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

Area of Science:

• Surgical Education
• Clinical Decision-Making
• Health Professions Education

Background:

• Surgical training often lacks structured methods for teaching vital decision-making skills.
• The process of care from a surgical decision-making viewpoint requires mapping.
• Developing accessible formats for surgical trainees is a key objective.

Purpose of the Study:

• To map the process of care from the perspective of surgical decision-making.
• To deconstruct surgical decision-making into an accessible format for trainees.
• To enhance surgical training through structured decision-making analysis.

Main Methods:

• Conducted semistructured interviews with 10 experienced surgeons.
• Used symptomatic gallstones as a clinical exemplar for decision-making analysis.
• Analyzed interview data to identify decisions, cues, and decision rules, with thematic analysis.

Main Results:

• Identified 18 specific decisions with significant interreviewer reliability (Spearman's rho = .65, P = .004).
• Arranged identified decisions into a "decision map" for clarity.
• Described two main decision-making strategies employed by surgeons.

Conclusions:

• Successfully mapped decisions in the care of symptomatic gallstone disease patients.
• Emphasized that surgical competency assessment must include decision-making at all patient care stages.
• Highlighted the importance of structured decision-making frameworks in surgical training.