Predictors of the response of operating room personnel to surgeon behaviors

Purpose: Several studies have assessed the physician–nurse relationship, particularly between females working together. While the surgeon workforce is increasingly represented by females, gendered relationships and biases in the operating room remain largely unstudied. Methods: We performed a prospective randomized study in which operative support staff, including nurses, surgical technologists, and surgical assistants, assessed scenarios describing questionable surgeon behaviors. Respondents were randomized to a survey that either discussed a female or male surgeon. For each scenario, one of the four standardized responses was selected. The respondents’ assessments of surgeon behaviors were analyzed. Results: The response rate was 4.4% (3128/71143). Females were more likely than males to deem the surgeon’s behavior inappropriate regardless of surgeon sex (p = 0.001). The likelihood of writing up the surgeon was predicted by role, with technologists, nurses, and assistants reporting surgeons at frequencies of 65.5%, 53.2%, and 48.8%, respectively (p = 0.008). While the overall respondents did not show a propensity to write-up either sex differentially (p = 0.070), technologists were significantly more likely to report female surgeons than male surgeons (p = 0.006). Conclusion: Characteristics of operative personnel were correlated with varying tolerance of surgeon behaviors, with specific subgroups more critical of female surgeons than males. Further exploration of these perceptions will serve to improve interactions in a diverse workplace.