A tool for training in decision making for emergency general surgery--explicit training is possible through...

Area of Science:

• Medical Education
• Surgical Training
• Health Services Research

Background:

• Emergency general surgery requires improvement within the UK's National Health Service.
• A novel decision-making tool was developed to assess and enhance surgical trainee performance in emergency settings.

Purpose of the Study:

• To evaluate the feasibility of a new tool in assessing surgical decision-making among trainees.
• To identify differences in decision-making accuracy across various surgical training levels.

Main Methods:

• A decision-making tool was integrated into patient clerking for emergent surgical admissions.
• Decisions were categorized (discharge, observation, operative) and compared to "ideal decisions" determined by independent clinicians.
• Data analyzed by comparing the percentage of correct decisions and deviations from ideal decisions across surgeon grades.

Main Results:

• The tool was used for 136 emergent surgical admissions over two months.
• Interns made significantly fewer "ideal" decisions compared to attending surgeons (45% vs. 70%, p=0.0001).
• Interns were more likely to opt for observation/investigation, while attending surgeons favored operating or discharging patients.

Conclusions:

• Significant disparities in decision-making quality exist between interns and attending surgeons, highlighting a learning curve.
• The tool explicitly facilitates discussion and aids in decision-making training for surgical trainees.
• The study demonstrated internal consistency and feasibility of the tool in assessing surgical decision-making.