The Anatomy of Gossip: Dissecting Dynamics and Impacts in Surgical Residency

Introduction

Gossip, defined by social scientists as “evaluative talk about an absent third party,” is pervasive in society (1, 2). A 2019 study randomly sampled audio segments from the conversations of over 450 people during a three-day period and found that they spent 52 minutes per day gossiping on average (3). Others estimated gossip to be even more prevalent in daily interactions (4, 5). In fact, anthropologist Dunbar stated, “Gossip is what makes society as we know it” (6). While the intentions behind gossip vary, these conversations build and maintain the social networks that make us human (7).

Gossip has yet to be empirically studied in general surgery training programs. Redelmeier et al. illustrated both positive (e.g., maintains a sense of belonging and inclusion) and negative (e.g., propagates harmful misinformation) impacts of gossip within a general hospital setting (8). Thomas & Rozell described positive and negative effects of gossip on nurses and potential downstream impacts on patient care (9). Ultimately, Chaikof et al. calls for acceptance of gossip as a normal part of interpersonal healthcare dynamics and highlights the importance of further study (10). General surgery residents frequently face high-stakes clinical situations, which mandate communication with patients, families, attending surgeons, nursing staff, and each other (11, 12). Given this high frequency of interpersonal interactions, gossip not only occurs in, but likely affects the surgical learning environment. Large survey-based studies demonstrate that surgery residents suffer from burnout at alarming rates, which is impacted by communication and organizational culture (13, 14). Calls for wellness initiatives in surgery training programs could be informed by an analysis of the social interactions—including gossip— which residents experience on a daily basis (15).

In this study, we sought to explore gossip in surgical residency through semi-structured interviews with residents across the U.S. The primary aims were to 1) construct a process model for how and why gossip occurs in general surgery residency programs, 2) uncover the positive and negative impacts of gossip, and 3) determine how to enhance the benefits of gossip while curtailing its drawbacks.

Methods

This project was deemed exempt from full review by the Institutional Review Board. This study followed the Consolidated Criteria for Reporting Qualitative Research guidelines (Appendix A) (16, 17).

Participants

Author JCL invited members of the Collaboration of Surgical Education Fellows (CoSEF), a multi-institutional, resident-led group of surgical education fellows, to join this initiative (18). Collaborators recruited four participants from their institution through purposive sampling. All categorical general surgery residents at their institutions met inclusion criteria. Author JCL conducted all interviews. Due to the sensitive nature of these interviews, no participants from JCL’s home institution were included. The interviewer emphasized that participation was entirely voluntary, and responses would be deidentified. Participants consented to participate verbally prior to their interview.

Semi-Structured Interviews

Authors JCL & BAAW created a semi-structured interview guide using an attributional process model of workplace gossip as a framework (Appendix B). This theory posits that people contextualize gossip by considering both internal (e.g., personality attributes) versus external (e.g., situational attributes) factors (19). JCL piloted the interview guide iteratively with CoSEF members. First, participants described their definition of gossip before the interviewer provided the academic definition (“evaluative talk about an absent third party”) to establish a consistent, shared understanding for the remainder of each interview (1, 2). The interviewer then asked participants for instances of gossip that they had recently heard and shared with others and prompted exploration of intent, purpose, and impact for each instance. Interviews occurred from July 2, 2023, to October 5, 2023 via Zoom™ videoconferencing, which lasted 15-30 minutes. Only author JCL and the participant were present for interviews. No participants were interviewed more than once. Each interview was transcribed using Zoom™. Collaborating authors each manually reviewed and anonymized transcripts from conversations who were not from their own institution. Participants were provided their anonymized transcript and given the opportunity to provide clarifications or redactions.

Analytic Approach

We conducted a reflexive thematic analysis of transcripts using a grounded theory approach (20, 21, 22). First, authors JCL and BAAW read four transcripts independently to gain familiarity with the data. These two authors met to discuss patterns and develop an initial codebook based on the attributional process model of workplace gossip (19). After both authors independently coded the first four interviews, it became clear that many recurring concepts were not captured by this initial approach. Therefore, coders moved to open coding. They met again to discuss codes and consolidate a final codebook. Once authors JCL and BAAW agreed on code definitions, they divided the transcripts and coded them independently using the finalized 48-item codebook (Table 1) (23). After coding was complete, all authors met to construct themes via collaborative discussion. Study participants were provided with the final themes and given an opportunity to comment. In order to establish trustworthiness, researchers engaged with the data over nine months, participated in peer debriefing, and vetted themes as a team (24). Coding was organized using Microsoft Excel (Version 2312, Redmond, WA, USA, 2021).

Reflexivity

The first author and solo interviewer (JCL) is a male general surgery resident with an MD who holds an undergraduate degree in Psychology. During the study period, he was pursuing a Master of Health Professions Education with coursework in and had prior experiences using qualitative methods (25). He regularly engaged in feedback sessions with author BAAW regarding his interview techniques. To promote honesty and vulnerability given the sensitive nature of gossip, he emphasized confidentiality prior to each interview. During each interview, he documented his own reflections.

Authors JCL and BAAW performed transcript coding. BAAW is a female Associate Professor of Health Professions Education with an EdD and MA whose career has focused on teams in medicine. She teaches qualitative methodology courses to Masters and Doctoral students. As a non-surgeon, she carried fewer preconceptions about gossip among surgical residents, which provided a different lens through which to carry out thematic analysis. The remainder of the study team included a gender-diverse group of clinical general surgery residents ranging from PGY-1 through PGY-6 from nine institutions across the U.S. who were able to contextualize participant stories through their own experiences.

Results

Participant Demographics

Thirty-six general surgery residents participated in interviews (Table 2). Nine academic training programs were represented across each U.S. geographic region (Northeast=1; Midwest=2; South=2; West=4). The mean participant age was 30.5 years. Twenty-five were females (69%). Twenty-six were white (72%). While each post-graduate year was represented, the majority were senior (PGY 3-5) residents (87%).

Gossip Process Model

Forty-eight codes were organized into six categories and eleven subcategories (Table 1), which were used to construct a process model describing how gossip occurs in surgical residency (Figure 1). First, a gossip sender observes an event (e.g., poor performance on a task) involving the gossip target (e.g., co-residents, attendings). The gossip sender, with a specific motive (e.g., to make meaning out of a situation), describes this event to the gossip recipient at a particular time and place (e.g., at shift change). The gossip recipient participates in or resists the gossip conversation. The recipient can then perform several actions: 1) do nothing; 2) seek resolutions to the situation; 3) perpetuate the gossip; or 4) give feedback to, support, or condemn the gossip target directly. They also may or may not change their perception of the gossip target or sender. Program culture (e.g., transparency, hierarchy) influences each step of this process.

Overarching Themes

1.      The definition of gossip is elusive yet can include both positive and negative connotations. Although most participants defined gossip as negative talk, several gave examples of gossip as positive talk: “I gossip about people in a positive way. I'm frequently like, “Oh, my gosh. This person [is] so cool. I did this case with her, and she's so smart . . . You want to do cases with her.” (P22) Because of the negative connotation of gossip in popular culture, some participants did not consider negative content with positive intent as gossip, blurring the lines between “positive” and “negative” gossip: “If someone had a negative experience with the individual [and wanted to discuss it], I don't see that as gossip, because they’re trying to talk through a problem with a friend.” (P14)  

2.      Gossip contributes durably to one’s reputation within a program. Typically, participants described the potential for negative reputations to develop early in residency: “Once you establish a reputation with the faculty, it sticks, and it's really hard to shake. There are some specific examples of residents who didn't get off on the right foot when they started as interns, but really turned things around. But, they get treated a little differently.” (P23)

3.      Gossip can be used as a form of instruction. Informal conversations about others’ mistakes can be used as learning opportunities, although the lesson may be incomplete: “[Gossip is] like M&M. It's really helpful for us . . . you hear about these negative things that have happened in the past and it does make you more aware of the pitfalls that you could run into. But... with gossip, the person who actually made the mistake doesn't get to actually share what they learned from it, which is probably the most important piece of it all.” (P6)

4.      Gossip flourishes in environments that lack transparency and among those experiencing burnout. When decisions are made without explanation to those directly impacted, gossip inevitably occurs, especially when people feel overworked: “[I was on a team with a co-resident] who got pulled out of clinical rotation. . . No one got an explanation. Of course we're all a little bit peeved because it sucks to have your schedules changed last minute, especially getting pulled to cover the worst rotations, losing days off, and in some cases … almost… violating duty hours. Almost instantaneously, people identified . . . this resident . . . and people were making up whatever stories [about their absence that] made sense.” (P13) 

5.      Gossiping across a hierarchy may force those lower on the hierarchy into uncomfortable situations. Some residents described feeling unable to stand up to gossip from attendings: “There's such a power dynamic between attending staff, fellows, residents… if I were in another setting I would have said ‘that's not professional.’ But it doesn't really feel like you can say that in surgery to your attending.” (P29). Furthermore, sharing gossip about a superior’s performance may influence power dynamics: “It will be me and a medical student, and [an attending] would ask me about the [junior residents] . . . how they’re doing. It was well intentioned, but if I were the medical student, I’d feel kind of awkward. If I were the intern, I don't know that I would want the medical student knowing my deficiencies necessarily.” (P21)  

6.      Remaining mindful of gossip’s potential impact can improve culture. Appreciating the complexity of situations and assessing the potential impact on others as a gossip sender and recipient can mitigate negative effects: “[Every] story has two sides. When I am both hearing and sharing gossip, I try to keep in mind how the individual that's being talked about would respond to the situation again. Would they feel comfortable in this [conversation]? And then I try to react accordingly.” (P25)

7.      Gossip can build or destroy trust. Sharing gossip with others can signal to the recipient that they are worthy of being trusted with information: “He must trust me or must see me as a friend, because he's willing to share this gossip with me and is willing to let me in [on the gossip]. It made me feel like I had a bond with him.” (P27) When hearing gossip from a superior, the gossip recipient may view this as a breach of power and perceive them as untrustworthy: “It's one thing I think, for somebody who's your peer to share things with you. I think it's something entirely different when somebody who's in a position of power shares something like that with you, especially something that the resident I'm sure told [this attending] in [confidence]. [This] made me think twice about sharing things with that [attending].” (P11)

Discussion

Through qualitative semi-structured interviews, we rigorously deconstructed gossip in surgical residency. We built a process model for gossip in surgical residency and described seven overarching themes. These results provide a better understanding of the training environment and insight into improving the gossip culture. Gossip is innate to any place where humans work together; it cannot be removed or destroyed (5). While the content of the gossip may be positive or negative in valence, the intentionality of sharing the message is much more critical (26). For example, sharing that a resident is struggling and in need of peer support is negative gossip. However, if sharing this information with others is intended to or solicits peer support, the outcome is positive. Participants emphasized the importance of promoting gossip that can bring about positive change (pro-social) and decreasing hurtful, harmful, and unproductive gossip (anti-social). We have identified several ways to achieve this objective at the institutional and individual level.

Culturally driven elements of an institution including transparency and burnout influence gossip. Surgery residents highlight that gossip occurs when the truth is withheld. Good surgical leadership includes transparent communication (27). Often formal transparency involves sharing information after decisions have already been made whereas gossip circulates in real time (28). Informal gossip democratizes information, thereby making it more available to the general population (29). Real-time transparency from the department level may reduce unnecessary gossip by providing truth. Many situations (e.g., a resident struggling) require a balance between transparency and privacy. In an argument for transparency, residents expressed that knowing the reason for sudden schedule changes to cover for a co-resident improves willingness to help. Additionally, through gossip, residents will likely find out regardless of efforts from the program to hide this information. When matters of a struggling resident will impact others directly, discussing a situation dissemination plan with the struggling resident may reduce factually incorrect and anti-social gossip. Nevertheless, residents must maintain their right to privacy should they want it. In addition to encouraging transparency, addressing burnout will likely decrease anti-social gossip. Burnout—a complex syndrome of emotional exhaustion and depersonalization—runs rampant amongst general surgery residents (30). In the hospital setting, anti-social gossip is associated with burnout (31). Improving resident wellness through multilevel approaches may decrease anti-social gossip (15, 32).

Gossip, power, and hierarchy are interconnected. In this study, surgery residents described knowing and using gossip as social capital that influences one’s power within the program. Undeniably, gossip can be weaponized; information about others can be selectively shared to negatively impact rivals’ reputations (33). However, high-frequency gossipers may be perceived as less powerful and less well liked by peers (34). Those who do not know any gossip may have been marginalized from a group and hold little social capital, whereas those who gossip regularly may be viewed as untrustworthy (2, 34). Selectively sharing gossip maximizes power (34). Notably, the status differential between the gossiper and recipient impacts gossip. Social exchange theory suggests that people gossip upward (with their superiors) to exert influence and gain resources from the person in higher power, while they gossip laterally (with their peers) for social support. Social scientists posit that downward gossip (with subordinates) may be less common because subordinates do not have useful social resources to offer (35). Nevertheless, hearing gossip from a superior may increase feelings of well-being, belonging, and empowerment according to commitment theory (36, 37). Ultimately, hearing gossip—particularly negative comments about a friend—from across a hierarchical differential can be uncomfortable and may damage relationships (38). In this study, residents are divided; some felt that gossiping with people higher on the hierarchy was a positive experience, while others described feeling coerced to participate in gossip with their supervisors. This difference in experiences likely depended on the gossip content and the gossip receiver’s relationship with the gossip target and the gossiper. While senior residents should consider sharing lighthearted gossip with their juniors to foster inclusion, they should avoid sharing sensitive information or gossip about a junior’s peers with them.

At the individual level, mindfulness and emotional intelligence are critical to reducing anti-social gossip. Mindfulness (being present in the moment to become less reactive and more responsive (39)) and emotional intelligence (having insight into yourself and others to more effectively manage your behavior and relationships (40)) center around emotional perception and considerate action. Both skills can be taught to surgical residents (12, 41). Rahmani produced a useful model for responding to anti-social gossip that invokes these concepts: initially, remain indifferent and do not propagate; second, consider the impacts of sharing this information from a variety of perspectives; third, weigh the pros and cons of taking action; finally, craft the appropriate action plan (42). The gossip process model developed in this study similarly describes the potential actions that a gossip recipient can take. Using discretion, seeking resolutions, and providing feedback to gossip targets are most likely to have a positive impact.

This study has key limitations. First, despite the diverse participant pool, there may be relevant concepts that were not well represented in these interviews. Second, residents more prone to gossip may have been more likely to agree to participate, and therefore may be overrepresented. However, the intent of this work was to develop a better understanding of the phenomenon rather than quantitatively describe gossip among surgical residents. Third, this study involved only general surgery residents; different specialties have different cultures and may therefore experience gossip differently (43). Finally, while residents gossip, their perspectives do not provide a complete story. Future work from our group aims to capture the attending surgeon perspective on gossip in surgical training programs.

Conclusion

Gossip is a complex social phenomenon that can harm or help surgical residents. Gossip cannot be removed from surgical training. Instead, programs should increase transparency, enhance resident wellness, build awareness of existing hierarchies, and improve resident emotional intelligence to encourage the known positive impacts of gossip.

Acknowledgements

The authors would like to thank Dr. Irene Yu for her artistic representation of the gossip process model.

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Table 1:

Table 2:

Appendix A

Appendix B