Objective:
This national cross-sectional study aims to establish the prevalence and potential impact of performance anxiety among surgeons and investigate its association with psychological traits and wellbeing.

Summary and background data:
Despite a growing awareness that human factors, non-technical skills and wellbeing in healthcare affect patient outcomes, an area that has remained unexplored is surgical performance anxiety (SPA).

Methods:
A prospectively registered, cross-sectional study using mixed methods was conducted across the United Kingdom (U.K.). Data captured included demographics, surgical specialty, trait anxiety, trait perfectionism, SPA and surgical perfectionism scores. Wellbeing was assessed using The Short Warwick-Edinburgh Mental Wellbeing Scale, while qualitative data were collected regarding surgeons’ experiences of SPA.

Results:
A total of 631 responses were collected. Mean age was 41·2 years and mean surgical experience 15·3 years. 62% were male and 52% of consultant grade. 100% felt that SPA affected surgeons, with 87% having experienced it themselves. 65% reported SPA negatively impacted surgical performance and 96% felt SPA negatively impacted surgeons’ wellbeing. Male surgeons reported significantly better wellbeing than female surgeons. Surgeons with SPA reported significantly worse wellbeing compared with surgeons who did not experience SPA. Surgeons in general experienced significantly lower mental wellbeing compared with population norms. Thematic analysis highlighted a reticence to share SPA openly and need for cultural change.

Conclusions:
SPA is a very common and significant challenge among surgeons across all specialties at all levels of experience in the U.K. It is perceived by surgeons to affect surgical performance adversely and is associated with worse psychological wellbeing. A more open culture of sharing and acknowledgement has been identified to be beneficial.