William B. Elder

A Model of Disruptive Surgeon Behavior in the Perioperative Environment

BACKGROUND Surgeons are the physicians with the highest rates of documented disruptive behavior. We hypothesized that a unified conceptual model of disruptive surgeon behavior could be developed based on specific individual and system factors in the perioperative environment. STUDY DESIGN Semi-structured interviews were conducted with 19 operating room staff of diverse occupations at a single institution. Interviews were analyzed using grounded theory methods. RESULTS Participants described episodes of disruptive surgeon behavior, personality traits of perpetrators, environmental conditions of power, and situations when disruptive behavior was demonstrated. Verbal hostility and throwing or hitting objects were the most commonly described disruptive behaviors. Participants indicated that surgical training attracts and creates individuals with particular personality traits, including a sense of shame. Interviewees stated this behavior is tolerated because surgeons have unchecked power, have strong money-making capabilities for the institution, and tend to direct disruptive behavior toward the least powerful employees. The most frequent situational stressors were when something went wrong during an operation and working with unfamiliar team members. Each factor group (ie, situational stressors, cultural conditions, and personality factors) was viewed as being necessary, but none of them alone were sufficient to catalyze disruptive behavior events. CONCLUSIONS Disruptive physician behavior has strong implications for the work environment and patient safety. This model can be used by hospitals to better conceptualize conditions that facilitate disruptive surgeon behavior and to establish programs to mitigate conduct that threatens patient safety and employee satisfaction.

Barriers to advancement in academic surgery: views of senior residents and early career faculty.

BACKGROUND A significant faculty attrition rate exists in academic surgery. The authors hypothesized that senior residents and early-career faculty members have different perceptions of advancement barriers in academic surgery. METHODS A modified version of the Career Barriers Inventory-Revised was administered electronically to surgical residents and early-career surgical faculty members at 8 academic medical centers. RESULTS Residents identified a lack of mentorship as a career barrier about half as often as faculty members. Residents were twice as likely as faculty members to view childbearing as a career barrier. CONCLUSIONS Many early-career faculty members cite a lack of mentors as a limitation to their career development in academic surgery. Childbearing remains a complex perceived influence for female faculty members in particular. Female faculty members commonly perceive differential treatment and barriers on the basis of their sex. Faculty development programs should address both systemic and sex-specific obstacles if academic surgery is to remain a vibrant field.

Meaning in life, emotional distress, suicidal ideation, and life functioning in an active duty military sample

The present study examined the relationship of meaning in life with emotional distress, suicidal ideation, and life functioning in a sample of 273 active duty Security Forces personnel assigned to two US Air Force bases. Results of regression analyses indicated that stronger meaning in life was significantly associated with less severe emotional distress (p < 0.001, ΔR 2 = 0.047) and suicidal ideation (p = 0.043, ΔR 2 = 0.017), and better functioning at work and in intimate relationships, nonfamily relationships, and recreational activities (p < 0.001, ΔR 2 = 0.073). Meaning in life showed stronger associations with outcomes relative to other predictors and covariates and explained the relationship between belonging and life functioning. Findings suggest that meaning in life is associated with less emotional distress and suicide risk, and greater success and performance across multiple domains in life among military personnel.

Sexual Self-Schemas of Bisexual Men A Qualitative Investigation

This qualitative study investigated the sexual self-schemas and masculinity ideologies of 20 bisexual men. Sexual self-schema was defined as a cognitive generalization about sexual aspects of the self, as derived from past experience and sociocultural context, which guides current experiences and facilitates the processing of sexual information. In-depth interviews, a focus group, documentary evidence, and grounded theory analysis were used. Categories were coded and analyzed, revealing two models. The first, the sexual self-schema of bisexual men, is an eight-category model of the bisexual male sexual self-schema describing men’s relationships with other men and with women, as well as attitudes about themselves. The second model, the process of emerging awareness of bisexual attraction, outlines how sexual and romantic relationship experiences lead to bisexual sexual orientation identity. The two theoretical models depict how bisexual men understand their own sexual self-schemas. Implications for counseling psychology research and practice are addressed.

Sexual Self-Schemas of Gay Men A Qualitative Investigation

Self-schemas derive from past experience, influence current experiences, and facilitate the processing of sexual information. Using this concept, this study addressed the following question: How do gay men understand their own sexual self-schemas? Perspectives of 20 gay men were drawn together using a grounded theory methodology and member checking. A seven-category model emerged depicting the behaviors and values participants described as the gay male sexual schema (e.g., Avoidance of Emotional Expression; Pornography and Sexual Orientation Identity; Physically Attractive Men; Managing Sex and Social Perception; Competition for Men; Sex, Emotion, and Intimacy; and Commitment and Work in Relationships). In addition, all participants discussed a process of sexual self-schema transition over time. The resulting model may be used in counseling and in social justice and advocacy to produce adaptive changes for gay male clients.

Conceptual Model of Male Military Sexual Trauma.

Objective: Male sexual trauma is understudied, leaving much to be known about the unique mental health needs of male survivors. This study examined veteran men’s perceptions of the effects of military sexual trauma. Method: Military sexual trauma was defined as physically forced, verbally coerced, or substance-incapacitated acts experienced during military service. Interviews were conducted with 21 male veterans who reported experiencing military sexual trauma. Data were drawn together using a grounded theory methodology. Results: Three categories emerged from data analysis, including (a) types of military sexual trauma (being touched in a sexual way against their will [N = 18]; sexual remarks directed at them [N = 15]; being physically forced to have sex [N = 13]); (b) negative life effects (difficulty trusting others [N = 18]; fear of abandonment [N = 17]; substance use [N = 13]; fear of interpersonal violence [N = 12]; conduct and vocational problems [N = 11]; irritability/aggression [N = 8]; insecurity about sexual performance [N = 8]; difficulty managing anger [N = 8]); and (c) posttraumatic growth (N = 15). Conclusions: Results from this study suggest sexual trauma in the military context may affect systems of self-organization, specifically problems in affective, self-concept, and relational domains, similar to symptoms of those who have experienced prolonged traumatic stressors. This model can be used by clinicians to select treatments that specifically target these symptoms and promote posttraumatic growth.

Life meaning following combat among air force security forces personnel

An active duty Air Force ground combat unit (n = 189) completed surveys about trauma and combat exposure, mood symptoms, and meaning in life. Two dimensions of deployment-related traumas were assessed: combat (e.g., firing weapons, being fired upon) and aftermath (e.g., seeing dead bodies, injury). Results of regression analyses indicated that Airmen who experienced more intense combat reported less presence of meaning in life, although the significant interaction with gender suggested declines in meaning in life were especially pronounced among males with higher combat intensity. In contrast, more intense aftermath exposure was associated with slightly stronger meaning in life, with no differences by gender. Intensity of combat exposure might differentially affect perceived meaning in life for male versus female combatants.

Masculinity as an Avoidance Symptom of Posttraumatic Stress

For individuals diagnosed with posttraumatic stress disorder (PTSD), trauma-related stimuli signal danger and provoke high levels of anxiety. Avoidance of these stimuli, a key feature of PTSD, prevents emotional processing of the thoughts, feelings, and cognitions associated with a traumatic event. This study examined how masculinity norms can function as a precipitant of trauma-related avoidance behaviors for male survivors of sexual assault. The gendered context of trauma, as well as the survivor’s gender identity, may lead survivors to employ avoidance behaviors associated with traditional masculinities in an attempt to protect from future harm. Interviews were conducted with 21 male veterans who had reported experiencing military sexual trauma (MST) to their clinician. Data were drawn together using a grounded theory methodology. A 3-category model emerged depicting the gendered behaviors participants described following arousal to threatening stimuli (e.g., enact heterosexuality to avoid blame, engage in sex to avoid negative thoughts, appear strong to avoid feeling weak). The resulting model is discussed in light of evidence-based PTSD treatments.