title: The effects of stress on surgical performance.
abstract: BACKGROUND
  Although the general literature on stress and performance is extensive, little is known about specific effects of stress in surgical practice. This qualitative study explored key surgical stressors, their impact on performance, and coping strategies used by surgeons.
  
  
  METHODS
  Individual in-depth semistructured interviews with surgeons were analyzed by 2 researchers independently. Key themes were discussed within the research team.
  
  
  RESULTS
  Sixteen interviews were performed, including interviews with consultants (n = 9) and surgeons in training (n = 7). A wide range of intraoperative stressors was identified. Although stress had both positive and negative effects, undue levels of stress impaired judgment, decision making, and communication. Although junior surgeons showed uncertainty about their ability to cope, senior surgeons had developed sophisticated strategies for controlling each situation.
  
  
  CONCLUSIONS
  Although stress poses significant risks, coping strategies are not taught explicitly during surgical training. This article presents a framework for categorizing surgical stress and suggests key elements for effective coping strategies.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College, London, UK. c.wetzel@imperial.ac.uk
authors.forename: Cordula M
authors.initials: CM
authors.lastname: Wetzel
authors.forename: Roger L
authors.initials: RL
authors.lastname: Kneebone
authors.forename: Maria
authors.initials: M
authors.lastname: Woloshynowych
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
authors.forename: Krishna
authors.initials: K
authors.lastname: Moorthy
authors.forename: Jane
authors.initials: J
authors.lastname: Kidd
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000223:Adaptation, Psychological; D003142:Communication; D003657:Decision Making; D005260:Female; D013502:General Surgery; D006801:Humans; D007600:Judgment; D008297:Male; D011597:Psychomotor Performance; D012647:Self-Assessment; D013315:Stress, Psychological; D013514:Surgical Procedures, Operative / Q000523:psychology* / Q000592:standards*; D013647:Task Performance and Analysis