title: Pressures to "measure up" in surgery: managing your image and managing your patient.
abstract: OBJECTIVE
  To identify pressures created by surgical culture and social setting and explore mechanisms for how they might impact operative decision-making.
  
  
  BACKGROUND
  Surgeons apply judgments within a powerful social context and are constantly socialized and influenced by communicative exchanges. In this study, the authors characterized the nature of the surgical social context, focusing on the interactions between external social influences and the cognitive ability of the surgeon to respond to uncertain, unexpected, or critical moments in operations.
  
  
  METHODS
  The authors reviewed the sociological and psychosocial literatures to examine concepts in identity construction, socialization process, and image management literatures and synthesized a conceptual framework allowing for the examination of how social factors and image management might impact surgical performance.
  
  
  RESULTS
  The surgeon's professional identity is constructed and negotiated on the basis of the context of surgical culture. Trainees are socialized to display confidence and certainty as part of the "hidden curriculum" and several sociocultural mechanisms regulating "appropriate" surgical behavior exist in this system. In the image management literature, individuals put on a "front" or social performance that is socially acceptable. Several mechanisms for how image management might impact surgical judgment and decision-making were identified through an exploration of the cognitive psychology literature.
  
  
  CONCLUSIONS
  Sociopsychological literatures can be linked with decision-making and cognitive capacity theory. When cognitive resources reach their limit during critical and uncertain moments of an operation, the consumption of resources by the pressures of reputation and ego might interfere with the thought processes needed to execute the task at hand. Recognizing the effects of external social pressures may help the surgeon better self-regulate, respond mindfully to these pressures, and prevent surgical error.
authors: Faculty of Medicine, University of Toronto, Canada.
authors: Chunzi Jenny
authors: CJ
authors: Jin
authors: Maria Athina
authors: MA
authors: Martimianakis
authors: Simon
authors: S
authors: Kitto
authors: Carol-Anne E
authors: CA
authors: Moulton
mesh_terms: D001519:Behavior; D003466:Cultural Characteristics; D007600:Judgment; D010820:Physicians / Q000523:psychology*; D011787:Quality of Health Care; D012649:Self Concept; D012933:Social Identification; D013043:Specialties, Surgical / Q000592:standards