Incivility and the effect on the learning environment within operating rooms
DOI:
https://doi.org/10.5737/ornac18165Keywords:
learner, student, incivility, operating room, learning environmentAbstract
Incivility in the operating room (OR) is well documented, yet its effect on learning remains unclear. This narrative review explores how perioperative learners, including nursing, medical, anesthesia, and surgical technology students, experience incivility during OR clinical practicums and how it shapes the learning environment. Fourteen studies published from 2018–2025 were analyzed. Findings indicate that incivility contributes to anxiety, avoidance behaviours, reduced engagement, and weakened professional identity. The OR learning environment is further influenced by instructor support, the high-stress, high-risk nature of the setting, and the established OR culture. Gaps include the need for discipline-specific research, Canadian studies, and comparisons across healthcare systems. This study advocates for establishing a safe and supportive learning environment for learners in perioperative clinical practicums. This includes having consistent, supportive instructors; preparing students for the stressful operating room environment with timed simulations, cognitive rehearsals, and stress management training; and preventing the normalization and recurring cycle of incivility through clear policies and accessible reporting systems.
References
Abate, L. E., & Greenberg, L. (2023). Incivility in medical education: A scoping review. BMC Medical Education, 23(1), 24. https://doi.org/10.1186/s12909-022-03988-2
Babchenko, O., Scott, K., Jung, S., Frank, S., Elmaraghi, S., Thiagarajasubramanian, S., Rendell, V., Poore, S. O., Bentz, M. L., & Garland, C. B. (2020). Resident perspectives on effective surgical training: Incivility, confidence, and mindset. Journal of Surgical Education, 77(5), 1088–1096. https://doi.org/10.1016/j.jsurg.2020.04.002
Bruun, A. M. G., Valeberg, B., & Leonardsen, A.-C. L. (2022). Moral courage: Student registered nurse anesthetist experiences on the operating team. AANA Journal, 90(2), 121–126.
Canadian Centre for Occupational Health and Safety, G. of C. (2025, January 15). CCOHS: Violence and harassment in the workplace. https://www.ccohs.ca/oshanswers/psychosocial/violence/violence.html
Castillo-Angeles, M., Calvillo-Ortiz, R., Barrows, C., Chaikof, E. L., & Kent, T. S. (2020). The learning environment in surgery clerkship: What are faculty perceptions? Journal of Surgical Education, 77(1), 61–68. https://doi.org/10.1016/j.jsurg.2019.07.003
Chrouser, K. L., & Partin, M. R. (2019). Intraoperative disruptive behavior: The medical student’s perspective. Journal of Surgical Education, 76(5), 1231–1240. https://doi.org/10.1016/j.jsurg.2019.04.002
Cronin, P., Ryan, F., & Coughlan, M. (2008). Undertaking a literature review: A step-by-step approach. British Journal of Nursing, 17(1), 38–43. https://doi.org/10.12968/bjon.2008.17.1.28059
Eka, N. G. A., & Chambers, D. (2019). Incivility in nursing education: A systematic literature review. Nurse Education in Practice, 39, 45–54. https://doi.org/10.1016/j.nepr.2019.06.004
Fast, I., Villafranca, A., Henrichs, B., Kirby, M., Christodoulou, C., & Jacobsohn, E. (2020). Disruptive behaviour in the operating room is under-reported: An international survey. Canadian Journal of Anesthesia, 67(2), 177–185. https://doi.org/10.1007/s12630-019-01540-3
Hedlund, J., Blomberg, K., Hjelmqvist, H., & Jaensson, M. (2024). Student nurse anesthetists’ and supervisors’ perspectives of learning in the operating room: An integrative review. Journal of PeriAnesthesia Nursing, 39(2), 303-310.e8. https://doi.org/10.1016/j.jopan.2023.07.023
Johnsson, A., Månsson, J. S., & Pennbrant, S. (2023). Scaffolding for learning and establishing a professional identity: A qualitative descriptive study of nursing students’ experiences of learning with a student-centered supervision model based on patient-oriented care during clinical placement. Nordic Journal of Nursing Research, 43(3–4), 20571585231221257. https://doi.org/10.1177/20571585231221257
Kolstad, L. R., & Thyli, B. (2024). How do operating room nurse students experience the learning environment in the operating room? Inspira: Journal of Anesthesia & Intensive Care / Tidsskrift for Anestesi- Og Intensivsykepleiere, 19(1), 36–46. https://doi.org/10.23865/inspira.v19.6318
Maslow, A. H. (1970). Motivation and personality (2nd ed). Harper & Row.
Merola, K. (2024). Incivility in the operating room: A student’s experience. International Student Journal of Nurse Anesthesia, 23(1), 19–22.
Nordquist, J., Hall, J., Caverzagie, K., Snell, L., Chan, M.-K., Thoma, B., Razack, S., & Philibert, I. (2019). The clinical learning environment. Medical Teacher, 41(4), 366–372. https://doi.org/10.1080/0142159X.2019.1566601
Shen, H., Wang, H., Yan, L., Liu, W., Zhang, J., Zhou, F., Kong, S., & Deng, L. (2020). Incivility in nursing practice education in the operating room. Nurse Education Today, 88, 104366. https://doi.org/10.1016/j.nedt.2020.104366
Taylan, S., & Özkan, İ. (2022). “I felt alienated in the operating room”: A phenomenological qualitative study. Journal of PeriAnesthesia Nursing, 37(1), 63–68. https://doi.org/10.1016/j.jopan.2020.11.005
Taylan, S., Özkan, İ., & Yavuz Van Giersbergen, M. (2024). Nursing students’ operating room experiences: A qualitative metasynthesis. Journal of PeriAnesthesia Nursing, 39(5), 892–901. https://doi.org/10.1016/j.jopan.2023.12.029
Torralba, K. D., Jose, D., & Byrne, J. (2020). Psychological safety, the hidden curriculum, and ambiguity in medicine. Clinical Rheumatology, 39(3), 667–671. https://doi.org/10.1007/s10067-019-04889-4
Ulz, J. (2023, March 20). What is a research paradigm? Types and examples. https://researcher.life/blog/article/what-is-a-research-paradigm-types-examples/
Villafranca, A., Fast, I., & Jacobsohn, E. (2018). Disruptive behavior in the operating room: Prevalence, consequences, prevention, and management. Current Opinion in Anaesthesiology, 31(3), 366–374. https://doi.org/10.1097/ACO.0000000000000592
Villafranca, A., Hiebert, B., Hamlin, C., Young, A., Parveen, D., Arora, R. C., Avidan, M., & Jacobsohn, E. (2019a). Prevalence and predictors of exposure to disruptive behaviour in the operating room. Canadian Journal of Anesthesia, 66(7), 781–794. https://doi.org/10.1007/s12630-019-01333-8
Villafranca, A., Magid, K., Young, A., Fast, I., & Jacobsohn, E. (2019b). Abusive behaviour in Canadian and US operating rooms. Canadian Journal of Anesthesia/Journal Canadien d’anesthésie, 66(7), 795–802. https://doi.org/10.1007/s12630-019-01334-7
Zardosht, R., Moonaghi, H. K., Razavi, M. E., & Ahmady, S. (2020). Educational concern of surgical technology students in the operating room: A grounded theory study. Journal of Education and Health Promotion, 9(1), 58–58. https://doi.org/10.4103/jehp.jehp_348_19