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

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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.
Keywords
Non-technical attributes, Surgical training, Communication style, Risk aversion, Reaction to uncertainty, Self-assessment, HEALTH SURVEY SF-36, OPERATING-ROOM, SURGEONS, SKILLS, PHYSICIANS, UNCERTAINTY, TOLERANCE, SELF

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MLA
Doyen, Bart, et al. “Non-Technical Attributes and Surgical Experience : A Cross-Sectional Study Comparing Communication Styles and Attitudes in Surgical Staff, Trainees and Applicants.” INTERNATIONAL JOURNAL OF SURGERY, vol. 63, 2019, pp. 83–89.
APA
Doyen, B., Vlerick, P., Maertens, H., Vermassen, F., & Van Herzeele, I. (2019). Non-technical attributes and surgical experience : a cross-sectional study comparing communication styles and attitudes in surgical staff, trainees and applicants. INTERNATIONAL JOURNAL OF SURGERY, 63, 83–89.
Chicago author-date
Doyen, Bart, Peter Vlerick, Heidi Maertens, Frank Vermassen, and Isabelle Van Herzeele. 2019. “Non-Technical Attributes and Surgical Experience : A Cross-Sectional Study Comparing Communication Styles and Attitudes in Surgical Staff, Trainees and Applicants.” INTERNATIONAL JOURNAL OF SURGERY 63: 83–89.
Chicago author-date (all authors)
Doyen, Bart, Peter Vlerick, Heidi Maertens, Frank Vermassen, and Isabelle Van Herzeele. 2019. “Non-Technical Attributes and Surgical Experience : A Cross-Sectional Study Comparing Communication Styles and Attitudes in Surgical Staff, Trainees and Applicants.” INTERNATIONAL JOURNAL OF SURGERY 63: 83–89.
Vancouver
1.
Doyen B, Vlerick P, Maertens H, Vermassen F, Van Herzeele I. Non-technical attributes and surgical experience : a cross-sectional study comparing communication styles and attitudes in surgical staff, trainees and applicants. INTERNATIONAL JOURNAL OF SURGERY. 2019;63:83–9.
IEEE
[1]
B. Doyen, P. Vlerick, H. Maertens, F. Vermassen, and I. Van Herzeele, “Non-technical attributes and surgical experience : a cross-sectional study comparing communication styles and attitudes in surgical staff, trainees and applicants,” INTERNATIONAL JOURNAL OF SURGERY, vol. 63, pp. 83–89, 2019.
@article{8603979,
  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.},
  author       = {Doyen, Bart and Vlerick, Peter and Maertens, Heidi and Vermassen, Frank and Van Herzeele, Isabelle},
  issn         = {1743-9191},
  journal      = {INTERNATIONAL JOURNAL OF SURGERY},
  keywords     = {Non-technical attributes,Surgical training,Communication style,Risk aversion,Reaction to uncertainty,Self-assessment,HEALTH SURVEY SF-36,OPERATING-ROOM,SURGEONS,SKILLS,PHYSICIANS,UNCERTAINTY,TOLERANCE,SELF},
  language     = {eng},
  pages        = {83--89},
  title        = {Non-technical attributes and surgical experience : a cross-sectional study comparing communication styles and attitudes in surgical staff, trainees and applicants},
  url          = {http://dx.doi.org/10.1016/j.ijsu.2019.02.002},
  volume       = {63},
  year         = {2019},
}

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