Perfectionism in the anesthesiological environment

doi:10.21203/rs.3.rs-3197234/v1

Background. Perfectionism today is understood as an individual's psychological conviction that the ideal can and should be achieved, and the imperfect result of work (physical, intellectual, etc.), in their opinion, has no right to exist.

The purpose of the study: Our goal was to consider this psychological phenomenon in the community of anesthesiology interns in comparison with the indicators of practicing doctors, to investigate its negative and positive features, their prevalence and dynamics.

Materials and methods. An anonymous survey of 92 medical interns and 124 participants of short-term trainings in the specialty "Anesthesiology" was conducted according to the M.M. Smith questionnaire. (2016).

Results. Interns showed an average level of tendency towards perfectionism on all other scales, except for "other-oriented perfectionism" where the level of the indicator was low. Practitioners showed an average level of tendency towards perfectionism on the scales "self-worth contingencies", "concern over mistakes", and "doubts about actions", according to all other indicators, the level of tendency was low. Among medical interns, the distribution on a Big-Three Perfectionism Scale showed that the degree of their attachment to rigid, self-critical, and narcissistic types of perfectionism was at an average level, including general. Practitioners showed an average level of tendency only to the rigid type of perfectionism, as for the self-critical and narcissistic types, the level was low, as well as the general one, which except for the average tendency to rigid perfectionism can be assessed as hypoperfectionism.

Conclusions. 1. Neither interns nor participants in training in the specialty "Anesthesiology" in general are supporters of hyper-perfectionism. 2. Intern doctors showed a rather high tendency to "concern over mistakes", which is explained by the fact that they are not yet specialists, but only learning. This can be assessed as constructive perfectionism. 3. Practitioners are prone to "self-oriented perfectionism", which involves high self-demand. This is explained by the specificity of the work of anesthesiologists (surgeons work in a team, an anesthesiologist - alone), who must first of all rely on themselves, and only then on the help of others. 4. Hypoperfectionism of the self-critical and narcissistic types in anesthesiologists with a certain length of work is associated with psychoprotective deviation of professional behavior, which excludes setting extremely high demands for the results of one's work, since the self-critical type implies a high probability of psycho-emotional burnout syndrome, and the narcissistic type sometimes leads to medical errors.

postgraduate studies

interns

training participants

perfectionism

Modern societal and social transformations are accompanied by significant dynamics of basic personality characteristics: clip thinking is spreading, the ability to adapt to stress is undergoing serious changes, optimization of psychological resourcefulness, empathic abilities, prioritization of motivation, the phenomenon of procrastination, conflict competence, etc. As a result, there are problematic issues of providing modern higher medical education for future specialists [1], one of which is the problem of addictive behavior, the most common predictor of which is perfectionism.

Perfectionism today is understood as an individual's psychological conviction that the ideal can and should be achieved, and the imperfect result of work (physical, intellectual, etc.), in their opinion, has no right to exist [2]. The progressive spread of perfectionism in modern society is connected with the popularization of neoliberalism. According to this philosophical direction, confrontation between individuals and competitive individualism can contribute to the achievement of ideals. That is, if everyone manages to surpass everyone else, it will turn into a social good for society. However, this does not determine success, but, on the contrary, is a direct path to nervous distress [3].

Perfectionism is a multidimensional trait that is important for understanding adaptation. Pulitzer Prize winner Sylvia Plath vividly illustrated the destructiveness of perfectionism, calling this phenomenon a demon in her personal writings that ultimately led her to commiting suicide at the age of 30. She was very self-critical, worried about mistakes, doubted her abilities and was sure that others demanded perfection from her [3].

An example of a perfectionist who directed his pursuit of perfection onto others in a grandiose, hypercritical way, was Apple co-founder Steve Jobs. After his death in 2011, according to biographical accounts, it became common knowledge that he expected perfection from others in a legitimate, demanding and hypercritical manner. His employees could be instantly demoted "from hero to zero" for even minor mistakes. Despite S. Jobs's perfectionism (strict demands for flawless work from others) and his narcissism (entitlement and grandiose sense of superiority over others), his personality does not fit neatly into any model of perfectionism. Modern research divides pathological narcissism into two subtypes: grandiose narcissism (self-aggrandizement, arrogance, power, and exploitation) and vulnerable narcissism (entitlement and grandiose expectations of oneself and others with a clear idea of hopelessness, narrowness, and isolation) [3].

But since everything is learned by comparison, perfectionists are much more prone to addictive behavior than other people. If we resort to the extreme manifestations of such a mental phenomenon, then initially a false opinion is formed about a perfectionist, that such a person does not have the leadership qualities and he can only be a fairly conscientious performer. Another common belief is that these individuals with some obsessive idea that "there is no limit to perfection" is not self-sufficient, because such a goal is practically unattainable as infinity, "it is impossible to hug a baobab tree" and so on. In this pseudo-philosophical polemic, both the first and the others are probably wrong. Thus, on the one hand, a person's desire for perfection in his own activity can be considered as a positive personal trait of character and identified with a strong motivation to achieve success, which is a positive feature of personal growth [2], on the other hand, extensive literature associates perfectionism with a number of negative implications for mental health: correlational analysis showed that self-critical perfectionism and extraversion, agreeableness, conscientiousness, and neuroticism were significantly associated with burnout [4]. Paradoxically, this can become another vicious circle, as recent research shows that perfectionistic concerns are negatively related to academic achievement, which can increase perceptions of failure and inadequacy [5]. Idealistic thoughts can change mental health: either improve it or threaten it [6].

Perfectionism has polar characteristics that can be mutually transformed. With "normal" perfectionism, a person is motivated to self-development, is able to derive moral satisfaction from work and distinguish between the concepts of personal and situational perfection. "Neurotic" perfectionism is characterized by an obsessive thought about the general lack of perfection of the results of one's own and social activities, then any matter causes a stressful situation for a prone person with negative experiences and even suicidal thoughts [6, 7]. In Japan, where workers cannot afford to finish their work without giving it an ideal degree of perfection, a special term "yaroyisatsu" (suicide due to stress at work) appeared [8].

Perfectionism is understudied among physicians, but the results of a few studies suggest that addressing the systemic and individual factors that encourage perfectionism is warranted and can significantly reduce the risk of emotional burnout. Thus, emergency physicians report significantly lower emotional burnout than physicians who do not work in emergency situations [4].

According to Craiovan R.M. research (2014), doctors and nurses with high perfectionistic tendencies are more likely to develop burnout symptoms (emotional exhaustion and depersonalization) and, to some extent, to develop psychopathological symptoms (somatization, anxiety, and depression). Perfectionism, stress and exhaustion in the medical field can negatively affect the effectiveness of medical care for patients [9].

Anesthesiologists, in particular, have certain personality traits that can be problematic when working with patients. To a greater extent than other physicians, they tend to avoid possible harm, which manifests itself in increased anxiety, pessimism, and doubt. Modern psychological studies have shown that anesthesiologists are more emotionally stressed and less self-confident than representatives of the average population, but are significantly more conscientious, which may be related to perfectionism [10].

Personal and social types of perfectionism are distinguished, which are divided by components into positive, as a result of the connection of positive reinforcement with previous perfectionist behavior, and negative - as a consequence of negative reinforcement [8]. A positive perfectionist strives to achieve his goals, which requires perseverance. He tries to use mature defense mechanisms by strengthening individual capabilities (pragmatism, acceptance of personal limitations, optimism, etc.) [6].

Perfectionism is a personality trait of interest in the medical field, not only because medical students exhibit higher levels of perfectionism than their peers in other fields of study, but also because it is associated with anxiety, depression, burnout and emotional distress [5].

Returning to the empirical data, a recent large meta-analysis found a significant increase in medical students' levels of perfectionism and their belief that others are more demanding of them than previously. This has led experts to consider perfectionism a serious, even deadly, epidemic in modern Western societies. Thus, studies have shown that an increasingly competitive society exposes dysfunctional perfectionists to a high risk of burnout and psychological distress, but also that self-compassion can be a powerful "antidote" to this social "poison" [5, 11].

The purpose of the study: Our goal was to consider this psychological phenomenon in the community of anesthesiology interns, who have now been undergoing sufficient training at our department for three years, in comparison with the indicators of practicing doctors, to investigate its negative and positive features, their prevalence and dynamics, and generally to determine whether this phenomenon is as dangerous for the educational medical process and for mental and physical health, as certain authors assure [4, 5, 8].

The Big-Three Perfectionism Scale was proposed by Smith M.M. with co-authors in 2016 [12]. It is devoid of the disadvantages of previously existing evaluation options. The authors considered this phenomenon as a multidimensional construct that includes three components: rigid, self-critical, and narcissistic types of perfectionism [4, 13, 14]. We conducted an anonymous survey of 92 medical interns and 124 participants of short-term training in the specialty "Anesthesiology" according to the Smith M.M. questionnaire, which consists of 45 statements, and perfectionism is presented as a multidimensional construct that combines three basic types of perfectionism: rigid, self-critical and narcissistic. The rigid type combines the scales "self-oriented perfectionism" and "self-worth contingencies"; self-critical - "concern over mistakes", "doubts about actions", "self-criticism" and "socially prescribed perfectionism"; narcissistic - "other-oriented perfectionism", "hypercriticism", "entitlement" and "grandiosity" [12].

The analysis of the obtained results was carried out using descriptive statistics methods with determination of the mean value and standard deviation. Calculations were performed using the Microsoft Excel 2016 software package.

The research was conducted in accordance with the 1964 Helsinki Declaration and approved by Dnipro State Medical University ethics committee (Protocol No.9 from May 24, 2023).

The results of the analysis of anonymous questionnaires are shown in Table 1.

Table 1 Levels of manifestation of tendency to perfectionism of interns and practicing doctors in the specialty "Anesthesiology"

Scale	Interns			Physicians
Scale	M (SD)	Min	Max	M (SD)	Min	Max
Self-oriented perfectionism	14,81** (3,11)	11	18	16,12*** (2,91)	13	19
Self-worth contingencies	17,52** (2,12)	8	22	17,21** (2,12)	5	25
Concern over mistakes	17,31*** (2,34)	7	25	13,91** (2,41)	9	25
Doubts about actions	11,42** (3,11)	6	14	10,33** (3,02)	6	16
Self-criticism	13,53** (2,43)	5	20	11,12* (2,14)	8	15
Socially prescribed perfectionism	9,82** (1,99)	4	18	7,51* (1,12)	4	12
Other-oriented perfectionism	11,83* (3,11)	6	22	8,93* (2,81)	5	15
Hypercriticism	9,21** (1,88)	4	18	7,01* (2,31)	4	13
Entitlement	8,42** (2,12)	4	16	6,61* (1,12)	4	9
Grandiosity	10,53** (3,12)	4	16	7,22* (2,52)	4	11

* low level

** medium level

*** high level

A high level of perfectionism was found in medical interns on the "concern over mistakes" scale, which is seen as a tendency to overreact negatively to perceived failures and mistakes. Young colleagues who are still studying thus try to avoid the negative consequences of their activities, which can have both positive and negative results [13, 14].

Anesthesiologists with some experience in practical work, on the contrary, showed a high level on the "self-oriented perfectionism" scale, among individual respondents the results were distributed almost equally as high and average (near the upper limit). People susceptible to it make impossible demands on themselves, they carefully analyze every smallest component of their actions in search of errors. In the case of an "imperfect" result of their work, anesthesiologists feel guilty, even if they themselves could not influence the development of events. This type of perfectionism is characterized by excessively harsh self-criticism, a tendency to emotional burnout, and a constant feeling that one's own expectations are not justified. This type is associated with various components of social adjustment and may be accompanied by anxiety and mild depression [14, 15].

According to other scales, a high level of tendency to perfectionism was not determined in any respondent.

The medical interns demonstrated an average level of tendency towards perfectionism on all other scales, with the exception of "other-oriented perfectionism" where the level of the indicator was low. That is, the respondents of this research group are not overly picky, have no problems with trust, shifting blame to others, and hidden hostility [15].

Practitioners showed an average level of tendency towards perfectionism on the scales "self-worth contingencies", "concern over mistakes", and "doubts about actions", according to all other indicators the level of tendency was low. Thus, too harsh self-criticism, demanding perfection and being picky about others, confidence in their incomparability, pretentiousness, and cranky confidence that everyone owes them something are not characteristic of them at all [13, 14].

This means that doctors with practical experience have already gone through a certain school of life, which made them much more socially adaptable than future anesthesiologists, who are primarily concerned with their own mistakes.

The distribution of research subjects by basic types of perfectionism is shown in fig. 1.

According to the generally accepted psychotypes, individuals are divided into hyper-perfectionists, constructive perfectionists, destructive perfectionists and hypo-perfectionists [2].

Rigid perfectionism is self-demanding to flawless work; it contains the boundaries of self-oriented perfectionism and strict self-esteem, reflecting personal strivings for perfection, as well as the perception of one's self-esteem as dependent on meeting personal standards of perfection. In both research groups, signs of rigid perfectionism were at an average level.

Self-critical perfectionism is characterized by anxiety with an overly negative reaction to perceived mistakes and failures, pervasive insecurity and dissatisfaction with one's work, overly self-critical responses to perceived lack of perfection, and a sense that others demand perfection from oneself [4]. Self-critical perfectionism predicts the development of emotional burnout both directly and indirectly, due to the effect of low self-compassion [5]. The results of the analysis showed an average level of self-critical perfectionism among medical interns, and a low level among general practitioners.

Narcissistic perfectionism is defined as a tendency to demand perfection from others in a grandiose, hypercritical and domineering manner [5]. According to this basic type, interns showed an average level, and general practitioners showed a low level.

According to generally accepted psychotypes, individuals are divided into hyper-perfectionists, constructive perfectionists, destructive perfectionists and hypo-perfectionists [2].

Among medical interns, the distribution on a Big-Three Perfectionism Scale showed that the degree of their attachment to rigid, self-critical, and narcissistic types of perfectionism was at an average level, including general. Accordingly, they are able to formulate achievable goals and adjust them depending on the situation, while allowing the possibility of both success and failure, but maintain a very high level of optimism [16, 17]. This can be assessed as constructive perfectionism.

At the same time, practicing physicians showed an average level of tendency only to the rigid type of perfectionism, as for the self-critical and narcissistic types, the level was low, as well as the general one, which, with the exception of the average tendency to rigid perfectionism, can be assessed as hypo-perfectionism.

1. Neither interns nor participants in training in the specialty "Anesthesiology" in general are supporters of hyper-perfectionism.

2. Intern doctors showed a rather high tendency to "concern over mistakes", which is explained by the fact that they are not yet specialists, but only learning. This can be assessed as constructive perfectionism.

3. Practitioners are prone to "self-oriented perfectionism", which involves high self-demand.This is explained by the specificity of the work of anesthesiologists (surgeons work in a team, an anesthesiologist - alone), who must first of all rely on themselves, and only then on the help of others.

4. Hypoperfectionism of the self-critical and narcissistic types in anesthesiologists with a certain length of work is associated with psychoprotective deviation of professional behavior, which excludes setting extremely high demands for the results of one's work, since the self-critical type implies a high probability of psycho-emotional burnout syndrome, and the narcissistic type sometimes leads to medical errors.

Conflict of interest. The authors declare that there is no conflict of interest and no financial interest in the preparation of this article.

Funding. The research has no external funding.

Authors contributions:

O.V. Kravets – Conceptualization, Methodology, Writing - Review & Editing

V.V. Yekhalov – Conceptualization, Methodology, Formal Analysis, Writing - Original Draft

D.M. Stanin – Resources, Writing - Review & Editing

D.A. Krishtafor – Resources, Writing - Review & Editing

D.A. Martynenko – Translation

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No competing interests reported.

Perfectionism in the anesthesiological environment

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Abstract

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Introduction

Materials and Methods

Results and Discussion

Conclusions

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References

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