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BJS Prize 2 Exploring variation in surgical practice: the colorectal surgeon's personality influences anastomotic decision-making in rectal cancer


 
 
 The influence of internal surgeon-specific factors, such as personality, on cognitive bias and decision-making in surgery is not well understood. These factors may be particularly influential in clinical cases where there is a high degree of equipoise. This study aimed to explore personality traits that may influence anastomotic decision-making in rectal cancer.
 
 
 
 Colorectal surgeons were invited via social media to participate in a 2-part online survey (Snap11). The survey included: 1) 44-item Big Five Inventory (personality), 2) 30-item DOSPERT (risk-taking), 3) 3-item Cognitive Reflection Test (thinking style), and twenty hypothetical patient scenarios involving rectal anastomotic decisions.
 
 
 
 186 certified colorectal surgeons participated with 127 completing both parts (68.3%). 143 participants in this cohort were aged 30–49 years (79.6%) and 131 participants were male (70.4%).
 Surgeons scored higher than average population levels for emotional stability (degree of even-temperedness; 3.25 vs 2.97), with lower levels of agreeableness (ability to cooperate with others; 3.03 vs 3.74) and openness (creativity; 3.19 vs 3.67). Personality influenced anastomotic decision-making in specific circumstances e.g., high levels of openness predicted stoma formation when providing a second opinion, whereas high levels of extraversion predicted stoma formation when the patient was a staff member. Early career surgeons were highly influenced by colleague criticism following recent anastomotic leakage.
 
 
 
 Surgeon personality influences anastomotic decision-making in difficult circumstances. Colleague support is vital following anastomotic leakage and is influential upon early career surgeons’ subsequent decision-making. Personality is modifiable through experiences, therefore targeted educational interventions (e.g. reflexivity) may enable surgeons to recognize their own cognitive biases.
