larger, qualitative study in which we interviewed 18 attending surgeons from 14 surgical subspecialties affiliated with a large, academic institution. Snowball and purposive sampling were used to achieve diversity in our sample. Data coding was inductive and descriptive and conducted until thematic saturation was reached. Results: There were 3 over-arching causes of fear: operating alone in chaos, operating in uncertainty, and operating alone in judgement. All surgeons used mitigating strategies to interrupt the escalation of fear, which if uninterrupted, could be calamitous. These strategies can be mapped to the causes of fear, but can also be called "emotion regulation." Calling for help was the most commonly listed strategy for managing fear. Fear was distinctly aversive, but commonly reappraised as "useful" provided it was well managed. Discussion: Most surgeons in this study experienced fear in the OR, though the causes were myriad. Some fear was recognized as useful, though too much fear was considered deleterious. All surgeons endorsed receiving help from trusted colleagues as the ultimate rescue strategy for both the presence of and the management of fear in the OR.