Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
World J Surg. 2011 Jun;35(6):1214-20. doi: 10.1007/s00268-011-1089-4.
Decision making is a key competency of surgeons; however, how best to assess decisions and decision makers is not clearly established. The aim of the present study was to identify criteria that inform judgments about surgical trainees' decision-making skills.
A qualitative free text web-based survey was distributed to recognized international experts in Surgery, Medical Education, and Cognitive Research. Half the participants were asked to identify features of good decisions, characteristics of good decision makers, and essential factors for developing good decision-making skills. The other half were asked to consider these areas in relation to poor decision making. Template analysis of free text responses was performed.
Twenty-nine (52%) experts responded to the survey, identifying 13 categories for judging a decision and 14 for judging a decision maker. Twelve features/characteristics overlapped (considered, informed, well timed, aware of limitations, communicated, knowledgeable, collaborative, patient-focused, flexible, able to act on the decision, evidence-based, and coherent). Fifteen categories were generated for essential factors leading to development of decision-making skills that fall into three major themes (personal qualities, training, and culture). The categories compiled from the perspectives of good/poor were predominantly the inverse of each other; however, the weighting given to some categories varied.
This study provides criteria described by experts when considering surgical decisions, decision makers, and development of decision-making skills. It proposes a working definition of a good decision maker. Understanding these criteria will enable clinical teachers to better recognize and encourage good decision-making skills and identify poor decision-making skills for remediation.
决策是外科医生的关键能力；然而，如何最好地评估决策和决策者尚不清楚。本研究的目的是确定告知外科实习生决策技能判断的标准。
一项定性的、基于网络的自由文本调查分发给外科、医学教育和认知研究方面的知名国际专家。一半的参与者被要求确定良好决策的特征、良好决策者的特征和培养良好决策技能的基本要素。另一半则被要求考虑这些方面与不良决策的关系。对自由文本回复进行模板分析。
29 名（52%）专家对调查做出了回应，确定了 13 个评判决策的类别和 14 个评判决策者的类别。12 个特征/特征重叠（考虑、知情、时机恰当、意识到局限性、沟通、知识渊博、协作、以患者为中心、灵活、能够根据决定采取行动、基于证据和连贯）。产生了 15 个类别，这些类别是决策技能发展的基本要素，分为三个主题（个人素质、培训和文化）。从好坏两个角度编制的类别主要是相互对立的；然而，对某些类别的重视程度有所不同。
本研究提供了专家在考虑外科决策、决策者和决策技能发展时描述的标准。它提出了一个好的决策者的工作定义。了解这些标准将使临床教师能够更好地识别和鼓励良好的决策技能，并识别需要纠正的不良决策技能。
