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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.

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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.

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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.