Thinking like an expert: surgical decision making as a cyclical process of being aware

Abstract Background Education researchers are studying the practices of high-stake professionals as they learn how to better train for flexibility under uncertainty. This study explores the “Reconciliation Cycle” as the core element of an intraoperative decision-making model of how experienced surge...

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Published inThe American journal of surgery Vol. 211; no. 1; pp. 64 - 69
Main Authors Cristancho, Sayra M., Ph.D, Apramian, Tavis, Vanstone, Meredith, Ph.D, Lingard, Lorelei, Ph.D, Ott, Michael, M.D, Forbes, Thomas, M.D, Novick, Richard, M.D
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.01.2016
Elsevier Limited
Subjects
Adaptation, Psychological
Awareness
Clinical Decision-Making - methods
Decision making
Education
Experts
Follow-Up Studies
Grounded Theory
Humans
Interviews as Topic
Intraoperative Period
Models, Psychological
Qualitative Research
Reconciliation cycle
Research methodology
Situation awareness
Studies
Surgeons - psychology
Surgery
Uncertainty
Situation awareness
Reconciliation cycle
Decision making
Surgery
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Summary:Abstract Background Education researchers are studying the practices of high-stake professionals as they learn how to better train for flexibility under uncertainty. This study explores the “Reconciliation Cycle” as the core element of an intraoperative decision-making model of how experienced surgeons assess and respond to challenges. Methods We analyzed 32 semistructured interviews using constructivist grounded theory to develop a model of intraoperative decision making. Using constant comparison analysis, we built on this model with 9 follow-up interviews about the most challenging cases described in our dataset. Results The Reconciliation Cycle constituted an iterative process of “gaining” and “transforming information.” The cyclical nature of surgeons’ decision making suggested that transforming information requires a higher degree of awareness, not yet accounted by current conceptualizations of situation awareness. Conclusions This study advances the notion of situation awareness in surgery. This characterization will support further investigations on how expert and nonexpert surgeons implement strategies to cope with unexpected events.
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ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2015.03.010