title: The call, the save, and the threat: understanding expert help-seeking behavior during nonroutine operative scenarios.
abstract: OBJECTIVE
  Asking for help in the operating room occurs within a surgical culture that has traditionally valued independence, decisiveness, and confidence. A tension exists between these deeply ingrained character traits and the new culture of team-based practice that emphasizes maximizing patient safety. The objective of this study is to explore surgeon-to-surgeon help-seeking behaviors during complex and unanticipated operative scenarios.
  
  
  METHODS
  Semistructured interviews were conducted with a purposeful sample of 14 consultant surgeons from multiple specialties. We used constructivist grounded theory to explore help-seeking experiences. Analysis occurred alongside and informed data collection. Themes were identified iteratively using constant comparisons.
  
  
  METHODS
  The setting included 3 separate hospital sites in a Canadian academic health sciences center.
  
  
  METHODS
  A total of 14 consultant surgeons from 3 separate departments and 7 divisions were included.
  
  
  RESULTS
  We developed the "Call-Save-Threat" framework to conceptualize the help-seeking phenomenon. Respondents highlighted both explicit and tacit reasons for calling for help; the former included technical assistance and help with decision making, and the latter included the need for moral support, "saving face," and "political cover." "The Save" included the provision of enhanced technical expertise, a broader intraoperative perspective, emotional support, and a learning experience. "The Threat" included potential downsides to calling, which may result in near-term or delayed negative consequences. These included giving up autonomy as primary surgeon, threats to a surgeon's image as a competent practitioner, and a failure to progress with respect to independent judgment and surgical abilities.
  
  
  CONCLUSIONS
  Our "Call-Save-Threat" framework suggests that surgeons recurrently negotiate when and how to seek help in the interests of patient safety, while attending to the traditional cultural values of autonomy and decisive action. This has important implications for surgical postgraduate education and also throughout a surgeon's career trajectory.
authors.affiliation: Department of Surgery, Schulich School of Medicine and the Centre for Education Research and Innovation, Western University, London, Ontario, Canada; Department of Medicine, Schulich School of Medicine and the Centre for Education Research and Innovation, Western University, London, Ontario, Canada. Electronic address: rjnovick@uwo.ca.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Novick
authors.affiliation: Department of Medicine, Schulich School of Medicine and the Centre for Education Research and Innovation, Western University, London, Ontario, Canada.
authors.forename: Lorelei
authors.initials: L
authors.lastname: Lingard
authors.affiliation: Department of Surgery, Schulich School of Medicine and the Centre for Education Research and Innovation, Western University, London, Ontario, Canada.
authors.forename: Sayra M
authors.initials: SM
authors.lastname: Cristancho
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D000066491:Clinical Decision-Making; D032882:Comprehension; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D007400:Interprofessional Relations; D007407:Interviews as Topic; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration; D061214:Patient Safety; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D013043:Specialties, Surgical / Q000193:education / Q000941:ethics
keywords: Interpersonal and Communication Skills; Patient Care; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; collaboration skills; communication skills; constructivist grounded theory; practice-based learning; professionalism; qualitative research