How can surgeons facilitate resident intraoperative decision-making?
Katherine A Hill1, Mohini Dasari2, Eliza B Littleton2
1Department of Surgery, University of Pittsburgh Medical Center, F600 Presbyterian Hospital, Pittsburgh, PA, USA.
American Journal of Surgery
|July 8, 2017
Summary
Resident decision-making during surgery is improved by dialogue and safe struggle. Unanticipated findings and time pressures create barriers, highlighting the need for pre-operative discussions to enhance surgical training.
Area of Science:
- Surgical Education
- Medical Simulation
- Cognitive Science in Medicine
Background:
- Decision-making is crucial for surgical autonomy.
- Resident decision-making during laparoscopic cholecystectomy was explored.
Purpose of the Study:
- To investigate factors influencing resident decision-making in the operating room.
- To understand the role of attending surgeons in resident skill development.
Main Methods:
- Semi-structured interviews with attending surgeons and residents post-procedure.
- Analysis of 30 interviews from 15 laparoscopic cholecystectomy cases.
- Inductive thematic analysis of interview data.
Main Results:
- Facilitators included dialogue, safe struggle, and appreciation for retraction.
- Barriers comprised aberrant cases, anatomic uncertainty, and time pressure.
- Attending-resident dynamics revealed issues in transferring operative control.
Conclusions:
- Concept-driven feedback and reciprocal dialogue enhance intraoperative teaching.
- Unanticipated findings hinder resident decision-making.
- Pre-operative discussions are suggested to improve surgical training and decision-making.
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