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The long game: Evolution of clinical decision making throughout residency and fellowship
Ingrid A Woelfel1, Brentley Q Smith2, Ritu Salani2
1Department of Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43201, USA.
Background:
The purpose of this study was to explore the trajectory of autonomy in clinical decision making.
Methods:
We conducted a qualitative secondary analysis of interviews with 45 residents and fellows from the General Surgery and Obstetrics & Gynecology departments across all clinical postgraduate years (PGY) using convenience sampling. Each interview was recorded, transcribed and iteratively analyzed using a framework method.
Results:
A total of 16 junior residents, 22 senior residents and 7 fellows participated in 12 original interviews. Early in training residents take their abstract ideas about disease processes and make them concrete in their applications to patient care. A transitional stage follows in which residents apply concepts to concrete patient care. Chief residents re-abstract their concrete technical and clinical knowledge to prepare for future surgical practice.
Conclusions:
Understanding where each learner is on this pathway will assist development of curriculum that fosters resident readiness for practice at each PGY level.
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