Mapping surgical practice decision making: an interview study to evaluate decisions in surgical care

American Journal of Surgery
Ros JacklinCharles Vincent

Abstract

Training surgeons in vital decision-making skills remains unstructured. We aimed to map a process of care from the perspective of surgical decision making and test whether it could be deconstructed into an accessible format for trainees. Semistructured interviews were conducted with 10 experienced surgeons by using symptomatic gallstones as a clinical exemplar. Data were analyzed by 2 independent reviewers to identify decisions, cues, and decision rules, with further thematic analysis of selected decisions. Eighteen specific decisions were identified in 6 or more transcripts, with significant interreviewer reliability (Spearman's rho = .65, P = .004, n = 17, 1 outlier excluded). These were arranged to form a "decision map." Two main decision strategies were described. We identified and mapped the decisions made in the care of patients with symptomatic gallstone disease. The interpretation of competency at any procedure should include the surgeon's ability to make appropriate decisions at all stages of patient care.

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Citations

Mar 1, 2012·International Urology and Nephrology·Hamid AbboudiProkar Dasgupta
Jan 5, 2010·International Journal of Surgery·Sonal Arora, Nick Sevdalis
May 25, 2012·Academic Medicine : Journal of the Association of American Medical Colleges·Dana K Andersen
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May 23, 2012·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·K M AugestadUNKNOWN International Rectal Cancer Study Group (IRCSG)
Jul 31, 2013·The British Journal of Ophthalmology·Keryn PauleyAugusto Azuara-Blanco
Feb 19, 2014·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·M KorenkovH Zühlke
Jan 22, 2013·American Journal of Surgery·Sayra M CristanchoMichael Ott
Apr 12, 2011·American Journal of Surgery·Keryn PauleyGeorge Youngson
Aug 20, 2010·Surgical Oncology·B LambN Sevdalis
Jun 14, 2015·American Journal of Surgery·Sayra M CristanchoRichard Novick
Jun 19, 2008·American Journal of Surgery·Nick SevdalisCharles A Vincent
Sep 4, 2014·ANZ Journal of Surgery·Jeff BezemerRoger Kneebone
Apr 16, 2010·American Journal of Surgery·Peter SzatmaryNick Sevdalis
Jan 7, 2011·Annals of Surgery·Michael KorenkovStefan Sauerland
Feb 12, 2019·The Journal of Hand Surgery, European Volume·Vanessa I RobbaClaire Diver
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Dec 12, 2018·Khirurgiia·A V AlekberzadeN N Krylov
Mar 17, 2021·World Neurosurgery·Leeat GranekJonathan Roth

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