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Complex decision making in medical training: key internal and external influences in developing practical wisdom
Paul Paes1,2, David Leat3, Jane Stewart1
1School of Medical Education, Newcastle University, Newcastle upon Tyne, UK.
Medical Education
|November 27, 2018
Summary
Trainee doctors develop practical wisdom through experience, influenced by their environment and internal factors like self-efficacy. Targeted interventions can enhance this development for better complex decision-making skills.
Area of Science:
- Medical Education
- Professional Development
- Cognitive Psychology
Background:
- Effective decision-making and judgment are crucial for skilled professionals, especially doctors.
- Limited research exists on how doctors develop practical wisdom and handle complex decisions.
- Understanding this development is vital for improving medical training and practice.
Purpose of the Study:
- To explore how trainee doctors cultivate practical wisdom.
- To identify influences on the development of practical wisdom in doctors.
- To suggest interventions for enhancing practical wisdom in medical training.
Main Methods:
- A social constructivist framework was employed.
- Qualitative semi-structured interviews were conducted with trainee doctors at various career stages.
- Grounded theory with constant comparative analysis was used to analyze data on decision-making approaches and training influences.
Main Results:
- A conceptual model of practical wisdom development in trainee doctors was constructed.
- Key internal (self-efficacy) and external (environment) factors were identified as moderators.
- Relational agency and self-efficacy were highlighted as critical enablers of the decision-making process.
Conclusions:
- Postgraduate medical training should foster self-regulated learning in supportive environments.
- Enhancements in clinical learning environments (structure, culture, supervision, feedback) are beneficial.
- Targeted interventions can improve self-efficacy and relational agency, accelerating practical wisdom development.
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