Department of Surgery and Cancer, Imperial College London, UK.
Am J Surg. 2011 Jul;202(1):110-5. doi: 10.1016/j.amjsurg.2010.03.010. Epub 2010 Sep 27.
The aim of this study was to capture quantitatively surgeons' decision making when faced with a choice of open or laparoscopic inguinal hernia repair.
Twenty-one general surgeons (10 consultants or attending surgeons, 11 registrars or residents) were presented with 46 clinical vignettes differing in clinical and patient factors. Surgeons' choices of open or laparoscopic repair were submitted to multiple regression. Beta coefficients were computed for each factor and compared across expert and novice participants.
Consultants and attending surgeons considered the nature of the hernia (primary or recurrent; β = .40), the site of the hernia (unilateral or bilateral; β = .27), American Society of Anesthesiologists score (β = -.25), and previous abdominal surgery (β = .20). Trainees weighted most the site of the hernia (β = .30), previous abdominal surgery (β = .23), the nature of the hernia (β = .20), and American Society of Anesthesiologists score (β = -.10).
This study offers an objective assessment of surgeons' decision making, with specific application to hernia repair. Further research into quantitative methods that capture surgeons' thinking processes could distill factors that expert surgeons consider important in a number of key situations and assist in trainees' decision making.
本研究旨在定量捕捉外科医生在面对开放式或腹腔镜腹股沟疝修补术选择时的决策过程。
21 名普通外科医生（10 名顾问或主治外科医生，11 名住院医师或住院医生）对 46 个临床病例进行了评估，这些病例在临床和患者因素方面存在差异。外科医生对开放式或腹腔镜修复的选择被提交给多元回归分析。对每个因素进行β系数计算，并在专家和新手参与者之间进行比较。
顾问和主治外科医生考虑疝的性质（原发性或复发性；β=.40）、疝的部位（单侧或双侧；β=.27）、美国麻醉医师协会评分（β= -.25）和先前的腹部手术史（β=.20）。住院医师更看重疝的部位（β=.30）、先前的腹部手术史（β=.23）、疝的性质（β=.20）和美国麻醉医师协会评分（β= -.10）。
本研究提供了对外科医生决策过程的客观评估，特别适用于疝修补术。进一步研究捕捉外科医生思维过程的定量方法，可以提炼出专家外科医生在许多关键情况下认为重要的因素，并有助于住院医师的决策。
