When surgeons face intraoperative challenges: a naturalistic model of surgical decision making

• Published in: The American journal of surgery Vol. 205; no. 2; pp. 156 - 162
• Main Authors: Cristancho, Sayra M., Ph.D, Vanstone, Meredith, Ph.D, Lingard, Lorelei, Ph.D, LeBel, Marie-Eve, M.D, Ott, Michael, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2013; Elsevier Limited
• Subjects: Adult; Bone surgery; Decision Making; Emergency procedures; Female; Grounded theory; Humans; Interviews; Intraoperative challenges; Intraoperative Period; Laparoscopy; Male; Middle Aged; Models, Theoretical; Operating Rooms; Physicians; Problem Solving; Qualitative research; Reconciliation; Specialties, Surgical; Surgeons; Surgery; Surgical Procedures, Operative; Task analysis; Intraoperative challenges; Decision making; Reconciliation
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2012.10.005

Abstract Background Surgery is an environment in which being an expert requires the ability to manage the unexpected. This feature has necessitated a shift in surgical decision-making research. The present study explores the processes by which surgeons assess and respond to nonroutine challenges in the operating room. Methods We used a grounded theory methodology supported on intraoperative observations and postoperative interviews with 7 faculty surgeons from various specialties. A total of 32 cases were purposively sampled to compile a dataset of challenging situations. Results Thematic data analysis yielded 3 main themes that were linked in a cyclic model: assessing the situation, the reconciliation cycle, and implementing the planned course of action. These elements were connected through 2 points of transition (ie, active and confirmatory reconciliation), during which time the surgeons continue to act although they may change the course of their action. Conclusions The proposed model builds on existing theories of naturalistic decision making from other high-stakes environments. This model elaborates on a theoretic language that accounts for the unique aspects of surgery, making it useful for teaching in the operating room.