Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 19;87(4):1995-1999.
doi: 10.1097/MS9.0000000000003181. eCollection 2025 Apr.

Fostering an open surgical culture: strategies to eliminate inappropriate behavior in surgical practice

Joris J Blok  1   2 , Heleen S Snijders  3 , Floortje Huizing  4 , Roderick F Schmitz  1 , Lieke J Kerstjens  1 , Vincent Q Sier  2 , Cathelijne C Blok  5 , Maarten A Lijkwan  6 , Abbey Schepers  2
Affiliations

Fostering an open surgical culture: strategies to eliminate inappropriate behavior in surgical practice

Joris J Blok et al. Ann Med Surg (Lond). .

Abstract

Surgery is a demanding and stressful profession. Unfortunately, inappropriate behavior is still not banished from the daily surgical practice and we are dealing with the negative consequences (e.g. negative working environments or burn-out). To adequately treat this type of behavior we first have to acknowledge its existence and create a proper path to discuss it inside our own ranks. The only manner to achieve this, is through an open culture. An 'open surgical culture' is the key, as it creates an environment with psychological safety and allows all involved parties to be able to speak up without fear for retaliation. Theoretical models such as Bateson's pyramid, McClelland's iceberg, and Dweck's Growth Mindset Theory can serve as valuable sources of inspiration to addressing cultural change by approaching both individual and organizational levels. Examples of cultural change attempts can be as small as discussing inappropriate behavior through pocket cards with statements of certain behavior or during national conferences, e.g. the annual meeting of the Dutch Surgical Society (Chirurgendagen). Only together we are able to achieve an open surgical culture, in order to ban mistreatment from the surgical profession. Here a roadmap to achieving an open surgical culture is presented and discussed.

Keywords: behavior; interprofessional relations; surgery; workplace environment.

PubMed Disclaimer

Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. All the authors have read and agreed to the submitted version of the manuscript. The material is original and has neither been published elsewhere nor submitted for simultaneous publication. None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this manuscript. There are no author disclosures or conflicts of interest.

Figures

Figure 1.
Figure 1.
Bateson’s pyramid with different levels of learning and behavioral change.
Figure 2.
Figure 2.
Elements needed to create an open and safe surgical environment/culture.
See this image and copyright information in PMC

References

    1. Jagsi R. Sexual harassment in medicine – #meToo. N Engl J Med 2018;378:209–11. - PubMed
    1. Halim UA, Riding DM. Systematic review of the prevalence, impact and mitigating strategies for bullying, undermining behaviour and harassment in the surgical workplace. Br J Surg 2018;105:1390–97. - PubMed
    1. Huang Y, Chua TC, Saw RPM, et al. . Discrimination, bullying and harassment in surgery: a systematic review and meta-analysis. World J Surg 2018;42:3867–73. - PubMed
    1. Hu YY, Ellis RJ, Hewitt DB, et al. . Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med 2019;381:1741–52. - PMC - PubMed
    1. Gianakos AL, Freischlag JA, Mercurio AM, et al. . Bullying, discrimination, harassment, sexual harassment, and the fear of retaliation during surgical residency training: a systematic review. World J Surg 2022;46:1587–99. - PubMed

LinkOut - more resources