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When surgeons face intraoperative challenges: a naturalistic model of surgical decision making
Sayra M Cristancho1, Meredith Vanstone, Lorelei Lingard
1Department of Surgery, Department of Medical Biophysics, Centre for Education Research & Innovation, Western University, London, ON, Canada. Sayra.Cristancho@schulich.uwo.ca
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.
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