Uncertainty Among Acute Care Surgery Providers Does Not Change with Experience.

Abstract

Background: Acute care surgery (ACS) is a demanding profession that is by its na- ture unpredictable and requires practitioners to routinely deal with uncertainty and stress. We hy- pothesized that the field attracts people who are comfortable working in such an environment and that their comfort with uncertainty increases with experience. A surgeon's stress with uncertainty can be assessed usingthe previouslyvalidated Physician Reaction to Uncertainty Scale (PRU scale).

Methods: After approval from our IRB and the Eastern Association for the Surgery of Trauma (EAST) Research and Scholarship Committee, an online-survey was sent to EAST members. The survey included demographic questions and the PRU scale. 'The PRU scale requires answering 15 questions on a scale of one to six (strongly disagree to strongly agree) with four subsections measuring anxiety to uncertainty, concern about outcomes, reluctance to disclose uncertainty to patients, and reluctance to disclose mistakes to physicians. A higher score represents greater discomfort. Survey requests were sent to 1707 members; 424 surveys were complete and used for analysis.

Results: Most respondents were surgeons (92.4%) and male (77.1%). Average total score was 40.4/90. Overall discomfort with uncertainty on the PRU scale did not vary with gender (p = .88), experience (P=.11), age (P=.21), or practice location (P=.26). With increased experience, there was decreased re- luctance to disclose uncertaintyto patients (P = .03) and a trend to decreased anxiety about outcomes (P=.09).

Conclusion: Overall discomfort with uncertainty among ACS providers appears to be inherent in their personality and does not change over a career span.'Ihis factor may play a role in the development of occupational stress since discomfort with uncer- tainty appears to persist over time. Future studies looking at other surgical specialties for comparison and atlongitudinal studies may provide insight into the personality of the community.