Order in the OR: Gender matters

Researchers led by Emory primatologist Frans de Waal found that medical teams working in operating rooms (ORs) follow patterns of cooperation and conflict similar to those of non-human primates.

In the study, researchers observed and recorded all social interactions in three ORs during 200 surgical procedures.

Previous studies of behavior in health care teams have mostly relied on questionnaires rather than records of actual behavior.

Researchers found that:

• 
conflicts were directed mostly down the hierarchy between members several ranks apart
• 
cooperation and conflict in the OR varied by gender, with less cooperation when the OR team included more male members
• 
less conflict and more cooperation existed if the attending surgeon’s gender (male or female) differed from that of the majority 
of the team.

“We used the techniques and concepts of evolutionary biology to understand how humans interact in the operating room,” says de Waal, director of the Living Links Center at Emory’s Yerkes National Primate Research Center. “Our findings show that the OR is a microcosm of typical primate social tendencies.”

Indeed, primates in general jostle for position more within their own 
gender group.

“Based on what we know about other species as well as human anthropology, rivalries and conflict are more typical within than between genders,” says Laura Jones, a postdoctoral research fellow with Living Links. “This is why higher-ups in the social hierarchy, such as the alpha individual, need to assert their status, especially vis-a-vis their own gender. This dynamic may explain our results.”

Researchers mainly looked at cooperation versus conflict. Cooperation was defined as affiliative behavior and team building, including chit-chat, exchanging pleasantries, two-way joking, and teaching. Conflict was defined as team-disintegrating behaviors, including yelling, being curt or disrespectful, and one-way joking.

The study was conducted between 2014 and 2016 at three large, urban teaching hospitals and included the participation of 400 different clinicians, including attending surgeons, surgical fellows or residents, anesthesia providers, circulating nurses, and surgical scrub personnel.