The long game: Evolution of clinical decision making throughout residency and fellowship

• Published in: The American journal of surgery Vol. 223; no. 2; pp. 266 - 272
• Main Authors: Woelfel, Ingrid A., Smith, Brentley Q., Salani, Ritu, Harzman, Alan E., Cochran, Amalia L., Chen, Xiaodong (Phoenix)
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022; Elsevier Limited
• Subjects: Autonomy; Clinical Competence; Clinical Decision-Making; Curricula; Curriculum; Datasets; Decision analysis; Decision making; Fellowships and Scholarships; Focus groups; Gynecology; Humans; Internship and Residency; Interviews; Obstetrics; Patients; Qualitative analysis; Secondary analysis; Skills; Surgeons; Surgery; United States > US; Ohio; Clinical decision-making; Autonomy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.03.023

The purpose of this study was to explore the trajectory of autonomy in clinical decision making. We conducted a qualitative secondary analysis of interviews with 45 residents and fellows from the General Surgery and Obstetrics & Gynecology departments across all clinical postgraduate years (PGY) using convenience sampling. Each interview was recorded, transcribed and iteratively analyzed using a framework method. A total of 16 junior residents, 22 senior residents and 7 fellows participated in 12 original interviews. Early in training residents take their abstract ideas about disease processes and make them concrete in their applications to patient care. A transitional stage follows in which residents apply concepts to concrete patient care. Chief residents re-abstract their concrete technical and clinical knowledge to prepare for future surgical practice. Understanding where each learner is on this pathway will assist development of curriculum that fosters resident readiness for practice at each PGY level. [Display omitted] •Clinical judgment develops in distinct phases as residency progresses.•Residents begin with an abundance of abstract knowledge about patient care.•Mid-level residents have a strong but concrete understanding of surgical disease.•Chiefs prepare for practice with re-abstraction of concrete disease knowledge.•The tandem advancement of clinical and operative judgement is essential for competence.