Flin Rhona, Youngson George, Yule Steven
School of Psychology, University of Aberdeen, Aberdeen, UK.
Qual Saf Health Care. 2007 Jun;16(3):235-9. doi: 10.1136/qshc.2006.020743.
Surgeons' intraoperative decision making is a key element of clinical practice, yet has received scant attention in the surgical literature. In recent years, serial changes in the configuration of surgical training in the UK have reduced the time spent by trainees in the operating theatre. The opportunity to replace this lost experience with active teaching of decision making is important, but there seem to have been very few studies that have directly examined the cognitive skills underlying surgical decision making during operations. From the available evidence in surgery, and drawing from research in other safety-critical occupations, four decision-making strategies that surgeons may use are discussed: intuitive (recognition-primed), rule based, option comparison and creative. Surgeons' decision-making processes should be studied to provide a better evidence base for the training of cognitive skills for the intraoperative environment.
外科医生的术中决策是临床实践的关键要素，但在外科文献中却很少受到关注。近年来，英国外科培训结构的一系列变化减少了学员在手术室的时间。用积极的决策教学来取代这种损失的经验很重要，但似乎很少有研究直接考察手术过程中外科决策背后的认知技能。根据外科领域的现有证据，并借鉴其他对安全要求严格的职业的研究，本文讨论了外科医生可能使用的四种决策策略：直觉（基于识别启动）、基于规则、选项比较和创造性。应该对外科医生的决策过程进行研究，以便为术中环境下认知技能的培训提供更好的证据基础。
