Intra-operative decision making by ophthalmic surgeons.

Area of Science:

• Ophthalmology
• Cognitive Psychology
• Surgical Decision Making

Background:

• Intra-operative risks are frequent and significant, yet research often overlooks them, focusing instead on peri-operative care.
• Understanding surgeons' cognitive processes during surgery is crucial for improving patient safety and outcomes.

Purpose of the Study:

• To examine the intra-operative decision-making and risk management strategies of ophthalmic surgeons.
• To explore potential differences in cognitive processes influencing these decisions.

Main Methods:

• Critical Decision Method interviews were conducted with 12 consultant ophthalmologists.
• Surgeons recalled intra-operative cases, detailing key decisions, decision-making styles, and risk management approaches.
• Interview transcripts were coded for decision-making strategies (analytical, recognition-primed decision, creative, rule-based) and risk management factors (threats, assessment, tolerance).

Main Results:

• Key intra-operative decisions were equally split between rapid, intuitive thinking (50%) and deliberate, analytical comparison (50%).
• Rule-based or creative decision-making strategies were not employed by the surgeons.
• Risk management involved threat perception and assessment, significantly influenced by individual risk tolerance, particularly when a stopping rule was needed. Time pressure did not appear to affect risk management.

Conclusions:

• Ophthalmic surgeons utilize either intuitive or analytical thinking for critical intra-operative decisions.
• Individual personality traits seem to influence ophthalmic surgeons' risk assessment, risk tolerance, and overall decision strategies.